Rationing Health Care - it's a lie!

[kellyb]

There are alternatives to surgery that are frequently used. This is done for good reason. Whenever you cut open a human body, you have a non-negligible chance that your patient will end up dead. Start fooling around with major organs, and this chance rises. This is bad.

There are things that are rationed. Organ transplants. Research money. MRI/Ultrasound usage. And so on and so forth. You can use all of them as good, good examples of rationing. Surgery? Not so much.

I think everything really expensive in medicine is rationed. HMO's evaluate cost effectiveness in terms like "quality" to disguise their cost-centered motives.
They're eternally looking to get more bang for their buck, even when actual effectiveness is slightly reduced, as long as the cost saving is significant enough. So they'll do things like penalise a PCP for referring to a surgeon if an "almost equivalent" cheaper alternative is available. They always force PCP's to do their evil bidding. That's why a lot of PCP's are leaving medicine; they're refusing to compromise "the best" care and are taking a huge financial hit when they do. Those "retainer doc" guys aren't just greedy bastards. Rather a lot of them feel they can't continue to provide excellent care with all these P4P measures making them practice medicine on the cheap.
healthcare rationing in the US is both ubiquitous and covert.

 

[kellyb]

The other day I called to get my car fixed. They didn't have time for me until Tuesday.

My car fixing wasn't rationed. It just wasn't available for a bit. You totally have no idea what rationing is, which is kinda sad, but does explain this discussion.

Rationed would be "You have a lousy car, you can't get it fixed." This DOES happen with organ donors - doctors judge patients chances of survival and their expected lifespan with the donate organ before performing surgery. Those who don't get organs DIE. This does NOT happen in what you're describing.

What if the waiting list for non-emergent but pain-alleviating surgery (say, knee replacement) was 7 years? And the reason was lack of funding because ER docs and the like were needed more.

Would that be rationing?

 

[gtc]

You totally have no idea what rationing is, which is kinda sad, but does explain this discussion.

What definition of rationing are you using?

I think I need to repeat that I think that governments should ensure that everyone has access to a certain level of health care irrespective of ability to pay.

 

[gtc]

Would that be rationing?

In my opinion, yes.

It isn't a bad thing to ration access in this way even if it would be terrible to be on one of those waiting lists and it would be good if the government would increase funding to cut waiting times.

I think the general public agrees with this as waiting lists for elective surgery are almost invariably one of the most important issues at state elections in Australia.

 

[Dancing David]

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.

Um, we have schedule lists here, and if you don't have the insuranse or a wad of money, you won't get the surgery. It would have to be an emergent situation with no other treatment options for you to get 'indigent' care here.

But everyone has to go on a list. You wait to be scheduled. You wait for your surgery.

 

[Dancing David]

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.

Thanks. There already is rationing. It is just a term used by some to bash the idea of a government health insurance plan.

That is my big beef, it is NOT 'health care reform', it is 'health insurance reform'. The only way to have a price change from 'health care reform' would be to tell manufacturers that they have price controls and profit controls. (Such that pharma can't have advertising costs as 'development', if that is not an urban myth)

 

[NoZed Avenger]

I'd rather have the government ration health care based on needs instead of the health-insurance companies rationing health care based on profits.

And I think that this is a far better and sounder argument than complaining about framing or trying to parse the term "rationing."

 

[Francesca R]

Tell me something we buy that isn't rationed?

You don't buy in a UHS. The state is an intermediary that buys for you. Or doesn't as the case may be.

 

[Francesca R]

Is it rationing when a consumer chooses to buy a certain health care plan?

Not relevant--See previous post.

 

[Darth Rotor]

I'd rather have the government ration health care based on needs instead of the health-insurance companies rationing health care based on profits.

The balance between cost and availability will probably create a situation where not everyone is happy.

What is the formula for making the least number of people unhappy while staying on a budget? <----

That last is a non trivial concern.

 

[Professor Yaffle]

The balance between cost and availability will probably create a situation where not everyone is happy.

What is the formula for making the least number of people unhappy while staying on a budget? <----

That last is a non trivial concern.

If you equate happiniess with satisfaction with your health system, it seems that Denmark is the closest (see table 1):

http://dll.umaine.edu/ble/U.S. HCweb.pdf

 

[GreyICE]

What definition of rationing are you using?

I think I need to repeat that I think that governments should ensure that everyone has access to a certain level of health care irrespective of ability to pay.

It's so funny that I explained this and you... slid past it. Not redoing myself, it's a few posts above yours.

 

[dudalb]

Let's drop the BS.
Health Care is a limited resource, and therefore it is going to get rationed. The question is how.

 

[Skeptic Ginger]

...A national health service creates a new buying pool that everyone has to join, paid for by taxes and with the government being responsible for what services to provide and what premium (in the form of taxes or co-payments) to charge.

Who do you think is paying for all the people who show up at hospital EDs now and don't pay for the care they receive? The law says they cannot be turned away.

..People will, presumably, still be able to join their existing buying pools or still go outside any buying pool but, presumably, less people will feel the need to do so.

The issue for many people is what quality of care will they receive compared to what they currently receive and how much will they pay in terms of taxes and health costs not covered by the government. If people feel the change is too risky or that their expenses will go up by too much relative to the extra benefits they receive then they won't support the change.

The debate needs to be honest in order for people to make informed choice. When the opponents are allowed to make false claims about rationing health care, lots of people are influenced. You can say it's their fault for not paying attention to the facts but the poorly informed group decides for all of us.

By pointing out the dishonest argument, I hope to steer the debate back to factual territory.

Maybe you should be emphasising that you believe that a basic level of health care is something that the government should provide just like EMT or police or military services.

I do emphasize that, along with the fact as I noted above, you are paying for the deadbeats right now both through taxes that fund public hospitals and by paying for health care since it includes hospitals recouping their bad dept.

 

[Skeptic Ginger]

If it is done for jurisdictional reasons - no. For budgetary reasons - yes. But I am not sure what that has to do with the topic of discussion.

Because it is analogous and yet it is not framed as rationing.

 

[Skeptic Ginger]

There are alternatives to surgery that are frequently used. This is done for good reason. Whenever you cut open a human body, you have a non-negligible chance that your patient will end up dead. Start fooling around with major organs, and this chance rises. This is bad.

There are things that are rationed. Organ transplants. Research money. MRI/Ultrasound usage. And so on and so forth. You can use all of them as good, good examples of rationing. Surgery? Not so much.

The best clinical decision is not the same as rationing.

See how absurd it starts to get to try to define all health care decisions as rationing?

 

[Skeptic Ginger]

As I said, we have waiting lists for elective (i.e. not immediately life threatening but still necessary) surgery in our government run health system because there are not enough surgeons to ensure that everyone has access to a surgeon straight away.

The government rations access to surgeons according to immediate need.

So waiting for an appointment now is rationing?

If you have to schedule the painter 4 weeks ahead to get your house painted, is that rationing?

 

[Skeptic Ginger]

Let's drop the BS.
Health Care is a limited resource, and therefore it is going to get rationed. The question is how.

Health care is not a limited resource. Actually it's a bottomless pit. Do you know how much health care is out there you could buy if you chose to and had the resources? Think of all the genes we know about that increase your various health risks you could see if you had if only you had the money for genetic testing. You could have MRI's and CT scans every year to be certain you caught every tumor in its earliest stage. You could have an angiogram before you had chest pain. The list is endless.

It's the money that is the limited resource.

And that's why calling it rationing is a lie. There are many things our limited resource, money, dictates we don't get. Why call health care you can't afford rationing but everything else you can't afford is something else but not rationing?

 

[Skeptic Ginger]

You don't buy in a UHS. The state is an intermediary that buys for you. Or doesn't as the case may be.

Of course you buy UHS. You pay via your taxes. You vote for the legislators who make the decisions on what will be covered.


There are two systems being discussed here so we should be clear. The complaint I have is calling any government run health insurance rationing.

However, someone else brought up the NHS in the UK and said it was government rationed care. And a UHS has been mentioned here.

But any health care plan, be it UHS, NHS or private insurance plans still consists of a product you purchase. That product is what it is. If you only have one option, you are still buying a product. If you pay for health care via a plan, the plan is the product you are buying. If you pay via your taxes, you are still buying a product.

Rationing is someone telling you what you get from the limited supply. It is not rationing because the product you bought doesn't include something.

Like I said, it is the money that is inadequate, it is not that health care is rationed if something in particular isn't covered in the product (UHS) you buy.

If there is a shortage of a particular health product or service, then you can call it rationing.

 

[Skeptic Ginger]

The balance between cost and availability will probably create a situation where not everyone is happy.

What is the formula for making the least number of people unhappy while staying on a budget? <----

That last is a non trivial concern.

You define the basic coverage everyone gets. You make it clear what is or isn't included in that baseline.

You have to be honest about it and it won't make everyone happy. If for example you say you will not include end of life care beyond $500,000 dollars, or you put the question to the public directly, do they want to be insured for transplants or do they want that to be an option requiring paying extra for? A lot of people will gamble and not pay for extra coverage such as this. But at least then they are responsible if they need a transplant and can't pay for one.

This then becomes clear you are not rationing, you are defining what is and what is not going to be considered basic coverage everyone has access to.

Trouble is, politicians are rarely if ever capable of the kind of brutal honesty that would make such a plan work.