Charles Krauthammer points out that the inevitable end of Obama's plans on Medicare will lead straight to health care rationing.
The hard part is Medicare and Medicaid. In an aging population, how do you keep them from blowing up the budget? There is only one answer: rationing.
Why do you think the stimulus package pours $1.1 billion into medical "comparative effectiveness research"? It is the perfect setup for rationing. Once you establish what is "best practice" for expensive operations, medical tests and aggressive therapies, you've laid the premise for funding some and denying others.
It is estimated that a third to a half of one's lifetime health costs are consumed in the last six months of life. Accordingly, Britain's National Health Service can deny treatments it deems not cost-effective -- and if you're old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures like hip replacements.
Rationing is not quite as alien to America as we think. We already ration kidneys and hearts for transplant according to survivability criteria as well as by queuing. A nationalized health insurance system would ration everything from MRIs to intensive care by myriad similar criteria.
The more acute thinkers on the left can see rationing coming, provoking Slate blogger Mickey Kaus to warn of the political danger. "Isn't it an epic mistake to try to sell Democratic health care reform on this basis? Possible sales pitch: 'Our plan will deny you unnecessary treatments!' . . . Is that really why the middle class will sign on to a revolutionary multitrillion-dollar shift in spending -- so the government can decide their life or health 'is not worth the price'?"
Before we go down that road, there are other alternatives that should be debated. Krauthammer proposes one that would lower costs and not involve government rationing.
My own preference is for a highly competitive, privatized health insurance system with a government-subsidized transition to portability, breaking the absurd and ruinous link between health insurance and employment. But if you believe that health care is a public good to be guaranteed by the state, then a single-payer system is the next best alternative. Unfortunately, it is fiscally unsustainable without rationing.
People need to understand the end result of the Democrats' proposal. As Krauthammer points out, all we're hearing now is about all the good stuff that we'll gain from a single-payer plan. But the reason why politicians hesitate to delve deeply into health care reform is because the choices are not pleasant. And the only way to pay for it all will be by limiting what care people can receive.
8 comments:
When you are one of 47 million Americans who doesn't *have* health care, rationed health care is a great improvement.
What does "rationed" mean in this context? That doctors will no longer schedule triple by-pass surgery when you are weeks away from dying of cancer.
And if you have terrific health care today, great! Keep on in that system. The president and the Democratic party are not taking anything away from anyone - they are adding to the choices available.
Why are you against Americans with no health coverage getting some? What part of Obama's health care plan do you object to? Do you even know what the plan is?
Still cursing the darkness I see! Why don't you provide some information that might change some minds?
Congrats on the win.
The first target of Obama's rationing will almost certainly be seniors. Funny that he would start with a group that is rather unlikely to vote for him. I suspect that will become a pattern. You'll be able to predict what group will be next to lose medical care by looking at voting demographics. I was getting into the habit of calling him The Light of Chicago. It will no doubt have to change to The Butcher of Chicago
Ms. Newmark – I just came across your blog, and I think we could have some great discussions.
In response to your post, it seems to me health care is already rationed in the U.S. The Dems are proposing an alternative allocation based on different values. The current system rations health care inefficiently, strongly favors the wealthy, and discourages med students from pursuing degrees in general practice and family medicine. The proposed alternatives are founded in long-standing American values of equity and equality (with all the joys and horrors that entail.) We as a nation are the outlier; our fellow advanced liberal-democracies have chosen the alternative. When you stand alone among well-respected peers, isn't it best to start by asking whether you've made the right choice?
markldubois
If, as you say, "The proposed alternatives are founded in long-standing American values of equity and equality," then why at this late date are these values suddenly being applied to so large a sector of the economy? I would say that we have other values as well. Americans value independence and freedom of choice and freedom of action as well. And all of these things we value will be removed from medical care. You're trying to sell us a 15 year old Toyota and you're acting like it's a Rolls when it's so obviously a 15 year old Toyota. Games like that tend to make people distrustful.
You're right about med students being steered away general and family practice. It would be good if we could change that. But it is not necessary to institute a total government takeover of their whole industry to change that. Because of independence and freedom of choice Americans have developed the ability to make changes without always giving the government complete control over most of their lives.
If you put the federal government control over healthcare you will only be creating a Kafkaesque monster that will take your freedom and treat you with disrespect.
Thanks for your response, Chris.
The reason I raise "long-standing American values" is simply to point out that alternative health care allocations can also be grounded in traditional American values (i.e. those who favor our current system which emphasizes the value of capitalist-based individual liberty don't hold a monopoly on American values.) Opponents of the proposed reforms often raise the point that doing so would "socialize" health care, using the term as a scary, foreign-sounding threat. It seems to me that some sort of dual-track system of government involvement/management alongside individual or private health care makes the most sense in balancing our supposed national/moral values. I'm afraid I don't follow the "Rolls" or "games" metaphors. I don't really think my post is all that dramatic! I make no claim that the alternative is a Rolls - just that it has the potential to be more equitable, equal and efficient than what we have now. These benefits come along with costs to those who benefit from the current allocation mechanism (as I describe in my first post.)
As for removing "all of those things we value..." that's quite an exaggeration. Given that our European and Canadian peers seem to be more efficient in their health care provision in many dimensions and have generally high levels of wellness, I can't imagine we'd be losing too much of value...The alternative comes with costs to certain beneficiaries of the status quo, no question about it. You make an interesting use of the term "value" by suggesting my prior post was all about monopolizing values (my reference to long-standing American values) and then suggesting that the alternative would cause us to lose all that we value - somewhat ironic.
Last, as for the "kafkaesque monster..." it just doesn't ring true with me. There are of course dangers with allowing the government to take too much control. Again, I fall back on my comparison with Canada and Europe. These places aren't really all that bad. Our fellow Westerners would probably suggest that rather than looking at exaggerated claims of future monsters, we should perhaps focus on the real problems that currently beset our system (tens of millions of uninsured, lack of efficient primary care, insurance companies with warped incentives, etc.)
I have posted this link before, but for anyone that thinks the Canadian system would be an improvement over the U.S., I suggest this 2005 Canadian Supreme Court Opinion.
The Court found that the system is so poor that people are dying from lack of treatment while on waiting lists and that waiting lists are “a more or less implicit form of rationing .... Waiting lists are therefore real and intentional.”
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
I balk whenever I hear someone claim a government run system would be more efficient. I would also suggest to our new friend markl that government interventions are very often the source of market distortions and high costs. Employee based insurance is one example.
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