Okay, thats a bean counter term that this poster would never have dreamed of hearing. Of course coming from an insurance qualifier the term "quality life" is probably something of an oxymoron anyway.

Keeping a terminally ill man alive long enough to watch his son recieve his high school or college diploma may not be cost effective according to some insurance or medical economist but it would be the exact sort of thing I want the society in which I live to strive for despite some invented QALY formula.

As for helping the extremely destitute in the worlds poorest countries one must realize that there are trade offs for the money available to be spent. Do we save one mans life for 25,000 dollars and then allow 500 others to fall sick for lack of the preventitive measures? Is that the same as telling the man your life is not worth living so we will not try to save you? To the Christians amoung us I ask, what if he is Christ, or an angel or GOD himself and his illness is to test us?

Perhaps one solution to these very hard problems would be to ensure that the resources being taken from these nations result in fair economic advancements for their people. The oil, diamonds and other valuable assests being mined, pumped and farmed from the poorest of these countries seldom ever result in any economic improvements in the lives of the people who live there. This is a crime against humanity. Instead of wringing our hands over how to spread the pitiful few dollars available for healthcare charity, perhaps its time to ensure that the billions of dollars worth of raw materials taken from these poor countries actually result in quality employment and opportunities for the citizens of these places.

What we have now is a small percentage of profits funneled to a few corrupt individuals who then turn a blind eye to the rape of their lands and their fellow citizens. Meanwhile a few handfulls of international corporations headed by people who sit on each others executive boards walk away with the rest of these disgustingly enormous profits.

Its long past time to remove our collective blindfolds as to the true human costs of our exploitation of the worlds poor and ignorant. Instead of patting ourselves on the back everytime we send a box of penicillin to Africa perhaps we should instead wonder why the continent most rich in natural resources cannot afford to manufacture or buy its own.

Yes there is corruption there, our international companies have helped to encourage it in order to only have to bribe a few people so they may keep all of the rest of the resources for themselves, though they are not solely to blame for all of that corruption. If we want to be serious about helping the most destitute across the globe we must finally address the true underlying economic problems being faced by these populations. Otherwise the questions of how best to allocate healthcare money is a question that can never have an adequate answer.

Enjoyed your write up here NIckD. You said:

"What we have now is a small percentage of profits funneled to a few corrupt individuals who then turn a blind eye to the rape of their lands and their fellow citizens. Meanwhile a few handfulls of international corporations headed by people who sit on each others executive boards walk away with the rest of these disgustingly enormous profits.

Its long past time to remove our collective blindfolds as to the true human costs of our exploitation of the worlds poor and ignorant. Instead of patting ourselves on the back everytime we send a box of penicillin to Africa perhaps we should instead wonder why the continent most rich in natural resources cannot afford to manufacture or buy its own. "

How true all this is. And what I find to be a sad state of affairs is when a country such as ours can manufactor medicines, ship them to other countries and WE, the American public can buy them BACK from OTHER countries CHEAPER than we can afford to get them here in our own back yard ! FW

"Keeping a terminally ill man alive long enough to watch his son recieve his high school or college diploma may not be cost effective according to some insurance or medical economist but it would be the exact sort of thing I want the society in which I live to strive for despite some invented QALY formula."

I'd agree that this kind of emotional appeal makes the QALY measure seem cold and irrelevant. But what about QALY bugs you? Is it the idea that a more sophisticated formula would yield better results? Or is it a belief that any kind of economical/actuarial approach to managing health care systems is just too cruel to contemplate?

If it's the latter, I'm afraid society simply can't strive for what you want. Because, no matter how highly society may prioritize health care, the demand for care will always outstrip the (finite) resources available to provide it. In that context, what else can we do, except try to allocate resources as efficiently as possible?

Returning to your example: if extending the terminally ill man's life an additional six months means that 3 people will be denied a procedure to save their eyesight, what do you think is the correct choice?

"...perhaps its time to ensure that the billions of dollars worth of raw materials taken from these poor countries actually result in quality employment and opportunities for the citizens of these places."

Wonderful thought. Now... how do you suggest we do that? The only way I see is at gun point, with the local people very much fighting against us (think Somolia). This is why we wave our hands and think grand thoughts.

As for the rest, someone with nice kids is going to die because he doesn't have enough money for the top of the line stuff. We as society can certainly throw enough money at him to make him better for a few months... but we simply don't have enough money to throw at everyone like that. So we have to make choices, and we have a finite amount of money.