Human Nature

In Praise of Lethal Rationing

Good front-page article in today’s New York Times on Britain’s National Institute for Health and Clinical Excellence (NICE), which, among other things, decides whether a few more months of your life are worth the expense. The article begins with a guy named Bruce Hardy who needs a drug that might give him an extra half-year of life but would cost $54,000. NICE said no. The agency comes off as heartless. “Everybody should be allowed to have as much life as they can,” Hardy’s wife pleads. The article concludes: “Meanwhile, Mr. Hardy waits. In recent weeks his growing tumor has pressed on a nerve that governs his voice. He can barely speak and is increasingly out of breath.”

Aw, hell. It’d be great if we could buy an extra half-year for everybody. But we can’t. We have unmet needs everywhere. People die every day from being uninsured and unattended. They just don’t make the front page.

There’s a cruel bias built into our minds that makes you feel more for the person who’s suffering in front of you than for people whose suffering appears only in statistical form. (I can’t remember what the psychologists or economists call this bias. If you do, please share it with the class .) So now you know all about Bruce Hardy, and you probably regard the bureaucrats at NICE as cads for stiffing him. It’s harder to remind yourself of all the health and added life that $54,000 could buy for others. For example: Where does the Gates Foundation send its medical dollars for maximum efficiency? Childhood vaccines .

As far as I can tell, NICE is doing good work. Its refusal to pay any amount for life-prolonging drugs has forced drug companies to cut prices. And by drawing a line against paying too much in some tragic cases, NICE preserves money for other cases where the money can do more good. If anything, NICE is a bit soft. For instance, the Times reports: “After consulting a citizens group, the institute decided that the nation should spend the same amount saving or improving the life of a 75-year-old smoker as it would a 5-year-old.” If I ran NICE, the 5-year-old would take priority. And I’m irked to see that NICE is already backing off from its rejection of cases such as Hardy’s. According to the Times , this comes after NICE was “flooded with anguished comments.” I’m sorry, but anguish is everywhere. If patients like Hardy get funded at $9,000 per month, which other patients won’t be funded? What about their anguish? Or does your anguish count only if you have the means and know-how to lobby the government?

Yes, everybody deserves as much life as possible. But that means the person in front of you can’t take an undue share of limited public funds when others are in need.