# Ben Carson: Abolish medicare and medicaid, replace them with $2000 vouchers **URL:** \ **Category:** The BBQ Pit\ **Created:** [October 24, 2015, 2:35pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617 "2015-10-24T14:35:22Z")\ **Posts on this page:** 1\ **Showing post:** 37
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 25, 2015, 4:47pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/37 "2015-10-25T16:47:17Z")
> [@Broomstick](#): > > Yes, I’d be interested in knowing what treatments are unavailable under, say, the UK NHS that are readily available in the US. > > Now, people might have to _wait_ for non-emergency things… but that ain’t going to kill you. Sorry if you need to wait an extra two months to get your knee replaced. > > There’s also the issue of profit motive in the US system leading to over-treatment, which brings its own pile of problems. There’s a [couple of doctors](http://abc7chicago.com/health/indiana-cardiologists-sued-for-alleged-unnecessary-surgeries/370155/) in my area that are being dragged into court for performing _unnecessary open-heart surgery_ on dozens of people who should not have been operated on. I think that sort of abuse-for-profit is less likely under a single-payer system. Too much testing and over prescribing of drugs is definitely an issue, although that’s a tort problem as well as a profit motive problem. Single payer systems deal with that issue as well by not allowing big settlements. Tort reform and single payer go hand-in-hand. As for treatments unavailable, NICE denies drugs all the time for failing to meet cost/benefit estimates base on quality life years remaining. Yes, a number is actually put on people’s lives. > [@](#): > > NICE guidance supports the use of quality-adjusted life years (QALY) as the primary outcome for quantifying the expected health benefits associated with a given treatment regime. By comparing the present value (see discounting) of expected QALY flows with and without treatment, or relative to another treatment, the net/relative health benefit derived from such a treatment can be derived. When combined with the relative cost of treatment, this information can be used to estimate an incremental cost-effectiveness ratio (ICER), which is considered in relation to NICE’s threshold willingness-to-pay value.[24] > > As a guideline rule, NICE accepts as cost-effective those interventions with an incremental cost-effectiveness ratio of less than £20,000 per QALY and that there should be increasingly strong reasons for accepting as cost-effective interventions with an incremental cost-effectiveness ratio of over a threshold of £30,000 per QALY.[26] > > Over the years, there has been great controversy as to what value this threshold should be set at. Initially, there was no fixed number. But the appraisal teams created a consensus amount of about £30,000. However, in November 2008 Alan Johnson, the then Secretary of State, announced that for end-of-life cancer drugs the threshold could be increased above £30,000. [27] > > The first drug to go through the new process was Lenalidomide. And its ICER was £43,800.[28] > **[National Institute for Health and Care Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence#Quality-adjusted_life_years)** > > The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body, in England, of the Department of Health and Social Care, that publishes guidelines in four areas: > These appraisals are based primarily on evidence-based evaluations of efficacy, safety and cost-effectiveness in various circumstances. > It serves both the English NHS and the Welsh NHS. It was set up as the National Institute for Clinical Excellence in 1999, and on 1 April 2005 joined with ... And an example of a drug refused: > **[Breast cancer drug Kadcyla is too expensive for the NHS – not to pay for it...](https://www.theguardian.com/commentisfree/2014/apr/25/kadcyla-cancer-drug-too-expensive-nhs)** > > Deborah Orr: The NHS watchdog, Nice, is being portayed as penny-pinching over its refusal to fund a hugely expensive new cancer drug. But shouldn't we be asking why its manufacturers want to charge so much? --- _[View the full topic](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617)._