News came last week that Republican Senator Saxby Chambliss would remove his “hold” on the nomination of Cass Sunstein to be the next Administrator of the Office of Information and Regulatory Affairs. But, while Sunstein has seen a bit of opposition from Republicans critical of his generally left-of-center political views, the main opposition has come from far-left Democrats and the environmental and consumerist movements over Sunstein’s embrace of cost-benefit analysis in regulatory policymaking. Especially troubling to these groups is Sunstein’s support for what critics deride as the “senior death discount,” which Time describes as “the statistical practice of taking into account years of life expectancy when evaluating a regulation.”
If that’s a problem for Cass Sunstein, then what are we to make of various Democratic proposals to allocate fewer health care resources on the basis of their expected value to society? My colleagues and I have been critical of the Administration’s desire to insert comparative effectiveness analysis into both the new drug approval process and government health program reimbursement policies. Cost-benefit and comparative-benefit analysis are useful tools and should be used in regulatory analysis. But, these analytical tools don’t take sufficient account of the vast differences from person to person in both physiology and value preferences, and they should be relied upon much more sparingly where collective decision-making is intended to cut off individual choice. And people spending private money ought to be free to spend it, even on things the government or someone else might find wasteful.
Now, John Goodman at NCPA points out that White House health care policy advisor Ezekiel Emanuel has explicitly endorsed adopting not only comparative-effectiveness and cost-benefit analysis in the health care realm, but also the senior death discount. In an article in the Lancet on January 31, 2009, Emanuel “advocated allocating health resources in order to maximize collective life years,” according to Goodman. “Suppose a 25-year-old and a 65-year-old have a life threatening disease. Since the 25-year-old has many more potential years of life ahead of him, he should receive preferential treatment, says Emanuel. He justifies denying care to elderly patients in the following way:
[Directly quoting Emanuel’s Lancet article here:] The complete lives system discriminates against older people…. Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years.
Back in 2003, Senator Richard Durbin (D-Ill.) even proposed a statutory ban on regulatory agencies using the senior death discount. So, if embracing the senior death discount is sufficient grounds for people like Durbin to oppose Sunstein and his predecessors at OIRA — Susan Dudley and John Graham — I assume that, any day now, we can expect Senator Durbin and his colleagues to announce their opposition to the current health care reform proposals. Of course, I wouldn’t advise holding your breath.