Chart of the Week: The Rare Disease Spending Dilemma

Our Sunday Chart of the Week
Since our chart looks at Medicaid spending on rare diseases, we better start with Medicaid.
It is complicated. Yes, Medicaid targets the poor and has federal and state funding. However, varying from state to state, it has 50 versions because individual states implement their own eligibility criteria.
All states, though, face disproportionately high spending for a small number or illnesses:

High spending takes us straight to opportunity cost. Spend more state Medicaid money on one item and the opportunity cost is less for something else.
For example, with the elderly population growing, long-term care will need more Medicaid money.

And therein lies our dilemma and our bottom line: With scarcity an unavoidable economic principle, we not only need to decide how best to allocate our dollars within Medicaid but also between Medicaid and other state spending obligations. One Princeton economist suggests using the QALY.