The QALY and capitalism a Lacanian/Marxian perspective
The Quality Adjusted Life Year is used as a measure of healthcare effectiveness – used to compare lengths of time in different ‘health states’ – it is produced through citizen or patient opinion groups so is always in the line of the imaginary and might be better called Desirability Adjusted Life Years. It is ‘ostensibly’ to enable ‘decision makers’ to choose between different medical interventions when resources are scarce. Capitalism transforms the value of a health state by increasing its desirability by promising the fantasy that what is desirable is actually achievable – one step on the route to a death infinitely postponed. This is how capitalism turns money into more money, or a desirable health state into a more desirable health state, or signifies your current health state (whatever that is or how formulated) as undesirable, inadequate. This is consistent with Broussais’ ‘normal’ so matches the (imaginary) diachronic narrative of medical progress as progressive. The QALY is not simply a comparative ‘equivilator’ for health – a currency – it is the means by which the infinitely deep reservoir of potential pathology in the body is envisioned and mobilised by capital.
PS : Fantasy
The QALY ‘appears’ on the surface, to be ‘liberal’ -(‘as if’ promoting justice and egalitarian ideals) but instead, it normalises a standard life that makes ‘real’ life into a pathology. The actual desire isn’t important (in diachronic time this might be … Say The diagnostic test itself or the treatment) what matters is the fantasy behind, immortality. It, the QALY, hides a positivism, that is in a dialectic co-dependent relation with capital. One is a condition of possibility for the latter.