Who Do You Want To Ration Your Health Care?

The label on your bottle of today’s bitter medicine reads: “Health Care Rationing.”

Before the 20th century, health care was cheap. Very little could be done for a sick person. Starting around the Second World War, a cornucopia of medical and surgical treatments became available, all expensive. Now we have $50 pills; coronary artery stents; artificial parts like ceramic hips; replacement parts such as liver transplants; and soon stem cell even gene therapy.

Partly because of medical advances but primarily due better public health and nutrition, more of us are living longer meaning there are more old people. Health care for old people is very expensive.

People often behave against their own best health interest. They smoke cigarettes. They do not exercise. They eat to obesity with all of its complications. They fail to get regular check-ups. When ill, they delay seeking medical care so when they do, the illness is much worse and more expensive.

These are only three of the nine reasons for out-of-control healthcare costs.

Demands for health care services are increasing for reasons noted above. Supply of health care services is contracting, especially its personnel. With rising demand, decreasing supply and under our present system, supply cannot balance demand. Something or someone must create balance. That is called rationing.

Rationing means control by someone other than you of distribution to you of goods and/or services. Rationing is a very negatively charged word because it has been associated with periods of extreme scarcity: the Great Depression and two World Wars. The word itself comes from Latin “ratio” meaning to think or to reason. Strictly speaking, rationing is a process to create a “reasonable” balance between supply and demand.

If anyone other than you controls the balance of your demands with the available supplies, whatever euphemism they call it, that is rationing. In the USA, payers – insurance companies and the Federal government – delay or deny payments and pay according to predetermined schedules. By controlling payment, they control [ration] the delivery of goods and services.

What about countries with so-called universal health care? In Canada and Australia, the government determines what services it will pay for and how much. If what you want or need is not on the list, you do not get that ration. In Great Britain, the National Health Service “rations” by queueing: yes, you can get a hip replacement or dialysis…but you go on a waiting list and might wait years before your name comes up. If you die before that time with neither hip replacement nor dialysis, there is no expense.

SOMEONE will ration your health care. Call that someone the system, the government, the insurance company, the evil empire, or…could we create a system where WE ration our own health care? The answer is yes and that is what we need.

Healthcare is and will be rationed. Who do you want to do it?

System MD

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#1 “MediCare-for-All” –> No-Care-at-All. — Medical Malprocess on 09.26.09 at 3:30 pm

[...] tries to contain its costs in two ways: neither works and neither is what patients want. First, it rations care. Yes, I said it. Many of the things your doctor would like for you are denied as not “cost [...]

#2 July 4th Gift: Freedom from Newspeak, Scotoma, & Rose-Colored Glasses — Medical Malprocess on 09.28.09 at 4:24 am

[...] will do what all other countries with so-called universal health care do to control their expenses: they ration health care.  you like what you now hear using real words (oldspeak) and what you now see putting aside [...]

#3 A politically incorrect inconvenient truth you will never hear from a politician. — Medical Malprocess on 10.05.09 at 3:50 am

[...] “rationer” of your health care can either be the government or you. In every country with universal health care, the government [...]

#4 Anaxoras on 04.19.10 at 9:13 pm

This is stupid. It makes it sound like when the government doesn’t run healthcare “you” get to ration it. Do any of you really think you have that much influence to change anything? That your dollars and cents are really going to get the insurance companies to increase the number of people covered?

Lets be real here, in private health care “you” don’t decide anything, only the insurance company owners get to decide things. At least with government the goal is not profit, it’s coverage. When people aren’t covered by private health care they die and the media doesn’t say a word, when people die because government health care wouldn’t get there in time it’s a scandal for whoever’s in charge. The government would have a very real incentive to be extra careful that people with medical emergencies, people about to die or lose limbs if action isn’t taken immediately get help immediately.

There are major problems with government. Just like insurance conglomerates nobody there really cares about you, just their careers. Politicians and Bureaucrats often reward cronies and spend money on special interests. But at least there is some control with the ballot.

It would be better if neither government or corporations controlled health care and doctors and medical staff ran things themselves. At that personably of a level you’re not going to be able to look someone in the eye who will die without care and say “no”. But in the current system the doctor doesn’t get to choose, the company people, people who don’t even see the patient get to choose.

#5 deanewaldman on 04.27.10 at 3:37 pm

This is not “stupid.” This is reality. (Well maybe reality IS stupid in healthcare.)

As you suggest, under the current U.S. system (and all other ‘universal health care’ systems) the individual does NOT make rationing decisions in health care: either the government does or the insurance company does under government scrutiny. Both do it badly. Both have totally different agendas than our long term life and health. In essence, THAT is the problem in our health care system.

Interestingly, right this minute I am finishing an article titled, “Who will ration my health care?”

Government officials make decision solely (unfortunately I do mean solely) on the basis of their re-election strategy. They say things they know are untrue, like HR 3590 will save money or my personal ‘favorite, “I’m from the government and I am here to help.” Regulators, monitors and managers practice defensive bureaucracy even more than doctors practice defensive medicine.

You are right, in theory, that we have some control through the use of the ballot. Yet if that is true, why are Nancy Pelosi, Harry Reid, Ben Nelson, Marianne Landrieu still in office and exercising power despite the fact that have overtly “sold” their votes. Why is the re-election rate in Congress over 96% for incumbents? In theory, we also have control over insurance companies by taking our dollars to a different one. In practice, our will seems to have no impact on either Gov or insurance because that is the way they have set up the game rules.

As long as you and others say, we cannot fix what is really wrong so let’s tweak what we have to try to make it better, they have got us. WE NEED TO CHANGE THE GAME. WE NEED TO CREATE A NEW SYSTEM, WITH RULES THAT PROTECT US NOT THEIR JOBS. If you assume that we cannot fix healthcare, then you have a self-fulfilling prophecy.

I will not give up, ever. We cannot make the current system work (for us). We need a new one. Go to http://www.uproothealthcare.com, read the book, and get involved in fixing healthcare. As a colleague once quipped, “In death, there is hope.” The death we need is our current system, The hope is for a new one that works.

#6 Donald Poland on 11.19.10 at 5:56 pm

Although “average premium prices [for Medicare prescription drug plans] have increased for the last five years and are predicted to jump again in 2011, only 7 percent of the 27 million enrollees switch plans each year. It’s not hard to guess why. The process, research and shopping can feel like a complicated maze for seniors and family members who try to help. … An analysis by the nonprofit Kaiser Family Foundation predicts the average plan premium will increase by 10 percent this coming year, to $40.72, if beneficiaries stay with their choice

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