Better Health Care Through Rationing
"We don't want rationing!" goes a choir of angry voices in the health reform debate. Yet, when we are strictly honest with ourselves, we must admit that, as a society, we already ration. We ration whenever we make choices among the claims of individuals who are competing for scarce resources. Government, mainly through Medicaid and Medicare, pays for approximately 50% of the cost of U.S. health care. People may scream about "socialized medicine," but right now half of our health care in America is "socialized health care." Having undertaken to fund some health care, public policy must be accountable for the consequences of the decision to cover some Americans and not cover others. It is thus clear that the United States denies more health care to more people than any other developed nation. We win the rationing Olympics.
The United States now has the worst form of rationing. We ration people by leaving them out of the system. We tell each other that this is indirect rationing, and apparently we find this morally easier to accept than direct rationing. A sin of omission is easier to live with than a sin of commission. But it is rationing in its cruelest form: the Institute of Medicine estimates that 20,000 Americans die each and every year simply because they lack health coverage.
Let me present a more positive case for rationing. I suggest that a society will not start to maximize its health case access and quality until it fully confronts the issues involved in rationing. It is my passionate belief that we can all have better health care through rationing.
Over the last 40 years the cost of health care has risen from 6% of our Gross National Product to 17%. Most thoughtful health care providers now recognize that the genius of American medicine has invented more health care than we can afford to deliver to everyone. Our medical practice patterns, our medical ethics and our public expectations in health care have been formed during a time when health care costs have been growing at the unsustainable rate of 2 and 1/2 times the rate of inflation. No item in a public or private budget can grow forever at 2 and 1/2 times the rate of inflation; inevitably it must be reduced to no more than the rate of inflation or health care would crowd out all other public and private spending.
No modern society can afford to give to each of its citizens all the health care that is "beneficial." The health care system can no more afford to do everything "beneficial" for every patient than the education system can do everything "beneficial" for every student, or the police department can do everything "beneficial" for every citizen. We are delivering, and the public is expecting, more medicine than we can possibly afford to sustain.
Medical need is an infinitely expandable concept. There is always one more marginal procedure that can be done. There is no end to the medical and surgical treatments that a technologically sophisticated and advanced society can give to aging bodies. It is hard -- but necessary -- to change our thinking after years of "blank check" medicine.
It does little justice to this great country to avoid the rationing issue. The search for the health care system that does not ration, like the search for the chocolate sundae diet, is futile and demeaning. Increasing the efficiency of the existing system and ending fraud and waste, alone, will not come close to solving our volcanically growing health care costs. Rationing is the price we must pay for our creative success. It is the ugly child of the marriage of our ingenuity and our egalitarianism. It is increasingly obvious that the genius of American medicine has outpaced our ability to pay. As one expert, Laurene Graig, put it:
Modern men and women of medicine now have the capability to spend unlimited resources in heroic and sometimes vain attempts to extend life ... such changes pose a serious dilemma to society. A dilemma so new that neither our social, legal, and religious institutions, nor our health care providers or consumers have developed a satisfactory way of coping. How do we as a nation balance our beliefs in the individual choice and values in health care against our community priorities and resources?
We must confront this hard reality: All nations ration -- some by price, some by queuing, and some by setting priorities. I believe a nation does not maximize its health care until it starts to ask the hard question: How can we prioritize our expenditures to buy the most health care for the most people? We should not apologize for rationing; we should promote it and advance it. We cannot explore the "opportunity costs" of limited dollars unless we admit that we cannot pay for everything for everyone and spend our limited money where it will do the most good. In a world of public policy, we cannot say "yes" unless we say "no." It is an inevitable dialogue, and we ought to make a virtue out of necessity.
Matt Mackowiak: Gov. Rick Perry Once Pushed Government Intervention in Health Care
Gov. Rick Perry issued an executive order requiring that all Texas schoolgirls receive a questionable vaccine to prevent HPV. Doesn't that sound like expensive government intervention into a patient's health care?
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It's the doctors that need to start rationing, we all don't need a specialist for every little thing, we don't need nuclear medicine for a broken toe. Doctors know this too, but if they don't bring in a specilaist or run the most expensive test they open up themselves to lawsuits.
All this health care reform is a bunch of crap, it's heading in the wrong direction, we need better care through simple means like preventative medicine. I heard yesterday that the US ranks 39th in the world in how healthy our citizens are.
I have read many articles from many people on here, and the general feeling is that while the reform is necessary and good for country, they are missing the point. The federal governemt is doing what it can, it needs to concentrate a lot more on litigious isues too.
The states and us citizens need to do our part too. We need to start paying for simple things instead on insurance paying for everything. I went to my local grocer the other day and received a flu shot and paid for it with cash, the lady behind the counter was taken back and surprised that someone would do that. After all isn't health insruance supposed to pay for it? Well I don't have health insurance, but it wasn't a big deal anyway, it's ok to jut pay for it.
This is going to sound mean, but then I'm an old nurse. If pulling the plug on Grandma is going to kill her...she'
I believe you zephy. Saw my own mother suffer while everything was done to keep her alive for a few more weeks. The bills were sky high. It seemed like there was no end to all the things done to her. Not something I would want, and if others witnessed it I do not think others would want it either. And you are right, no one really cared about my mother. It was to make money for hospital.
HMOs ration.
It's hard to believe people still need to be reminded of that.
At last we hear from Gov. Dick Lamm! I've been fondly remembering his ahead-of-his-time comments on this matter in the mid-80s while Colorado governor (1975-1987).
While his so called "duty-to-die" comment and others earned him the nickname Governor Gloom, around here people didn't go psycho like many in the country are now. As Wikipedia puts it, "In 1984, his outspoken statements. . . generated 'some controvers
How I long for the days of "some controvers
Rationing occurs at the level of delivery. What doctor is going to tell a patient they cannot have the help they need? What doctor is going to deny the help a patient needs? Doctors are licensed. If they deny patients the help the patient needs, the license is revoked.
OK. So, what is the governor talking about?
Given the growth of the population we better get used to rationing.
Sustainability is going to start dominating all our endeavors sooner than most people think.
Some of the crappy whining that we put up with is just counter productive and a luxury we will be increasingly forced to abandon. Wait until water is the issue. Right , left center conservative , liberal won't mean jack when the country has half the water it needs.
I totally disagree. A health care system starts with prevention. The person who does not get sick does not go to the doctor. That starts with food safety, where the US clearly lags behind. Enforcing higher standards on land use, pollution and air and water. Before we ask the sick to take cuts, lets take the profit out of health care. It has become custom that before anybody lifts a finger, it has to be profitable. A horrible thought to think about the patience first, where health care is foremost keeping people long enough healthy to contribute to society as a whole. But this is actually the problem: society. You have to have one first, where the profits are measured in happiness and the sadness by the friends you have. Health care is care about people and finally society as a whole. There is not space left to be purely individualistic with approaching 8 Billion people of Earth's population. It is a dilemma best expressed by using corn for car fuel, while children die of hunger. There it is the moral problem. Rationing is to cut people of one way or the other. To have a person decide whether you die or live. I just do not see some stock holders or rich to pull the plug on me.
Yes, but I'd rather ration through my own personal choices rather than by the dictates of the government.
As it is, you are rationed by corporate interests, not your personal choices.
... after the enslaving subordination of the individual to the division of labor, and therewith also the antithesis between mental and physical labor, has vanished; after labor has become not only a means of life but life's prime want; after the productive forces have also increased with the all-around development of the individual, and all the springs of co-operative wealth flow more abundantly—only then can the narrow horizon of bourgeois right be crossed in its entirety and society inscribe on its banners: From each according to his ability, to each according to his needs!
Finally, an intelligent outline of the health care situation to combat all the ridiculous shouts of "socialism
The U. S. health care system is ranked 37th in the world. You might expect an elected offical to inspire, scold or otherwise encourage that sector to improve. Instead, we are asked to lower our expectations. This is a country that's supposed to be number one in the world. The question is, what's it number one in?
this ranking is bogus. it includes suicides, auto accident in the numbers. that is bogus. if those numbers were removed, the US would be #1. open your eyes and ears.
And this is where the entire debate bogs down. People are reluctant to deny Grandma that hip replacement, or that coronary bypass, or that chemotherapy, despite the fact she's 92 and has a poor quality of life which will be likely not be improved or prolonged by the procedure. Bring cost reduction into the discussion and the s**t really hits the fan. Only time and a sweeping cultural change will end this debate - if ever.
The United States is broke; we can only afford a free preventive health care for all system, which also gets to the root of of the ration theory.
We would be and we will be and we allways have rationalized care. The moment society decided that botox and rogaine and butt and breast implants were more important than finding a cure for real disease and disability, health care began to be rationed.
Actually it was way before then, like in the 1990s. I've even heard they did it way back in the 1980s.
I'm still waiting for Richard Simmons and Susan Powter to show me their MDs. Because around here, you'd think that you need an MD to manage obesity because it is (mistakenly) considered a medical condition.
Of course that would also mean that Suzanne Somers was an MD too for creating and pushing her ThighMaster ~eyeroll~
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