President Donald Trump’s work to lower prescription drug costs for patients will undoubtedly be one of his most significant legacies. From the legislation he recently signed to increase transparency among pharmacy benefit managers to the historic pricing deals he has negotiated with drug manufacturers, Trump has made more progress on this issue than any of his modern predecessors.
Yet while Trump’s energetic approach to drug pricing reform is admirable, prudence remains important, particularly when it comes to the “Most Favored Nation” pricing proposals that some conservatives in Congress are misguidedly championing.
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These proposals would tie U.S. drug prices to the artificially low rates set by foreign governments. In doing so, they would also import the broader healthcare policies other countries manipulate to game the system, policies that ration care and disregard human life.
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That may sound extreme, but consider that Canada and many European countries have embraced euthanasia with morbid enthusiasm. In fact, 5% of all deaths in Canada now result from assisted suicide, which the government-run health system pushes on patients who aren’t even terminally ill, just to save money. Those systems also use allegedly neutral but inherently biased cost-effectiveness metrics to justify rationing care to sick patients.
As doctors and as conservatives, we believe that every life has value. Young or old, healthy or sick, we all deserve a medical system that respects our God-given dignity. And we know there are millions of other pro-life Americans who agree it would be a mistake to embrace socialized, authoritarian medicine, especially since there are better ways to make medicines more affordable.
Most other developed countries use a variety of direct and indirect price controls to suppress spending on medicines. To justify setting artificially low prices, bureaucrats in those health systems typically use a seemingly objective metric, known as a quality-adjusted life year, or QALY, to measure how cost-effective a treatment is.
QALYs attempt to quantify the value of medicines by the number of years of “perfect health” they provide patients. One year of perfect health is equal to one QALY, and a year spent battling illness is just a fraction of a QALY.
The problem is that for many people, especially those with disabilities or incurable chronic diseases, it is impossible to achieve “perfect health” no matter which medicines they take. That does not mean they do not need medicines, but it does mean that many socialist governments will refuse to pay for them. In the United Kingdom, for instance, the government uses QALY calculations to decide which medicines to cover, and cancer patients lack access to many innovative drugs that are available in the United States.
The British government also recently denied coverage of two new Alzheimer’s treatments that have been proven to slow cognitive decline, concluding that the drugs were not “cost-effective.” Yet for degenerative conditions like Alzheimer’s, prompt treatment is key to improved outcomes. Treatment delayed is effectively treatment denied.
Similarly, many children with rare genetic diseases in the U.K. are denied access to new therapies due to the U.K.’s QALY-based regime, which assigns lower values to these patients. The Netherlands, Denmark, and many other countries have similar policies.
In the U.S., conservatives have long recognized the dangers of QALYs. Republicans demanded provisions in Obamacare to prohibit Medicare from using QALY-like metrics in coverage decisions — part of our efforts to prevent the “death panels” that conservatives have always warned inherently come with government-controlled healthcare.
Republican warnings even pressured Democrats to include similar safeguards in the Inflation Reduction Act’s drug price negotiation process. Even though Democratic leaders never planned to garner any Republican votes for the IRA, they recognized that including QALYs in the bill would have been indefensible.
Polling shows that voters across parties overwhelmingly oppose QALY-based rationing. More than eight in 10 voters say they are concerned about government and insurers making drug pricing and reimbursement decisions based on blanket cost-effectiveness metrics.
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Because foreign pricing relies on QALYs, indexing U.S. drug prices to those set by foreign health bureaucracies would necessarily import QALYs as well. As a result, the U.S. would at once begin devaluing lifesaving treatments for millions of patients. That prospect should prompt widespread resistance.
Mimicking foreign health systems’ price controls might look like a shortcut to savings. But by importing prices that reflect QALY-based metrics, we would simply be outsourcing our decisions about which patients deserve treatment. That bureaucratic rationing has no place in a country that recognizes the equal dignity of every human life.
Former Reps. Larry Bucshon, MD, (R-IN) and Michael C. Burgess, MD, (R-TX) served in Congress after decades practicing as a cardiothoracic surgeon and a doctor of obstetrics and gynecology, respectively.
