Is the QALY a technical solution to a political problem? Of course not!

Carr-Hill's critique of health economists' work on QALYs is based on a fundamental misconception about the role, nature, and purpose of policy analysis. Because he fails to distinguish analysis from decision-making, he is led to believe that, in pressing hard to make decision-criteria explicit and transparent, health economists are trying to usurp the decision-makers' role by insisting that the analysts' views replace the decision-makers' views. He believes that this is both naive and dangerous--and, if he were right, it certainly would be. But the truth is that the cause of democratic accountability is better served by relentless analysis designed to make explicit what might otherwise remain hidden, than by leaving the tough problems encountered in priority-setting to be sorted out in forums in which the decisive factors remain obscure.