Slate - great read. "We Have to Ration Health Care. Medicare for all would be a much better plan if
Medicare for all would be a much better plan if it acknowledged that simple reality.
http://www.slate.com/articles/health_and_science/medical_examiner/2017/10/we_should_ration_health_care.html
By Vishal Khetpal
When Sen. Bernie Sanders makes his argument for single-payer health care, he often leans on the phrase cost-effective to describe his fix for America’s health care crisis. It came up four times in a recent op-ed he penned for Fortune magazine about the potential benefits of Medicare for all for small businesses; when he and Sen. Amy Klobuchar took on their colleagues Lindsey Graham and Bill Cassidy on CNN, hours after the latest Republican bid for repealing the Affordable Care Act collapsed, it was also on the tip of his tongue. Cost-effective had been featured elsewhere in his media blitz last month for the new Medicare-for-all bill, in an interview with the Huffington Post and in another op-ed for the New York Times.
In health policy, cost-effective is not just a useful adjective. To wonks, it alludes to the highly technical practice of cost-effectiveness analysis, which is what it sounds like—studies, normally conducted by health economists, evaluating both the relative costs and the therapeutic benefits of a drug or medical intervention. The costs can be an individual’s, an insurance carrier’s, a government’s, or even those borne by society as a whole. The therapeutic benefit, or “effectiveness” part, is usually measured in quality-adjusted life years, or QALYs, which assign utility scores to different states of health based on population surveys—a QALY of 1 represents a year of perfect health. Together, they form an incremental cost-effectiveness ratio, or an ICER, quantifying how much bang for the buck a choice in medicine or public health may have. The lower a choice’s ICER, the more cost-effective it is.
Strangely enough, cost-effective or cost-effectiveness analysis are nowhere to be seen in the Medicare-for-all bill. Given that virtually every country that offers universal health care to its citizens uses cost-effectiveness analysis to help decide what services to cover, it’s a curious omission, particularly because Sanders keeps talking about it. Many argue that its inclusion is one of the key drivers for reducing drug prices and slowing the growth of health care costs in countries with universal health care while still improving health outcomes. Across a string of health care systems that bear little resemblance to one another, cost-effectiveness analysis has enabled governments to better spend their health care dollars by creating a common marker to compare the trade-offs of funding a public health campaign, a preventive health screening, or a routine medical service.
To be clear, the United States has been down this road before, and still uses cost-effectiveness analysis in some capacity today. The Office of Technology Assessment, or OTA, from 1974 until 1995, applied it to problems posed by science, including in health care. Oregon used it to pare down benefits and expand its Medicaid program in the 1990s. In more recent years, Medicare has quietly used cost-effectiveness analysis for prioritizing prevention programs. And last month, the Department of Veterans Affairs announced that it will begin to consider cost-effectiveness analyses when deliberating over which drugs to add to its national formulary.
snip - read it all - well worth it - lots more at the link above
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And this Congress - let alone Trump - is treating it like a political football! 
