The stakes of the EU debate just got a lot lower

We’re often told that the particular form of European integration we currently endure is somehow necessary for preventing another war in Europe.

Since Croatia’s accession last night, the cost of the most recent war in which EU member states were on opposite sides has now collapsed. Twenty-two years ago this week, Slovenia and Croatia fought on opposite sides of the Ten Day War which secured the former’s independence from Yugoslavia; no-one really wanted to be fighting, and the unhappy state of affairs constituted one of the least violent wars of all time: only 63 people were killed.

That magnitude of loss and foreshortening of human life is at the sort of scale that pharmaceutical regulators have to deal with when licensing drugs for use in the health system. In a world of finite resources and finite altruism, someone has to choose what drugs and medical procedures should be available at the expense of the taxpayer, and that means weighing the lives and health of different groups of people: if you have the cash to help either the diabetic or the woman with breast cancer, but not both, you have to have a reason for placing the life of one above the other. Just flipping a coin is morally repugnant. This is why we have QALYs.

A regulatory decision which makes drugs more expensive costs lives and suffering. Every time the EU’s deliberately undemocratic processes are captured by rent-seeking lobbyists trying to increase medical patent protection, there is a cost measurable in QALYs. Now when politicians raise the spectre of war to silence critics, those critics can say “well, the last war only cost 20000 QALYs, and your proposal looks worse”.

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