Letter to the Editor
While we can assume Dr. Steven P. Ringel is an informed and cogent expert in neurology, the Viewpoint, “How Neurologists Can Contribute to Health Care Reform Right Now,” (Aug. 3) is mortally flawed by a significant (and common) error. Cost-effective analysis is repeatedly posited as the prime tool for selecting between diagnostic studies and among disease-based therapies. As a perverse example, cost-effective analysis would favor encouraging everyone to smoke more. Lung cancer and death ensues, reducing the net lifetime health care cost to the system.
“Cost effectiveness” is a term that gravely misrepresents the far more disheartening necessary cost utility, cost per quality adjusted life year. This is the reality we must attend to: Care will be judged, permitted, or forbidden based on the cost per quality adjusted life year, sooner in a single-payor environment, sooner or later if we wish avoid bankrupting whatever system survives the ministries of our political class.
Martin Menkin, MD