Let UK Keep Drug Rationing

Any list of the world's most inhumane healthcare bureaucracies has to include Britain's National Institute for Health and Care Excellence at the top. For over two decades, the agency has employed ruthless cost-benefit analyses to effectively deny British patients access to the latest medicines.

Now NICE is looking to export its expertise rationing life-saving drugs to the United States.

The body recently announced a collaboration with the Institute for Clinical and Economic Review, a U.S. group that purports to determine the cost-effectiveness of medical treatments. Similar organizations in the Netherlands and Canada will be part of the group, too.

But why should U.S. patients worry? We can still define U.S. health care consistent with American values, right? Not if the Democrats have their way.

Already, we can see the left's years-long campaign to bring British-style drug rationing to the United States beginning to gain ground. And it's opening the door to global standards such as those being advanced under this NICE collaboration.

NICE is the U.K. government body tasked with recommending which drugs Britain's single-payer health system should pay for. In making such determinations, the agency employs discriminatory, one-size-fits-all "cost-effectiveness" standards to set a government value judgment for new medical tests and treatments, including prescription drugs.

To do so, it weighs the expected average clinical benefits against expected costs — and gives the thumbs-down to medicines it deems too expensive.

In other words, NICE advises the government on which British lives are worth saving, and which aren't.

This cold calculus often results in cruel policy decisions. In 2017, for instance, NICE initially rejected nivolumab, a "gamechanging" immunotherapy for head and neck cancers.

The agency in 2022 decided that the breakthrough prostate cancer drug olaparib was not cost-effective, even though the medicine proved effective in slowing the growth of prostate cancer in patients with certain genetic mutations who had stopped responding to existing hormone therapies.

Late last year, NICE issued draft guidance on a cocktail of cystic fibrosis "miracle drugs." The agency acknowledged that the treatment improved lung function, reduced the number of infections, and supported growth and weight gain better than standard alternatives. But unfortunately for patients, NICE's cost-effectiveness estimates for the drug were "above the range that NICE considers an acceptable use of NHS resources."

These bloodless assessments are a major reason why U.K. patients lack access to many of the medicines Americans take for granted — or gain access to them much later. Of the 460 new drugs launched across developed countries between 2012 and 2021, a mere 59% were available in Britain, compared to 85% in the United States.

If you think this couldn't happen in the United States, think again. The Centers for Medicare and Medicaid Services issued a policy last year under the Inflation Reduction Act saying the agency will "review and consider cost-effectiveness measures" in setting national drug price controls.

NICE does not yet have any direct equivalent in the United States. But ICER has been auditioning for that role for years. Although not a government agency, ICER adopts many of the same techniques as NICE to provide government officials and private insurers with data on the supposed cost-effectiveness of various drugs.

The recent push by Democrats to dictate the price of prescription drugs has paved the way for ICER — or some similar body — to step in as America's NICE in the near future. The most obvious example of this vision in action is the Inflation Reduction Act's landmark scheme for implementing price controls on prescription drugs through Medicare. But Democrats aren't stopping there.

This past January, Reps. Jerrold Nadler, D-N.Y., and Katie Porter, D-Calif., introduced the Independent Drug Value Assessment Act, which would "account for the benefits of a particular drug for an average patient, then compare those benefits with those provided by other potential treatments."

Similar proposals by progressives like Sen. Bernie Sanders, I-Vt., seek to impose a government-dictated "reasonable" price on prescription drugs that were developed with federal support.

Against this backdrop, the collaboration between NICE and ICER — as well as the Canadian Agency for Drugs and Technologies in Health and Holland's National Healthcare Institute — is all the more troubling.

One can imagine a future in which a small international consortium of agencies and nonprofits has the last word on whether an American patient can access a state-of-the-art drug that could save her life. It's a future in which the most personal healthcare decisions are left not to patients and their physicians but to a network of unelected bureaucrats and foreign governments.

There is much more we can, and must, do to improve the quality and affordability of health care in the United States. But we should never look to the compassionless decisions or crude standards rendered by European bureaucrats as the starting point.

This is the world Democrats are working to bring about. If they had any regard for the well-being of American patients, they'd see that the last place we should look for advice on drug pricing is the United Kingdom.