John L. Marshall, MD; Bruce D. Cheson, MD; David Kerr, CBE, MD, DSc, FRCP, FMedSci


June 10, 2013

In This Article

Healthcare Rationing That's Rational

Dr. Marshall: How do you think that sort of process could be applied in the United States? We are the last place on the planet that doesn't make some sort of value judgment [in healthcare].

Dr. Kerr: Right.

Dr. Marshall: If you were hired as a consultant to our country, how would we make these decisions?

Dr. Kerr: I would use a methodology. The unit "quality" allows us as cancer doctors to compare outcomes to those of the ophthalmologists or orthopedic surgeons because it is a whole-health economy. Although we are first and foremost cancer lobbyists, there is all of medicine, all of the [healthcare] budget. We could be functioning with a programmatic budget where there is no more money. You only have $1 to spend. Is it a cataract operation? Is it a new hip operation? Is it on the latest "ib" [as in imatinib, erlotinib, lapatinib] for whatever cancer we have?

There is a free market of reference that branches over all of medicine. It allows the voices of patients and the voices of experts and allows the statisticians to look at it. You can just crank it. You can say, "Let's have a debate about it. Let's stick our heads above the parapet, as we three often do. We have the bullet wounds and the missing earlobes to show for it. But can't we just get on with rationing in a way that is rational?


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