While Lobbyists Lament Rationing, Some Patients Want It

The health care industry is spending about $1.5 million a day on lobbying efforts in Congress. Most of those dollars are spent fighting against the threat of "rationing." That doesn't count the money that's spent on TV ads in which disgruntled people from Canada tell why they come to the United States for surgery (supposedly because public plans ration care.) The rant about rationing is designed to make consumers feel that no one will be able to get in to see a doctor under a public plan, and that grandma will be denied her hip replacement because she's -- heaven forbid -- over 65. It's designed to make efforts at real health care reform fail. Fear can be a powerful motivator, and the lobbyists and advertising campaigns are trying desperately to evoke as much fear as they can in the mind of the consumer, hoping that will influence Congress.

What most Americans don't realize is that our health care is rationed now. If you aren't employed by someone who provides health insurance your access to health care is limited by your ability to pay for it. That's rationing. If you are insured, but your plan doesn't cover the test your doctor thinks you need, or you think you want, your care is also rationed. It you lose your job, your care is rationed, because you probably can't afford COBRA. Right now, people who have health insurance that's provided by their employers feel complacent and, understandably, don't want reform. That perspective shifts in a minute when they get sick, or are unemployed.

Rationing can be done well. We can ration care that has not been proven to prolong life, or to be effective. My late husband, a radiologist, used to see cancer patients all the time. One of the things that made him most upset was when a patient was given chemotherapy or radiation therapy that would make them sick immediately with only a small chance of prolonging life for a few weeks. He thought that this "standard of care" -- try everything -- was permanent employment for oncologists, and he often counseled his friends to refuse treatment and live well, if not healthy, until they died.

He died twelve years ago this week. He was a Progressive, a man who believed in access to health care as a right. When he became ill, he looked at his own X-rays, realized he was terminal, and did the same thing he told his patients to do: he refused treatment. He happily played with grandchildren and went out to dinner until a week before he died, and then he asked me to make sure he would not receive any more treatment that wasn't just to relieve pain and suffering. He rationed himself.

Most of the US's health care dollars are spent in the last six months of a person's life, and often the patient doesn't even want the extraordinary measures, or doesn't know he or she is receiving them. It's the family that "tries anything" and authorizes the medical staff to use extreme measures. It's not the elderly person having a hip replacement that we should ration -- it's the elderly person who wants to die peacefully, but whose relatives won't let go, whose care should be "rationed."

And who should make that decision? The patient: far in advance of the moment it occurs. If we could get people to take charge of their own health, create "Advance Directives," and ask their families to abide by them, we'd have plenty of money to take care of the people who can actually benefit from the care they get. Not everybody can be saved.

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Comments

[S1m0n]

Forty percent of Americans recently told a Times Poll that they have avoided seeking medical attention because of concerns over cost. THAT's rationing, and it's rationing that doesn't even appear on the official stats, because these folks don't turn up at hospital or a doctor's office to be counted at all. Forty percent. And many of these are folks who officially have insurance.

Nothing like that happens in Canada. Here, first call on resources goes to patients with greater need. If I'm scheduled for elective surgery the day a 100 pile up happens on the highway, I'm likely to get bumped, because a trauma case needs the operating theatre more than I do.

[zoe27]

As a Canadian watching the debate in the U.S. over a public option in health care, I wish I could say I was surprised at the misinformation presented. Canadians choose their own doctor, not the Canadian government. Most are happy with a system that guarantees everyone has access to needed health care, even if waiting somewhat longer for it, rather than one where the wealthy get instant excellent care while others get inadequate or none. Wait times tracked by the government, by the way, in an effort to reallocate funds to address the issue, through equipment, personnel, etc. There have been at least three times when my family would have faced serious financial hardship, possibly bankruptcy due to health costs were they not covered. (Emergency C-section, baby born with birth defect, husband hit by car.) Not one of these could have been anticipated or prevented by proper nutrition, not smoking, and one of them was during a period of unemployment soh ow well the associated health costs were covered was not dependant on a changeable level of insurance set by an employer. A couple of years ago Canadians voted through a TV show for the "greatest Canadian". The winner was Tommy Douglas - the politician responsible for bringing in universal health care. Hopefully future Americans will get over the distracting "FREEDOM CHOICE AND BY GOD LET'S MAKE A PROFIT" noise going on now and look back on health care reform as one of this administration's best accomplishments.

[JuliaRain]

Thank you for this thoughtful post. End of life decisions should be part of one's long term health care planning. Thank you.

[been2there]

When my cat began to suffer, I held him as he went to his final sleep. I should do less for my beloved husband?

[classicalgeek]

Thank you for your rational, compassionate article. My own family has discussed this in detail, as well as noninvasive measures that can be taken by the family in an emergency. We have prepared all the legal documents, but my heart goes out to those who have not, and who are subjected to extraordinary measures they don't want or need. My own great-aunt died peacefully at age 102, after my family refused extraordinary measures that would have kept her alive for perhaps a day and a half, if that.

[FaceReality2]

"The rant about rationing is designed to make consumers feel that no one will be able to get in to see a doctor under a public plan, and that grandma will be denied her hip replacement because she's -- heaven forbid -- over 65."

All the Republicans have are lies, half-truths, and scare tactics.

[rkauff]

thank you for a hearfelt and thoughtful article. a central registry must be part of the health care reform where end-of-life decisions can be kept and quickly retrieved. in most communities, when EMS comes to a home they are required to apply resuscitation and will have no written DNR authorization, and the same applies in hospitals and intensive care units unless the family is armed with the right documents.