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Erin N. Marcus, M.D. Headshot

To Mitch McConnell: We're Already Rationing Care

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As someone who works with low-income patients, I have to scratch my head a bit at Senator Mitch McConnell's complaint that Dr. Donald Berwick shouldn't be appointed to run Medicare and Medicaid because he supports "rationed health care."

McConnell's opposition to Berwick purportedly stems from a statement Berwick made last year, in which he said the following:

"The decision is not whether or not we will ration care -- the decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

To which the logical response of anyone who has spent any time in an urban health care setting ought to be:

"Let's state the obvious!"

Now, I could offer up a litany of examples supporting my hypothesis. There's the middle-aged mechanic with blood in his stool who can't get a colonoscopy because he lacks the $1,000 needed to pay the upfront cost. The cancer patient waiting months to see the specialist for treatment at the jam-packed, over-subscribed charity clinic. The lines of people waiting around the block to see a first year medical student at a health fair because they see this as their only opportunity to get treatment, when the purpose of the fair is really just to offer some basic screening tests.

But those are just my personal observations, and for all I know might not represent what's really going on in our world-renowned health care system. So let's try to look at some more objective analyses:

Well, for starters, there's the Kaiser Health Foundation's nationally representative 2009 survey of 1,200 adults, in which six of 10 respondents said they or a member of their household delayed or skipped care in the past year due to cost, and one of three skipped filling a prescription due to cost.

There's an analysis of 23 million children by researchers at Johns Hopkins that found that being uninsured increases a hospitalized kid's risk of death by 60 percent versus that of an otherwise similar hospitalized kid with insurance -- leading, over the past 18 years, to the deaths of more than 16,000 children in the US.

There's the finding that 65 to 74 year olds who lack insurance and then get Medicare are more likely to be hospitalized for complications of cardiovascular disease and diabetes than comparable Medicare beneficiaries who had insurance all along, and that Medicare spends about $1,200 more annually on the "previously uninsured" with these conditions than on people with the same conditions who had been insured. The paper doesn't make any conclusions about why, but these findings lead one to suspect that diabetes and heart disease fester and get out of control in folks who can't afford care, so that when they finally get coverage, their problems are more difficult to treat.

And then there's that analysis of National Health and Nutrition Examination Survey data that found that adults younger than 65 who lack health insurance are 40 percent more likely to die than similar people with insurance. (This was after matching the two groups for age, gender, smoking status, income, education, body mass, alcohol use, ethnicity and their "health status" as described by both their doctor and themselves).

These are just a handful of the many studies conducted in the past few years demonstrating how our discombobulated system doles out care to those with and those without good insurance.

It's not that I think the Obama Health Plan, which offers a treasure trove of profit to the pharmaceutical and insurance industries, is such a great solution, either. But really, Senator, can't you come up with a better reason to oppose the guy? Rationing isn't "looming." It arrived at the train station a long time ago.

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