HEALTH CARE RATIONING
This health care debate gives me a headache.
I read. I ask questions and mostly what I get is opinions. There are two things of which I am certain:
First, and rather obviously, the cost of a plan depends upon what covered services it includes. There is no plan, in any country that covers "Everybody for Everything.";
Second, rationing happens. In the US we ration pretty much by wealth/plan access. In Canada they ration by time. It's all rationing and it usually applies to elective non-life threatening care.
So the questions on the table are "What do we want to cover?" and "What should our rationing method be?"
Damned if I know.
ABC
posted by UMRBlog @ 15:13
11 comments
11 Comments:
Precisely.
Got them Death Panel Blues, eh UMR?
Look on the bright side---the last overhaul of healthcare we had created HMOs, which put the death panels in the hands of pencil-necked geek corporate accountants.
With ObamaCare, the death panels will be run by faceless, unaccountable taxpayer funded, difficult to sue bureaucrats---it's change we can believe in!
You're mostly on target. The base question, however, may be whether we will decide that universal access to appropriate and necessary health care is a basic human right or whether it, like driving a car, is a privilege to be earned.
If we decide that health care is a for-profit, free market privilege then we should quit fussing about the cost because this privilege inevitably will cost us much more. Why? Because, in addition to the profit margin for everyone each step of the way, you will always have someone profiteering on the backs of the ill and elderly. It really is simple economics — which is why the civilized industrial world chose, after World War II, to implement various forms of universal single-payer health insurance.
It is also interesting that the medical facilities, such as Mayo (where many wealthy Quincyans go) and Cleveland, that are much touted for their excellence are non-profits using salaried physicians, at Mayo's roughly $250,000 a year. As the Mayo's CEO put it on C-SPAN, their docs are free to worry about quality of care rather than quantity of care. What an intriguing concept!
Josephus--
The decision whether something is a "right" is outcome-determinative. I think the better discussion is whether it's in our national interest to have a mechanism the covers yet-to-defined services under a yet-to-be-determined delivery system.
I'm not sure the not-for-profit model encourages the kind of medical research that makes some conditions obsolete. It could be one component.
On a national level, the question, regarding baseline and essential services is still not whether re ration them, but how.
Having said that, we still need to define the schedule of benefits for any mandatory program. Just like Illinois requires liability insurance of drives, the required coverage is not what any serious person would go out and buy.
It's a complicated topic that is not advanced by shrieking "It's Socialism!" But now I'm preaching to the choir.
TYFCB
QCE,
I'm all over the place on different components of this debate. The one "article of faith" that I do not buy is that having a publicly run option means everyone will flock to that option.
In the RW, lots of peeps on Medicare A chose to hang onto their regular MM insurance, including the hospitalization component. The people who are drains on the system have already become drains. They are on medicaid or some other form of Federally subsidized med expense delivery.
So, if I close my eyes and try to imagine what things would be like with a P.O., I don't see a lot of difference. Something like 70M are already on a P.O. anyhow.
As I mentioned to Josephus above. The real bottom line debate is the method of rationing, not whether we ration. We already do that.
TYFCB
josephus:
You don't have to be wealthy to go to the Mayo Clinic. Just setting the record straight. What you see at Mayo's and in Cleveland is the free market system at work. It's all about choice.
mr. bushie, I didn't say you had to be wealthy to go to Mayo's, I simply said that wealthy Quincyans go there; yes, that is their choice and it is based on trust and that trust is derived from the assumed quality of care and that quality comes from NOT being a fee-for-service provider.
Choice in health care is a dicey business. Free market choice works fine if the playing field is perfectly level; in health care it rarely is. How much choice do we really have in Quincy? Between Blessing and QMG, I suppose. I don't have to be wealthy to go to Mayo's, just wealthy enough to get there. And if I can't get there, do I have choice?
I have a malady and want a second opinion. If I don't have the knowledge to intelligently judge the second opinion against the first, how much choice do I have. And if choice is operative, then I think everyone should have the choice of a public plan similar to the government-run single payer plan I enjoy now, along with ranked private insurers.
In other words, how about just giving everybody the same plan that all federal employees enjoy. Could it be that the reason polls show a majority of folks like their health plan is because about two-thirds of the country is under some sort of government-run, low-overhead plan: Medicare, Medicaid, VA or the federal employees plan? If you want choice, then let's have real choice here.
Yes there is rationing, but some systems actually cause MORE rationing. (eg. You mentioned profits that sometimes in turn make conditions obsolete.)
Government price controls will drive doctors and staff out of business and drive new students to other professions. That will increase rationing.
Medicare is going broke so is a bad reference, and only looks relatively good because more boomers are paying in than elderly taking out.
My experience in fairly direct dealings for a decade indicates institutions milk Medicare in several ways. Patients spend more time in the hospital or skilled care than necessary, but they don't care because it is "free". Rationing would/should send them home sooner.
I don't see "rationing" as the best way to frame the discussion. The method used (free market or government) will determine cost, quality AND quantity. I think all would be worse with the "government option". "Rationing" is more an outcome, than determinative.
Medicaid folks will still be on Medicaid, but the government option would in time replace private insurance ... even Obama stated (back in 2003), that was the intended goal.
Obama claimed the government option would be revenue neutral ... but "he lies".
He also claims there is waste he can squeeze out of Medicare and the system, but apparently he is unwilling to squeeze unless he gets his government plan. Why not do it now?
Less government, allow me to buy insurance from any state, tort reform (it does work) ... start with those.
Don't let the unions, insurance companies, drug makers, and trial lawyers write the bills for their benefit. Answers are there, but there is no political will to fight all those interests.
2012,
There is exactly the same amount of rationing no matter what the system. The metering device just changes; sophistication, time, wealth, age, health plan. The list is endless.
Not only is "Rationing" the best place to begin this discussion. It is the only place based on economic reality. You can branch out to other stuff later but "rationing" is like the ocean: whether you believe in it or not, once you step in it, it will get you wet.
TYFCB
As I recall, the debate over what services to cover is what sunk Hillarycare. By the time all of the special interests had hung their ornaments on the tree, it fell under its own weight.
Vaccines? Easy yes -- inexpensive, preventative, protect the whole herd.
Reconstructive surgery? Where's the line between that and cosmetic surgery? Or should cosmetic surgery be covered if a psychiatrist says it's necessary to mental health? Or should all cosmetic surgery?
You can draw the lines in so many directions, and someone will always advocate for more coverage. We haven't even begun to discuss this about the current plan, and yet promises are being made about cost.
Why in the world would rationing be a constant in any system? You seem to completely ignore free market efficiences, and historical government inefficiencies.
It's been found that requiring even small co-payments made a large reduction in "social doctor visits", and in visits that really didn't require care.
That is an efficient system adjustment that RESULTS in less rationing, because waste is removed.
The system that most efficiently uses the available resources will be the one that YIELDS the least rationing. And even the resources will be influenced by the system used.
If Obamacare restricts pay for doctors or health care workers, and/or unionizes the whole bunch, we may be faced with severe shortages of competent workers ... RESULTING IN more rationing.
Rationing is like water, but with a major gash, do you want to be thrown in the ocean with the sharks, or get a bath at the hospital?
Special interests will try to eat us alive in any case ... and that is the main obstacle to real solutions. (as I see it)
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