Why We Must Ration Health Care

http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?ref=magazine&pagewanted=all

by robg • 17 years ago

15 30 17 years ago

jpwagner2• 17 years ago

...Why we must reform the current system without involving the federal government.

jrockway• 17 years ago

We've already seen how that works; the money is given to the shareholders of insurance companies rather than to the policyholders in need of medical care.

The government does not need to make a profit on healthcare, which is why people are turning to them. (Plus, we've seen this system work in other countries. The US will not be the first country to give everyone healthcare; it will be one of the last.)

gojomo3• 17 years ago

Depends on how you define 'work'. Nationalized healthcare where tried has delivered better results in some dimensions, worse in others. Those countries often rely on medicines and procedures pioneered in the USA's more open medical markets; if we give up that role, who will pick up the slack?

windsurfer• 17 years ago

Flagged for registration wall... even thought it's the nytimes. If someone wanted to write a synopsis and write a commentary about this article, that would be swell.

ryne• 17 years ago

http://www.bugmenot.com/view/nytimes.com

mynameishere2• 17 years ago

If we're going to be making up numbers like "How much is a human life worth?" perhaps we should first make up some less dangerous numbers like, "How much is a tiny little pill worth?" It isn't the free market that came up with "54,000" dollars--and if the government is gracing a company with patent enforcement (really, a price floor), it may as well grace it with a price ceiling as well.

potatolicious• 17 years ago

I commented on this on another forum as well. I'm a Canadian living in the USA, and the health care costs here are astounding.

As far as I am aware, we do not ration health care in Canada - if it is available and justified, we use it. Why? Because unlike the United States, the Canadian government doesn't pay $54,000 for a few pills. Yes, it's true, our public health system pays far less (sometimes over 70% less) for the exact same drugs from the exact same drug companies.

The problem here is that there is no bargaining power in private health care. The providers don't really care how much they pay for drugs, because any cost is simply passed onto you, the consumer. As consumers you have very little recourse except to take it. A large, centralized health care system has the bargaining power and the incentive to push drug companies for lower and lower rates.

Having now seen how much Americans pay for health care, and how little they get for their money, I have a hard time imagining why people continue to support private health care at all.

mynameishere2• 17 years ago

how little they get for their money

I fear that one of the things we get is to subsidize the world with respect to drug innovation. Pfizer, et al, put up the money to develop drugs knowing that they can gouge unwilling customers in the USA (all health care buyers are unwilling--that's why health care isn't a free market).

If the US starts putting ceilings in, the one big side-effect may be a reduction in research.

gojomo3• 17 years ago

As far as I am aware, we do not ration health care in Canada

A waiting list is rationing; a limited list of approved drugs/procedures is rationing; a ban on private insurance is rationing.

There are many accounts of Canadians seeking denied or long-waitlisted procedures elsewhere, usually the USA. Some examples are listed here with regard to court cases about provincial bans on private programs:

http://www.canadianmedicinenews.com/2008/01/is-universal-hea...

If the USA adopts the same national controls, an important safety valve for Canadians will disappear (and US citizens may find themselves medical tourists elsewhere).

Results for some diseases are worse in Canada, perhaps due to limited therapies and longer waits. Here's Dick Morris plugging his new book with some figures:

http://www.dickmorris.com/blog/2009/07/09/obama-will-repeal-...

In our new book, Catastrophe, we explain - in detail and in depth - the consequences the elderly of Canada are feeling from just this kind of program. Limited colonoscopies have led to a 25% higher rate of colon cancer and a ban on the use of the two best chemotherapies are part of the reason why 42% of Canadians with colon cancer die while 31% of Americans, who have access to these two medications, survive the disease.

Overall, the death rate from cancer in Canada is 16% higher than in the United States and the heart disease mortality rate is 6% above ours’.

It's Dick Morris, so I'm sure he's spinning and shilling, but there are tradeoffs inherent to single-payer cost-controls -- some people get worse care.

rdouble2• 17 years ago

As far as I am aware, we do not ration health care in Canada

I was feeling weird about a year ago, visited my doctor, and requested a metabolic panel and some blood sugar tests. A few weeks later, and about $10 out of pocket, I had my test results. (I paid about $200/m for health insurance at the time)

My Canadian friends tell me this isn't possible in Canada. The doctor simply won't order the tests for you because tests are expensive.

I'm curious as to whether this is widespread. If so, the Canadian health care system seems like the opposite of the American health care system. In the USA drugs are expensive but your insurance will pay for any sort of test. Indeed, doctors will over test you, or comply with any patient test request because insurance will readily reimburse them.

From what I know about Canadian health care, drugs are cheap, but doctors are discouraged from doing tests due to the cost. I'm curious as to whether this is an accurate assessment of the Canadian system...

jpwagner2• 17 years ago

Calling the current US system "private healthcare" without thinking of the idealized private healthcare is a fallacy.

Let's suppose drugs and medical procedures were not subsidized by any body. (Completely impractical (not a recommendation) but useful for this thought experiment.) What do you think would happen to the price of these drugs and medical procedures. People would pay for them if they valued them at their price.

In having people pool together money in an insurance body (of which there are currently many) you allow shared responsibility so that a disaster (theoretically) does not financially destroy someone. So now drug companies et al are indeed negotiating with insurance companies. Insurance companies have huge margins (nature of the business) and end up paying prices based on the value after margin. Because of this padding, prices go up.

Now imagine instead of a bunch of insurance companies you have one. This is public healthcare. Prices will be very high, but it won't look like that to the consumer because it is a public cost.

Furthermore the "ask Canada" argument from the privatize-it side points out the reduced wait-times and increased specialized innovation that occurs in America.

No one's arguing that the way it is now is perfect, but a public system in America is a scary thought.

sh1mmer5• 17 years ago

The author does point out in the article that those pills cost less in Britain (for example) because the market is based around the "cost-effectiveness" of treatments. As such many treatments are cheaper in order to come in under the limit set by government advisory agencies.

_cbsz• 17 years ago

I was a bit surprised that the article took so long to mention that everyone dies eventually. Lots of the rhetoric around this issue (e.g., "saving lives", "sentencing him to death") ignores that everyone is born with a death sentence.

(Sorry if this post makes you get all existential for a while. Seriously.)

sh1mmer5• 17 years ago

This is a really interesting article.

The author(1) looks at the reasoning behind healthcare rationing and suggests that it isn't as bad as it appears. Essentially he suggests that it's easy to find media-friendly stories of how rationing healthcare screws some hardworking soul, but that doesn't mean it isn't a good idea.

He look at how we already put a cost on life by limiting the budgets for things like consumer product safety standards, and the amount spent by transport agencies on safety. He argues there is an objective measure that economists have been using for years (quality-adjusted life-year, or QALY) to assess the cost-effectiveness of treatment and that the US government could use this for effective healthcare reform.

He goes on to point out that while it's easy to point out the places in universal health-care systems where people are excluded from treatment because the system tells them it isn't available, it's much hard to find when people self-deny treatment for fiscal reasons. He cites the case of a woman in the U.S. without health insurance who didn't take her blood pressure medication because she bought food for her family. As a results she died in the ER with a brain hemorrhage.

He also compares the system in the U.S. to those of the UK, Canada and Australia, and suggests that health-care reform in the U.S. would not have to be modeled on those systems but could even be modernized to a system that suited the American temperament better. The Australian system, for example, provides universal healthcare, but also allows citizens to buy into private healthcare schemes which do not restrict treatments.

This is just a poor summary and an extremely interesting article.

(1) Peter Singer is professor of bioethics at Princeton University. He is also laureate professor at the University of Melbourne, in Australia. His most recent book is “The Life You Can Save: Acting Now to End World Poverty.”

sh1mmer5• 17 years ago

I found this article really interesting but the author didn't talk about promoting wellness which seems to be a very taboo topic in the U.S.

I'm vegan (which reduces heart disease and cancer risks), I don't smoke and I exercise moderately. However the pool of risk into which I am assigned also includes people that eat large amounts of cholesterol, smoke and don't exercise at all.

In this article the author explores the topic of ranking treatments by their effectiveness in terms of QALYs, but a large amount of chronic and acute illnesses can be avoided by improved diet and exercise. As such any system of reform should look at a large piece of education and social change to encourage this.

jswinghammer• 17 years ago

It's true that you are right now subsidizing others health care and someone else will subsidize you when you're sick from something you didn't expect to get.

sh1mmer5• 17 years ago

It's not about me subsidizing others, I understand how insurance works it's about disproportionate risk. There isn't an emphasis on creating change in society to encourage people to live lifestyles that needlessly expose them to risk, and burden our health system.

It's unacceptable to not give people treatment for acute problems. However no-one is talking about how a lot of those acute problems are made much more likely by some lifestyles than others.

If you buy car insurance you pay more or less based on your risk factors such as age, experience, points on your license, etc. If people choose to increase their risk for health issues than it seems unreasonable that the rest of us should have to pay for their lifestyle choices.

It also seems like any healthcare reform should attempt to encourage people to reduce unnecessary burden on the system. That might make it more possible to increase the amount available to spend treatments for people with terminal illness, because less our of GDP would be spent on treating unnecessary chronic or acute illnesses.

tc2• 17 years ago

I don't want to start a deep thread on this, but I do want to point out that one of the advantages of a free market is that you only have to make these choices for yourself, not for others.

You can select an insurance policy with rationing and a $10M lifetime benefit, and I can select an insurance policy without rationing but with a flat $1M lifetime benefit. The system we have now is not free because governments dictate what kind of policies medical insurers can offer, preventing consumers from making many of these types of choices.

When we decide that one size fits all, then the only choice is to have politicians and bureaucrats making these decisions for everyone.

When you make a decision about what your life is worth, that seems morally sane. When someone else makes a decision about how much your life is worth, that seems morally objectionable. Only free markets allow us to mostly avoid the latter choice.

Raphael• 17 years ago

If the national health plan is inadequate for the rich, a private system will continue to cater to them. The point of the national plan is to raise the floor.

tc2• 17 years ago

Socializing healthcare drives up costs for everyone, pushing higher quality alternatives out of range for more people. Providers no longer compete on price, and consumers no longer factor price when selecting providers or moderating their use of resources. Combined, these factors will make (and already have been making) private alternatives unrealistic for all but the most wealthy, whereas prior to the government takeover of healthcare, high-quality private care was well within reach for (at least) the lower-middle class.

Why We Must Ration Health Care

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