Rationing Health Care - it's a lie!

[Brainster]

Peter Singer, in the New York Times Magazine:

Why We Must Ration Health Care

 

[kellyb]

Like I said, they are HMOs not HROs. Why do you think something called a maintenance organization is really a rationing organization?

It sells better that way.

 

[corplinx]

Your needs are anything to badmouth the Democrats. Are you claiming you are for national health insurance?

Yes I am.

 

[Francesca R]

The NHS does not ration health care

Oh yes it does. A universal health system with no rationing would be very very silly.

 

[Beth]

But it isn't correct at all and it harms a debate when one side frames the issue falsely.

I don't think it's framing the issue falsely. Words have multiple meanings. I think it's the connotation that you object to.

But see, that's my point. If you buy an inexpensive car because you cannot afford an expensive one, do you call that rationing cars?

No. Rationing usually conjures up the image of WWII ration books. Governmental control of limited resources. However, technically, it is a form of rationing. Likewise, I think any from of national health insurance can be considered rationing. And I am all for it! I have excellent insurance, but both me and my employer pay a huge sum for it. Health care costs are a serious drain on my finances, both for insurance and for what it doesn't cover.

I recently had to wait four months to buy new glasses for myself because due to the economy, my dh hasn't been working much and we couldn't afford the co-pays. At least, I put it on a lower priority than other expenses. I finally went ahead and got some with the money I got for my car.

It was totaled in a hail storm recently, which means I don't get sufficient funds to fix it. I either take what they offer and keep the car in damaged condition, or receive funds to purchase another. Since the car only suffered cosmetic damage and was in good mechanical shape, we decided to keep it and try to find a second vehicle with what we did receive.

We also decided to take some of that money and use it to purchase glasses with our new prescriptions. It wasn't a big change, but it's nice to see better. I'm glad I was able to get them finally. That's a form of rationing too. And a minor inconvenience only, especially when compared to the choices that people without insurance are facing.

I think we need to deal with debate by accepting the word rationing and talking about the details of what it should mean for us.

I occasionally catch a few minutes of FOX news while flipping through channels. I rarely last more than 4 or 5 because they are so badly biased I can't stand it. This week I caught some guy talking about national health care and describing it as meaning people might only get 6 months of high blood pressure medication and then their quota would be full and they'd have to do without for the rest of the year. I think that's ridiculous! It was phrased to stay just on the edge of not actually lying, but with serious and deceptive implications.

we should not fear discussions about limited resources.

Open, transparent, appeal-able rationing is FAR FAR more kind than insurance company rationing.

100% agree.

Peter Singer, in the New York Times Magazine:

I read this when it came out. Excellent!

 

[NoZed Avenger]

You would, you want to use the distorted framing as it suits your needs.

The term "framing" is a effort at framing.

That said, let's say we go with your formulation: healthcare is definitely not rationed, instead, the individual is "at the mercy of the buying pool."

Now that we call it something else, have all the arguments gone away?

 

[Darat]

I was about to post that the NHS does ration so the opening post was wrong however on balance I actually think Skepticgirl has a point about how the term is used in arguments about the USA health care system versus the rest of the developed world health care systems.

If you look at a bog-standard definition of rationing (Encarta dictionary):

1. fixed amount allocated to somebody: a fixed and limited amount of something, especially food, given or allocated to a person or group from the stocks available, especially during a time of shortage or a war
2. adequate amount: the amount of something that it seems fair or desirable for somebody to have rather more than your ration of good luck

Microsoft® Encarta® 2006. © 1993-2005 Microsoft Corporation. All rights reserved.

In the NHS there are some "services" which are indeed rationed under that definition, for example the NHS England will only pay for up to three cycles of IVF treatment However there are many "services" that are not rationed, for example no limits on the number of times I can see my GP. From what I've read about insured USA folk their insurance policies certainly seem to be are full of restrictions on the amount of treatment someone can receive so if someone wants to describe the NHS as "rationing" health-care then the same word has to be applied to the USA system.

In other words if you see the word "rationing" in an argument against universal health-care it is more than likely being used disingenuously.

(You could argue that only applies to insured people in the USA, that someone could pay for any treatment they wanted, but that would also apply to any argument about health-care in the UK.)

 

[corplinx]

The term "framing" is a effort at framing.

That said, let's say we go with your formulation: healthcare is definitely not rationed, instead, the individual is "at the mercy of the buying pool."

Now that we call it something else, have all the arguments gone away?

She needs to portray the people she doesn't like as persecutors who are useful idiots of the right wing spin machine.

Hence, people can't simply disagree with her. They are part of the framing effort.

In phase3 she adopts a tinfoil hat to keep the framing out.

 

[kellyb]

I think one of the biggest obstacles we American face when it comes to healthcare reform is our deep, insidious denial about the fact that healthcare is so expensive this day in age, that it absolutely must be rationed.
The political right and the insurance industry have fooled us for decades with the claim that we've got the best healthcare in the world, and this is supposed to be because "they" ration, but "we" don't.
It's totally false, and trying trying to argue against it by claiming (falsely!) that the NHS doesn't ration is a terrible idea. Of course they ration, and of course we do, too. They just do a better job of it than for-profit insurance companies who must make their rationing decisions in the dark, to maintain this illusion of "Nope! No rationing here! God bless the USA and long live BCBS!"

As long as we perpetuate the myth that healthcare need not be rationed, we enable the insurance companies to keep selling their myth we're so addicted to. Moreso than healthcare, they're selling an aversion to rationing and the myth that no such thing is happening here. Skeptigirl's total freakout at the word is evidence that they've a very good job, indeed.

 

[kellyb]

Also:

You keep not addressing my argument and instead just repeat your declaration a choice to purchase less health care is rationing while a choice to purchase a smaller car is not

.

Rationing is done by a "third party".
Who is the third party we pay or defer to, to decide what car we can or can't have?

 

[kellyb]

In the NHS there are some "services" which are indeed rationed under that definition, for example the NHS England will only pay for up to three cycles of IVF treatment However there are many "services" that are not rationed, for example no limits on the number of times I can see my GP. From what I've read about insured USA folk their insurance policies certainly seem to be are full of restrictions on the amount of treatment someone can receive so if someone wants to describe the NHS as "rationing" health-care then the same word has to be applied to the USA system.

In other words if you see the word "rationing" in an argument against universal health-care it is more than likely being used disingenuously.

Indeed, and I predict that before too long, the anti-UHC people will cease to even attempt making the argument, since to do so risks being hoisted on their own petard.

I present all 16 comments to this Forbes article as evidence to support my prediction:
http://www.forbes.com/2009/07/21/rationing-health-care-opinions-contributors-scott-atlas.html

 

[Delscottio]

I don't understand the fuss about all this, does any sane person think their isn't rationing of Health Care in private systems??

One system tends to ration on clinical need the other on how much the patient can afford. I prefer the former but thats just me.

 

[Beth]

I think one of the biggest obstacles we American face when it comes to healthcare reform is our deep, insidious denial about the fact that healthcare is so expensive this day in age, that it absolutely must be rationed.
The political right and the insurance industry have fooled us for decades with the claim that we've got the best healthcare in the world, and this is supposed to be because "they" ration, but "we" don't.
It's totally false, and trying trying to argue against it by claiming (falsely!) that the NHS doesn't ration is a terrible idea. Of course they ration, and of course we do, too. They just do a better job of it than for-profit insurance companies who must make their rationing decisions in the dark, to maintain this illusion of "Nope! No rationing here! God bless the USA and long live BCBS!"

As long as we perpetuate the myth that healthcare need not be rationed, we enable the insurance companies to keep selling their myth we're so addicted to. Moreso than healthcare, they're selling an aversion to rationing and the myth that no such thing is happening here. Skeptigirl's total freakout at the word is evidence that they've a very good job, indeed.

Amen Sister! Lets talk about what a fair and equitable distribution of health care is 'cause we got isn't.

 

[Francesca R]

The problem with the OP is that it leads to a faulty reply to opponents of universal health systems.

Proponents of partial cover systems say: "Well UHC means rationing!" in some attempt to scare folks or whatever. But if someone then tries to defend UHC with: "No it isn't rationed" then they can readily be shown to be incorrect, and so their "defence" is the kind that is needed like a hole in the head, and which might be expected more from foes.

 

[Skeptic Ginger]

In Australia, there are not enough surgeons to ensure that everyone has immediate access to a surgeon. The government decides who gets access to surgeons and puts those who can't get immediate access to a surgeon on a waiting list.

I can't see how my example is substantially different to your example.

And before you attack me - I think America would do well to copy our scheme. Those who don't want to wait as long can pay for private health insurance or pay per visit.

But you have just described a case that differs from how the words, rationing health care, are being used. You described something akin to the flu vaccine shortages.

It is technically true that when private market forces are allowed to operate and there is more demand than supply, money functions as the rationing decision maker. But no one frames things too expensive to buy as being rationed, unless they are using the term rationing as a metaphor.

I am calling BS on the false representation of this debate which is occurring when people are calling choices to buy or not buy a certain level of health care, rationing. It is totally dishonest.

 

[Skeptic Ginger]

It sells better that way.

Well you and the judge that wrote that opinion are poorly informed about what HMOs are all about. The concept began in the late 70s with some people in the health care field trying to change to a wellness centered care model from an illness centered model. Rationing is absolutely not what HMOs are all about.

 

[Skeptic Ginger]

Yes I am.

Then why do you accept a falsely framed argument about it?

 

[Skeptic Ginger]

Oh yes it does. A universal health system with no rationing would be very very silly.

So by that definition, all health care is rationed. I choose to ration my own care if I pay directly. The private insurers ration care to their clients and the government rations Medicare and the VA health care benefits in this country as well.

Tell me something we buy that isn't rationed?

 

[Skeptic Ginger]

I don't think it's framing the issue falsely. Words have multiple meanings. I think it's the connotation that you object to.

No, it is the fact that calling this rationing is dishonest in a debate of the matter.

I ask again, do we say we are rationing cars in this country because not everyone can afford a Porsche?

Rationing usually conjures up the image of WWII ration books. Governmental control of limited resources. However, technically, it is a form of rationing. Likewise, I think any from of national health insurance can be considered rationing. And I am all for it! I have excellent insurance, but both me and my employer pay a huge sum for it. Health care costs are a serious drain on my finances, both for insurance and for what it doesn't cover.

Rationing conjures up an image of control. Claiming government rations health care is an attempt to falsely frame a loss of control over decisions regarding one's health care.

You choose to buy certain coverage. The coverage is what it is. That is choosing what you are buying. Rationing is someone else choosing what you are going to get, including what you are able to buy. Your choice is not based on what you can afford, it is based on what someone says you have to take.

I recently had to wait four months to buy new glasses for myself because due to the economy, my dh hasn't been working much and we couldn't afford the co-pays. At least, I put it on a lower priority than other expenses. I finally went ahead and got some with the money I got for my car.

It was totaled in a hail storm recently, which means I don't get sufficient funds to fix it. I either take what they offer and keep the car in damaged condition, or receive funds to purchase another. Since the car only suffered cosmetic damage and was in good mechanical shape, we decided to keep it and try to find a second vehicle with what we did receive.

We also decided to take some of that money and use it to purchase glasses with our new prescriptions. It wasn't a big change, but it's nice to see better. I'm glad I was able to get them finally. That's a form of rationing too. And a minor inconvenience only, especially when compared to the choices that people without insurance are facing.

I'm not quite sure I understand your point here. Are you saying this was rationing or it wasn't rationing?

I think we need to deal with debate by accepting the word rationing and talking about the details of what it should mean for us.

So, is the government then telling you what health care you can get (rationing) or are you choosing what health care you are going to buy (not rationing)?

I occasionally catch a few minutes of FOX news while flipping through channels. I rarely last more than 4 or 5 because they are so badly biased I can't stand it. This week I caught some guy talking about national health care and describing it as meaning people might only get 6 months of high blood pressure medication and then their quota would be full and they'd have to do without for the rest of the year. I think that's ridiculous! It was phrased to stay just on the edge of not actually lying, but with serious and deceptive implications.

Fox takes the rationing lie 10 steps further into the BS zone.

 

[Skeptic Ginger]

The term "framing" is a effort at framing.

That said, let's say we go with your formulation: healthcare is definitely not rationed, instead, the individual is "at the mercy of the buying pool."

Now that we call it something else, have all the arguments gone away?

The problem is, framing influences people's perceptions. If an issue is falsely framed, people are influenced to believe false conclusions about the issue.

While people are at the mercy of the buying pool, they have the choice of which buying pool to join. If they are at the mercy of government rationing, the choice is taken away from them.