Rationing Health Care - it's a lie!

[Rolfe]

We're supposed to get "up to 60 consecutive days" of outpatient therapy. However, we were supposed to get "up to 120 days" inpatient care, [....]

How is that not rationing?

Yes, Susan goes on to say that Robert was actually given more inpatient days than the stated amount, but if you don't intend to hold anyone to these limits, why state them in the first place?

Rolfe.

 

[Neally]

Depends on which prices you are talking about. How about negotiating down the excessive profits of Big Pharma and Big Insurance? That's where the fat is.

Big insurance does not have "excessive profits". Average is 3.3% net profit margin. http://biz.yahoo.com/p/sum_qpmd.html Way down on the list comparatively. Plus there is Kaiser Permanente which is a non-profit and has rates that aren't way below market.

The solution to health care reform will not be found in fiddling with the insurance piece.

 

[Rolfe]

Looking at it another way, health insurance companies in the USA spend around 78% of their income on actual healthcare (and even that includes all the spending on the excessive "defensive medicine" investigations, and the inflated drug prices that are the norm in the USA).

In countries where insurance companies are part of the universal healthcare system, that proportion is about 95%.

Rolfe.

 

[Francesca R]

I’ve always appreciated the sense in this newspaper . . .

http://www.economist.com/opinion/displaystory.cfm?story_id=14258877

Rationing is not a four-letter word

The second thing to lament about the current apology for a debate is that it is giving the idea of controlling health-care costs a bad name. Mr Obama promised that his reform package would bring down costs, as well as extend coverage. But so spooked has the administration become by accusations of “rationing” health care, as is done in “socialist” systems like the NHS, that very little cost control is now to be expected from whatever bill eventually emerges (see article).

The reality is that America, like Britain, already makes extensive use of rationing. Around half of all Americans are covered by one government programme or another, including those providing health-insurance for the elderly, the poor and government employees. These schemes lay down in great detail, in the form of national and local “coverage determinations”, which treatments and procedures can be claimed for, and at what rates. And all but the most expensive private insurance policies impose limitations of their own. A more honest discussion would accept that cutting costs, as the administration has promised to do, must involve reining in a system that encourages patients to demand tests and procedures that they don’t really need and doctors to recommend them.

 

[Skeptic Ginger]

How is that not rationing?

Yes, Susan goes on to say that Robert was actually given more inpatient days than the stated amount, but if you don't intend to hold anyone to these limits, why state them in the first place?

Rolfe.

Limiting certain care to 'x' number of days would be rationing if there weren't enough caregivers to go around. As such under insurance plans it is saying you are buying 'x' number of days or visits for care and after that you must pay for additional days or visits.

I understand that some of you here are not buying what I've been saying and think this is all about semantics. It is about falsely framing an issue and by doing so the basis of the issue is clouded over with the false framing.

No one has given a good argument for why we don't call everything one cannot afford, rationing. Why only call health care you cannot afford, rationed?

 

[Skeptic Ginger]

I’ve always appreciated the sense in this newspaper . . .

http://www.economist.com/opinion/displaystory.cfm?story_id=14258877

I am voicing my concern about just this very thing. The fact people in all walks of life are calling limiting the health care product you are purchasing, rationing, is exactly the issue. You merely cite another example where this false framing of the problem is in evidence. If you are trying to argue by authority, it fails.

I also don't accept argument by majority. I am confident I am correct.

Another thing not demonstrated in arguments against my position is the fact when there is true rationing, it clearly differs from purchasing less than comprehensive medical coverage.

My comments about the gatekeepers has not been addressed. All gatekeeping is not rationing. Yet other forms of gatekeeping besides rationing are what is being confused with rationing. I can prescribe a drug most people cannot get in this county without a prescription. Should we call that rationing as well?

 

[Darat]

...snip...

No one has given a good argument for why we don't call everything one cannot afford, rationing. Why only call health care you cannot afford, rationed?

Often in English language the meaning that one wishes to convey by using a certain word is dependent upon the context in which the word is used. Also words can often have more than one meaning or just "shades" of meanings.

As has been said in quite a few times in this thread - if someone wishes to use the word "rationing" in regards to a health care system such as the NHS then it would be a consistent use of language to also describe the current health care system in the USA as also being "rationed".

 

[Skeptic Ginger]

Big insurance does not have "excessive profits". Average is 3.3% net profit margin. http://biz.yahoo.com/p/sum_qpmd.html Way down on the list comparatively. Plus there is Kaiser Permanente which is a non-profit and has rates that aren't way below market.

The solution to health care reform will not be found in fiddling with the insurance piece.

I think you need to recheck on the method the profits were determined in your cite. Other sources are reporting as much as a third of all health care dollars are going to insurance companies. If that is all admin costs except 3%, my first thought would be, they are manipulating the figures on paper. Like deducting depreciation for million dollar office complexes, for example.

 

[Rolfe]

Limiting certain care to 'x' number of days would be rationing if there weren't enough caregivers to go around. As such under insurance plans it is saying you are buying 'x' number of days or visits for care and after that you must pay for additional days or visits.

I understand that some of you here are not buying what I've been saying and think this is all about semantics. It is about falsely framing an issue and by doing so the basis of the issue is clouded over with the false framing.

No one has given a good argument for why we don't call everything one cannot afford, rationing. Why only call health care you cannot afford, rationed?

But I don't. This is perfectly normal use of language. Maybe I can only afford to fill up my car once a month. So I say I'm rationing myself to only 80 miles a week. Maybe I can only afford a single loaf of bread this week, so I say I'm rationing myself to only two slices a day.

I'd use it in other circumstances where the supply isn't limited. I might want to lost weight, and decide to ration myself to only one chocolate every evening. I might decide I'm spending too long on the internet, and ration myself to only two hours a night.

It is just semantics. You have an overly-narrow definition of a word which is quite widely and flexibly used.

Rolfe.

 

[Kestrel]

I think you need to recheck on the method the profits were determined in your cite. Other sources are reporting as much as a third of all health care dollars are going to insurance companies. If that is all admin costs except 3%, my first thought would be, they are manipulating the figures on paper. Like deducting depreciation for million dollar office complexes, for example.

Two thirds of the money is spent providing health care for customers. After paying for an army of clerks, buildings, lobbyists and executives, three percent is left over and reported as profit.

 

[Skeptic Ginger]

Two thirds of the money is spent providing health care for customers. After paying for an army of clerks, buildings, lobbyists and executives, three percent is left over and reported as profit.

There are a plethora of opinions out there as to what the insurers are actually making. Just making a statement the costs are funding clerks, etc., is not very reliable. You might as well say you believe 'X' and there's no reason to actually look any further.

This WSJ article is the best sourced one I can find showing specific company profit margins. This argument came up in the greedy oil company threads as well. Using the Wall St norm for a profitable company (aka one with a rising stock price) is actually a lot of the problem with the news media, (when Wall St became more important and it was efficient to unfund the investigative reporting); when the oil companies were recording the most profit ever of any corporation while the price of gas was hurting the poor (profit was claimed to only be 4% and good old Walmart makes 9%), and in this case as well.

Greed, in my book, is turning the news into a milquetoast commodity rather than a source of information because it makes the company more attractive to investors. We all lose with that one. Greed is pretending your profits are not obscene by claiming your margin is only 4% when quarter after quarter the company is reaping the largest profits in the history of modern corporations.

Greed is dropping paying customers when they have a costly health problem. Greed is when you have dropped your price as low as you can to compete, so you start finding new ways to increase profits like dropping anyone from the rolls that need to actually use the insurance they've been paying for for years.

Greed may or may not be reflected by the number Wall St likes to see for company profits.

And anyone can present one's profit margin from different angles. It looks lower when you figure your taxes and go before Congress to lobby against a 'public option' in health care reform. It looks higher when you put out your company profile advertising to potential investors.

 

[Skeptic Ginger]

....

It is just semantics. You have an overly-narrow definition of a word which is quite widely and flexibly used.

Rolfe.

I've not argued that one cannot find a way to rationalize the use of the word, rationing, when one really means what one can afford or not afford. What I've said is using the term specifically applied to health care decisions by government run entities is misleading and it detracts from a legitimate debate about the issues.

You do not hear the term, rationing, generally applied to things one cannot afford. You do not hear the term, rationing, generally applied to other forms of medical care gatekeeping, such as drugs which require a prescription. You have to go out of your way to point out the private insurers make the same decisions as a government health insurer/provider and say, "private insurer decisions are rationing too".

Why do you have to go out of your way to say that? Because you hear the term, rationing, being applied specifically to government run health insurance and/or health care and you don't normally hear the term applied to private insurers' health care decisions.

We should be discussing health care reform in terms of what can or cannot be afforded when it comes to what should be included in the universal care application. That is the actual issue. The issue is not about some gatekeeper government rationing care to its citizens.

 

[Architect]

Oh for heaven's sake, I've never seen such a daft argument about semantics outside of the 9/11 threads.

Let's be quite clear; rationing, by which we mean restricting the availability of healthcare on the basis of cost, happens in both systems. In UHC, it's the government bodies which do so. In private healthcare, it's the insurance companies.

There has been no substantive evidence that important or urgent clinical treatment is "rationed" under the NHS. It is clear to those of us in the UK that daft things like cosmetic surgery (i.e. for it's own sake, not as part of - say - treatment for burns) are rationed. I don't think that upsets us.

In the US system, it appears that insurance companies will likewise only pay for certain operations, treatments, etc. However a large number of Americans have no healthcare insurance and hence have to use Medicaid/care, which is - as far as we can tell - very proscriptively rationed.

So what the hell are you arguing about?

 

[jimbob]

skeptigirl,

The effect is the same as what is referred to as rationing when talking about UHC:


Private insurance-based system
If you can't afford to pay for the treatment yourself, and your insurance is maxed out, you can't get the treatment (not rationing) because if you could afford it, you could get it...

UHC:
If you can't afford to pay for the treatment yourself, and your national-supplier won't pay for it because of cost-benefit considerations, you can't get the treatment.

People commonly refer to this as rationing, even though the treatment might be available for someone with private funds to pay for it. (And I do not mean on the black market, as would be required under a system of "true rationing").


Whether you are technically correct is a different matter, but you are never going to get even a substantial minority to accept that the UHC case isn't rationing. In this situation, as almost everyone refers to the UHC situation as rationing, it is better to point out that equivalent "rationing" -maybe with quotation marks, also occurs under the private insurance-based system.

Often in English language the meaning that one wishes to convey by using a certain word is dependent upon the context in which the word is used. Also words can often have more than one meaning or just "shades" of meanings.

As has been said in quite a few times in this thread - if someone wishes to use the word "rationing" in regards to a health care system such as the NHS then it would be a consistent use of language to also describe the current health care system in the USA as also being "rationed".

I am voicing my concern about just this very thing. The fact people in all walks of life are calling limiting the health care product you are purchasing, rationing, is exactly the issue. You merely cite another example where this false framing of the problem is in evidence. If you are trying to argue by authority, it fails.

I also don't accept argument by majority. I am confident I am correct.
Another thing not demonstrated in arguments against my position is the fact when there is true rationing, it clearly differs from purchasing less than comprehensive medical coverage.

My comments about the gatekeepers has not been addressed. All gatekeeping is not rationing. Yet other forms of gatekeeping besides rationing are what is being confused with rationing. I can prescribe a drug most people cannot get in this county without a prescription. Should we call that rationing as well?

ETA: Architect's post above, too...

Skeptigirl,

Argument by majority is correct if you are talking about use of language.

The aim is to communicate.

For example I personally distinguish between "uninterested" and "disinterested" but I (grudgingly) accept that many people use "disinterested" where I would have used "disintereste".

My usage can be seen in the following:

"The purposes of justice are served best by disinterested but not uninterested parties".

In the situation thatwe are taliking about I would call it rationing if the reasons for supply choices are "economic" i.e. due to a scarcity of resources including money but also including, say organs, or vaccines...

 

[ddt]

For example I personally distinguish between "uninterested" and "disinterested" but I (grudgingly) accept that many people use "disinterested" where I would have used "disintereste".

My usage can be seen in the following:

"The purposes of justice are served best by disinterested but not uninterested parties".

In the situation thatwe are taliking about I would call it rationing if the reasons for supply choices are "economic" i.e. due to a scarcity of resources including money but also including, say organs, or vaccines...

This example is apt in more than one way. What I understand of this thread - well, sometimes it's hard to make heads or tails of it - is that skeptigirl's opposition to the use of the word "rationing" is in no small part inspired by the fact that the reform opponents use "rationing" as a scare word, on the same par as "liberal", "commie" and other "unamerican" things.

A bit more disinterest w.r.t. the rhetorics, but not uninterest in the case, would be fruitful to the discussion.

 

[kellyb]

I think what bugs me the most about making "rationing" a bad word in the healthcare debate, is that as medical science progresses, the need for rationing will continue to progress, too. We only have to ration it because it's gotten both so effective and so expensive. The coming decades will see lots and lots of expensive, fancy, new life prolonging drugs that will simply not be able to be universally affordable and provided.

For healthcare reform to stand a chance at being both "affordable" and "universal", we need to come to grips with this now. We need to understand that expensive healthcare is a "scarce resource" in a roundabout kind of way, and that ugly decisions will have to happen. Ugly debates will have to take place.

 

[Skeptic Ginger]

Oh for heaven's sake, I've never seen such a daft argument about semantics outside of the 9/11 threads.

Let's be quite clear; rationing, by which we mean restricting the availability of healthcare on the basis of cost, happens in both systems. In UHC, it's the government bodies which do so. In private healthcare, it's the insurance companies.

Here is a major error in your perception of events. Restricting access to health care because of cost can occur in 2 ways, one is rationing one isn't. These are hypothetical examples:

If I determine I, as an insurer, can only afford to provide a kidney transplant for 4 out of 10 people who need one, then I would need to ration health care due to economic circumstances.

If I determine I cannot include transplants at all in a universal health care plan because the public who must foot the bill in some way, be it insurance premiums or taxes, will not agree to provide transplants to everyone, then that is not rationing.

There has been no substantive evidence that important or urgent clinical treatment is "rationed" under the NHS. It is clear to those of us in the UK that daft things like cosmetic surgery (i.e. for it's own sake, not as part of - say - treatment for burns) are rationed. I don't think that upsets us.

So the NHS in the UK has 'x' number of cosmetic surgeries to dole out and they ration those surgeries?

In the US system, it appears that insurance companies will likewise only pay for certain operations, treatments, etc. However a large number of Americans have no healthcare insurance and hence have to use Medicaid/care, which is - as far as we can tell - very proscriptively rationed.

So what the hell are you arguing about?

What in Medicaid is proscriptively rationed? I do believe you are mistaken. Either you meet the qualifications for Medicaid or you do not. Either something is included in Medicaid coverage or it is not. That is not rationing.

 

[Skeptic Ginger]

ETA: Architect's post above, too...

Skeptigirl,

Argument by majority is correct if you are talking about use of language.

Not if the majority are duped as is not so uncommonly the case.

The aim is to communicate.

The aim is to communicate factually, not manipulatively.

For example I personally distinguish between "uninterested" and "disinterested" but I (grudgingly) accept that many people use "disinterested" where I would have used "disintereste".

My usage can be seen in the following:

"The purposes of justice are served best by disinterested but not uninterested parties".

In the situation thatwe are taliking about I would call it rationing if the reasons for supply choices are "economic" i.e. due to a scarcity of resources including money but also including, say organs, or vaccines...

Scarcity of organs or vaccines definitely results in rationing those resources. Deciding that universal health care will not include universal access to transplants is a decision not based on rationing transplants. It is based on not including transplants in a particular product.

If I decide to not include a CD player in a new auto unless it is purchased separately, that isn't a case of rationing CD players. It is a case of not including it in a product for sale.

 

[Skeptic Ginger]

I think what bugs me the most about making "rationing" a bad word in the healthcare debate, is that as medical science progresses, the need for rationing will continue to progress, too. We only have to ration it because it's gotten both so effective and so expensive. The coming decades will see lots and lots of expensive, fancy, new life prolonging drugs that will simply not be able to be universally affordable and provided.

For healthcare reform to stand a chance at being both "affordable" and "universal", we need to come to grips with this now. We need to understand that expensive healthcare is a "scarce resource" in a roundabout kind of way, and that ugly decisions will have to happen. Ugly debates will have to take place.

Another way to look at the problem is, as more health care advances are developed, not everyone will be able to afford them. Not everyone can afford a yacht as well. Who refers to yachts as rationed?

 

[jimbob]

Another way to look at the problem is, as more health care advances are developed, not everyone will be able to afford them. Not everyone can afford a yacht as well. Who refers to yachts as rationed?

If there was a UBS (Universal Boat Supply)* organisation that aimed to supply boats to everyone who needed it, and it had a limited budget, so that it was unable to supply all the yachts that people wanted to, then it could be argued that this was rationing.



*an example that is almost as inane as Beerina's sig