Want to know what the future of health care could look like? You should pay attention to a little-known yet hugely important event taking place this Thursday. But don’t expect a rosy vision – what you’ll actually see is terrifying.

The event in question is hosted by the Institute for Clinical and Economic Research, a national non-profit funded with millions of dollars from the health insurance industry and like-minded interests. The group – known as ICER – is discussing its new method of determining the cost of medical treatment for patients. It’s called a “value framework,” and it could profoundly harm the health and well-being of the millions of Americans with cancer and other life-threatening diseases.

If you haven’t heard of a “value framework” before, you’re not alone. They’re complicated mathematical formulas that dictate how much medicine a patient should receive in terms of cost. After a patient crosses a certain financial threshold, the framework determines that further treatment is financially unwarranted – and therefore shouldn’t be prescribed.

This sort of analysis may work for gauze and Q-Tips, but it’s utterly inhumane when applied to the diseases that many of us will struggle with throughout our lives.

Unfortunately, these frameworks are being developed for a wide variety of illnesses. The one being highlighted on Thursday is for a rare blood disease called multiple myeloma. The group has already indicated that it is developing similar analyses for lung cancer, which is one of the most common forms of cancer, followed by multiple sclerosis.

Here’s how they work in practice – and why they should frighten all of you. In this report, ICER estimates that every year of a sick patients’ life is worth as little as 3/5 of a year for a normal person. Once you reach a certain point in this analysis, the framework determines that you should be cut off from further treatment.

It won’t matter what your doctors says or whether there’s a drug that could help you – if the formula says it’s too expensive, you’re done.

But what’s frightening to you and me is exciting for the health insurance industry and government regulators. They see value frameworks as a means of holding down health-care costs. If and when these value frameworks get implemented in health-insurance plans, they will likely lead to de facto price controls on medicines and treatments.

That’s why health insurers are funding ICER’s work – its frameworks could benefit their bottom line. The group also has the tacit support of federal policymakers. And Medicare, which in practice dictates how the rest of the health-insurance industry operates, has already expressed interest in ICER’s work.

Yet those who are pushing for these value frameworks are forgetting what health-care is all about: the health and well-being of patients, especially those battling life-threatening illnesses. If value frameworks are allowed to proliferate, those patients could be among the first to suffer. I spoke with Tom Hardy, a patient with multiple myeloma, who expressed his fear about what ICER’s analysis could mean for him. He told me: “Patients like me have value to society. We are not worth less.”

Sadly, patients like Tom appear not to have figured into ICER’s calculus. The concepts behind its frameworks have so far been discussed almost exclusively in medical journals and among health insurers and policymakers – patients were left out of the discussion, to say nothing of the wider public. The voices that matter most have been largely ignored.

It’s time for that to change, starting this Thursday. ICER’s value framework is the first move in a campaign that could fundamentally transform how American health-care looks and works. If they succeed, the patients who need help the most will be the first to suffer.

One thing’s for sure: That’s not a health-care future worth seeing.

About the Author

Jonathan Wilcox is the Co-Founder and Policy Director of Patients Rising and Patients Rising NOW.  He is a fellow with the University of Southern California’s Unruh Institute of Politics and was a speechwriter for California Gov. Pete Wilson (R).




This Op-Ed was published in:

The Orange Country Register
The Detroit News
St. Louis Post-Dispatch