Rationing Health Care - it's a lie!

[GreyICE]

It's been noted that government control of industries tends to increase shortages, rather than decrease them.

Ok, then for whatever reason, there is a shortage. Now what?

Well, temporarily you can ration essential things in that local area so nobody dies.

But you get out of it in the long run by letting prices rise, then competition fills in the gap, and prices come back down.


It's debatable whether the former is even necessary except in extreme cases, and maybe not even then. In the US, hurricanes hit the southern coast. Power is out. People want to buy ice to keep food cool.

Ice bag prices skyrocket.


People in the north load up trucks of ice bags and drive south and sell them for $10 or $20 per bag.


Politicians pontificate, how horrible! How awful to take advantage of these people! This is now outlawed!


Take a guess what happens. Take a guess at what the average ice-ownership and food-spoilage and food-hunger rates of the affected people become.

Hint: Nobody's gonna fill a truck with ice and drive it down there to sell it for what they paid for it.



Oh, and there's more to this. For Katrina, government tried to make up the difference. Eight hundred quintillion tons of ice sat in ice warehouses over fifty thousand miles away for two years, then was destroyed as not fit for human consumption.

As another anecdote, a company near me just spent $15 million to recover and refurbish a derailed train engine worth $2 million, when scrapping it on site would have cost $1 million. The reason? They didn't have money in the budget for purchasing new engines.

My anecdote beats your anecdote I win.

Oh, here's another anecdote for you. The privately run American healthcare costs more than any other system in the world, and delivers worse health care than quite a few.

Oh wait, that's not an anecdote, that's a fact.

 

[kellyb]

Circular logic alert!

You are defining “rationing” as specific property that can only apply government run systems, and then trying to argue that non-government run systems are superior because they don’t have it even though an exact analogy exists and is only differentiated by your arbitrary definition. Critical thinking 101 demands that if you choose that particular definition for “rationing” you cannot appeal to it in any government vs private sector debate.

A more likely answer is that your definition is lacking, but you want to define it that way for reasons of political spin and that you would not challenge or would even encourage the misuse of this term should your favored definition be adopted.

Obviously hasn't read thread alert!

No, the Supreme Court has ruled :

http://www.law.cornell.edu/supct/html/98-1949.ZS.html

SUPREME COURT OF THE UNITED STATES

PEGRAM et al. v. HERDRICH

Like other risk bearing organizations, HMOs take steps to control costs. These measures are commonly complemented by specific financial incentives to physicians, rewarding them for decreasing utilization of health-care services, and penalizing them for excessive treatment. Hence, an HMO physician’s financial interest lies in providing less care, not more. Herdrich argues that Carle’s incentive scheme of annually paying physician owners the profit resulting from their own decisions rationing care distinguishes its plan from HMOs generally, so that reviewing Carle’s decision under a fiduciary standard would not open the door to claims against other HMOs. However, inducement to ration care is the very point of any HMO scheme, and rationing necessarily raises some risks while reducing others.

It has nothing to do with gov vs private and I never said it did.

The only way to get out of any form of healthcare rationing would be to move to a 100% fee for service model where the sick pay out of their own pockets for any and all care they get, and totally get rid of "risk pooling" and any sort of third party payer/decision maker/rationer.

Or, I suppose insurance companies and HMOs and the other third party payers could cease to attempt "cost control measures" (aka-"rationing") and to afford insurance, you'd pay whatever that might end up costing (say, a half million dollars a year, or whatever).

I don't advocate moving to a "pay out of pocket to your doc/hospital" model, by the way. I imagine that such a thing would drop life expectancy to around age 50.
But that would be, unfortunately, the only way to nix rationing in healthcare.

 

[lomiller]

You are still drawing an artificial distinction around the term rationing. For a finite pool of resources, only a certain number of people may receive treatment. Since the end result is always the same, calling some systems for divvying up this treatment rationing, while saying other systems are “not rationing” must fall into one of two categories. Either the distinction is logically inconsistent or the term itself is irrelevant to the real discussion.

 

[kellyb]

You are still drawing an artificial distinction around the term rationing. For a finite pool of resources, only a certain number of people may receive treatment. Since the end result is always the same, calling some systems for divvying up this treatment rationing, while saying other systems are “not rationing” must fall into one of two categories. Either the distinction is logically inconsistent or the term itself is irrelevant to the real discussion.

I'm saying the the fundamental difference between rationing vs "free market" (or, getting healthcare vs buying a car) is the existence of a third party that decides who can get what.
Only a "third party" (private or public, doesn't matter) can "ration" anything.

 

[tomwaits]

It's a lie most of the time. It sounds right using the term, rationing health care, so most people just accept that terminology is correct without thinking. But it isn't correct at all and it harms a debate when one side frames the issue falsely.


If I cannot afford all the health care that is available, that is not rationing. That would be choosing what I can and cannot afford.

If there is a shortage of flu vaccine and the government controls who gets a dose, that is rationing.

Do you see the difference?

Whoever said this to you was mistaken. Of course if the gov't controls the flu vaccines that would be rationing, but the price in the first example also is effectively rationing health care. They are both rationing that appears in different forms.

 

[NoZed Avenger]

I'm not parsing the term. But your post and a few others show how successful framing government run health care as rationing has been.

I see no point to a discussion, as you've already declared anyone who isn't 100% with you on semantics -- even where they may not have disagreed with the underlying point -- as too stupid to resist propaganda, etc. etc.

 

[gtc]

rationing is any system that distributes limited resources.

Like the price mechanism and like the waiting lists I mentioned. As we agree on the definition, I have no idea why you keep on insulting me.

Think, all this could have been solved if you used the example of organ donations. Of course it would be immediately obvious to all observers that the current system rations organ donations, so you had to use a system that was not rationed and imply it would become rationed. Cute scare tactics. Now stop insulting us by assuming we're this dumb. That crap flies well at freeperville, keep it there.

I've never been to freeperville. I have also made it very clear that I think that rationing occurs in both systems and that I am for the UHC that I already enjoy. As such I am not running any scare tactics.

I am not assuming you are dumb but maybe I need to re-evaluate my opinion.

 

[GreyICE]

Like the price mechanism and like the waiting lists I mentioned. As we agree on the definition, I have no idea why you keep on insulting me.

*sigh* Waiting lists are not rationing mechanisms people traditionally consider, unless one wants to expand the definition as much as possible. As I said earlier, my car repair was not rationed when the shop didn't have time to repair it for a week, except in the most facile sense.

Edited by Darat: 

Breach of Membership Agreement removed.

 

[ponderingturtle]

Why do people debate this as if that if universal health insurance is provided, then it will mean the government controls the entire health-care industry?

Because they can't win a reality based argument.

 

[Francesca R]

The ones who have significant vested financial interests in the (US) status quo do it that way to protect their interest by playing up the paranoia of gullible suckers. Mostly the rest do it that way because they are those gullible suckers.

 

[Rolfe]

I think Francesca just said it all.

Rolfe.

 

[Skeptic Ginger]

I see no point to a discussion, as you've already declared anyone who isn't 100% with you on semantics -- even where they may not have disagreed with the underlying point -- as too stupid to resist propaganda, etc. etc.

Intelligence has nothing to do with resisting propaganda. If it did, propaganda wouldn't be as effective as it is.

And while sometimes semantics arguments are merely sidetracks from the important points of a discussion, in this case the semantics is the discussion. Framing influences how we view an issue. Sometimes when framing is pointed out, intelligent people can see the reason it has influence and are less likely to be affected. But just because framing hasn't come to someone's attention has nothing to do with how smart they are.

It's like looking at a sea of people trying to find Waldo. If you don't see him it doesn't have anything to do with your intelligence. You could find him if you kept looking.

There's another thread going titled, "Patients forced to live in agony after NHS refuses to pay for painkilling injections". The OP suggests the reason for not allowing steroid injections for back pain is strictly a cost saving measure. As a clinical provider, I know it is a clinical decision, not one merely based on cost cutting.

Here is an example where you could falsely frame this gatekeeping as rationing. First, deciding not to pay for a service is defining your product. It isn't rationing your product. (The product in this case being heath care covered by the NHS.) If something isn't included in the service you pay for (pay for by taxes or insurance payments) then it isn't included.

What is happening here is people are unhappy about being told they can or can't have something. The loss of independent decision making is the issue. To address this one should correctly identify the problem. If you call it rationing, that is not correctly identifying the problem. Rationing occurs when there isn't enough of something and someone is in charge of doling it out. In the case of the steroid injections, there is plenty to go around. There is no shortage of steroids or syringes or providers to do the injecting.

Instead there has been a clinical decision by a gatekeeper that the patient is unhappy with. In this case you have someone deciding not to pay for bad health care. That could have been the providers or the people in charge of determining if something is cost effective and should or should not be included in the service the taxpayers are paying for.

 

[Skeptic Ginger]

The ones who have significant vested financial interests in the (US) status quo do it that way to protect their interest by playing up the paranoia of gullible suckers. Mostly the rest do it that way because they are those gullible suckers.

This is the part we definitely agree on.

 

[Skeptic Ginger]

Whoever said this to you was mistaken. Of course if the gov't controls the flu vaccines that would be rationing, but the price in the first example also is effectively rationing health care. They are both rationing that appears in different forms.

Then every case of supply and demand is a case of rationing.

You can stretch a lot of definitions. The point is, is the framing honest and is it generally correct, or is is dishonest or generally not correct.

You have to have a prescription for a lot of drugs in the US. Some people think they should have the right to take prescription drugs without a prescription. Is the doctor rationing those drugs because the patient is at the mercy of the provider's gatekeeping?

 

[kellyb]

Framing influences how we view an issue. Sometimes when framing is pointed out, intelligent people can see the reason it has influence and are less likely to be affected.

You don't think everyone here has been aware of the fact that "ZOMG RATIONING!" has historically been a rightwing anti-UHC talking point?
Duh. We just have decided it's an argument worth reclaiming since it can be demonstrated that the private industry does it more. It works to our favor.

 

[gtc]

*sigh* Waiting lists are not rationing mechanisms people traditionally consider, unless one wants to expand the definition as much as possible.

You have no evidence for that statement. But even if 'people don't traditionally consider' them to be rationing, they are still a form of rationing.

If they raised the price of surgery until demand matched supply then there wouldn't be a waiting list. Some poorer people who would be better off with surgery would miss out and the wealthier people would be served immediately.

Instead, everyone is charged the same price (which may be a price of zero) and the limited number of slots are allocated according to immediate need.

Personally, I think that is socially desirable.

 

[GreyICE]

You have no evidence for that statement. But even if 'people don't traditionally consider' them to be rationing, they are still a form of rationing.

If they raised the price of surgery until demand matched supply then there wouldn't be a waiting list. Some poorer people who would be better off with surgery would miss out and the wealthier people would be served immediately.

Instead, everyone is charged the same price (which may be a price of zero) and the limited number of slots are allocated according to immediate need.

Personally, I think that is socially desirable.

This is silly. Waiting lists are simply a product of irregular demand and regular supply. Imagine that people did these sorts of surgeries, like knee replacements, exactly when the person came in. You'd have two weeks of 5 surgeries, then 15 people come in on the same day. This is efficient for nobody. The surgeon is incapable of making his maximal amount of money, because he has lots of idle time. The 5 people in the slow period are overpaying, because the surgeon doesn't do anything else. And the 15 people who came in on the same day (and trust me, these things pattern out this way) get screwed.

It's a nobody wins scenario, hence wait lists, or why I sometimes can't get my car fixed on the same day I need it fixed. You may think of that as rationing, but in reality, the free market frequently produces the same wait lists without government intervention, from the practicality of even demand. 'Free markets raise the price until demand = supply' is just not necessarily how they operate (as 'demand' and 'supply' are frequently less simple concepts than you think).

 

[Corsair 115]

It's a nobody wins scenario, hence wait lists, or why I sometimes can't get my car fixed on the same day I need it fixed. You may think of that as rationing, but in reality, the free market frequently produces the same wait lists without government intervention, from the practicality of even demand.

I think when most folks hear the word "rationing" they're going to think of life during WWII, which involved actual rationing. You had, for example, specific quotas of what you were allowed in a week. Use up that quota, and you were out of luck until next week.

Waiting lists bear no resemblance whatsoever to this kind of rationing, which, I would argue, is the proper and expected meaning of rationing to most people.

 

[Skeptic Ginger]

You don't think everyone here has been aware of the fact that "ZOMG RATIONING!" has historically been a rightwing anti-UHC talking point?
Duh. We just have decided it's an argument worth reclaiming since it can be demonstrated that the private industry does it more. It works to our favor.

What is ZOMG?

I don't doubt people here are aware of the anti-health care reform talking points. There are even a couple right wingers who have spoken up that are for reform.

And the insurance companies are no different as gate keepers than the government with the exception the private sector has a profit motive while the government likely has budget constraints. Both lead to some similar results.

None of that changes the fact calling all medical care gatekeeping, rationing, is inaccurate. This thread has made it clear to me there are 3 kinds of gatekeeping.

1) actual rationing
2) determining what a policy covers or doesn't
3) health care prescriptions or other forms of gatekeeping health care providers do


All three of these can be frustrating if someone else is limiting your access to something you want. But not all of these forms of gatekeeping are validly defined as rationing.

 

[NWO Sentryman]

Britain has huge waiting lists, contrary to whatever lies michael moore spouts. Sometimes people are taken off the list to deceive the public into thinking that waiting lists are getting shorter.

As for Cuba, it is NOT the Potemkin village darling of the left.

If the US adopted a British, or a scandinavian style healthcare system, then i think the deficit would shoot up. Covering 300 million people, with a significant proportion of them obese as well as other health problems will cost considerably more than the Iraq war.