Monday, July 20, 2009

We already ration health care!

I have been saying for years that the two most ridiculous arguments against government run health care are: 1) That health care would be rationed and 2) that a government bureaucrat will determine your care. Why? Well, because these 2 things are already occurring in our system, but in a way that is far less fair, moral, and efficient than in countries with universal coverage.

We already ration health care in this country, based on who can afford it. If you need, or want a treatment and have insurance that will pay, or can afford it out-of-pocket, you get it. Otherwise, good luck. You may get it in an emergency room, but only if it is an obvious emergency. Need your high blood pressure meds to keep from having a stroke and can't afford them, too bad. And as for the bureaucrats....well, what would you call the people who work at the insurance companies, and are hired to try to keep the company from paying for your care? I would call them murdering bastards, and I would prefer a bureaucrat to a murdering bastard!

That said, take a gander at the article in the NY Times Mag section this week by bio-ethicist Peter Singer. He maintains, as I do, that we are already rationing health care, but not wisely or fairly, and suggests some better ways to do it. In case you don't want to read the whole thing, here are a few relevant quotes:

On a blog on Fox News earlier this year, the conservative writer John Lott wrote, “Americans should ask Canadians and Brits — people who have long suffered from rationing — how happy they are with central government decisions on eliminating ‘unnecessary’ health care.” But as it happens, last year the Gallup organization did ask Canadians and Brits, and people in many different countries, if they have confidence in “health care or medical systems” in their country. In Canada, 73 percent answered this question affirmatively. Coincidentally, an identical percentage of Britons gave the same answer. In the United States, despite spending much more, per person, on health care, the figure was only 56 percent.

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care.

A recent Commonwealth Fund study led by Cathy Schoen and Robin Osborn surveyed adults with chronic illness in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom and the United States. Far more Americans reported forgoing health care because of cost. More than half (54 percent) reported not filling a prescription, not visiting a doctor when sick or not getting recommended care. In comparison, in the United Kingdom the figure was 13 percent, and in the Netherlands, only 7 percent. Even among Americans with insurance, 43 percent reported that cost was a problem that had limited the treatment they received. According to a 2007 study led by David Himmelstein, more than 60 percent of all bankruptcies are related to illness, with many of these specifically caused by medical bills, even among those who have health insurance. In Canada the incidence of bankruptcy related to illness is much lower.

Singer goes on to discuss some methodology for determining what a life is worth, so rationing could be applied sensibly and fairly. Of course, we are no where near coming to any sensible conclusions about our health care system. Obama's plan is a small step in the right direction, but too small in my opinion. We need to blow this mess up and start over. And over at the GOP, they think the problem is that too many people have access to health care. They would like to return to the times of 100 years ago, when the robber barons worked people to death, then they just died and got out of the way.

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