Doctors Say Health Care Rationing Already Exists
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All Things Considered, July 1, 2009
http://www.npr.org/templates/story/story.php?storyId=106168331
In the debate over how to fix the nation's health care system, one of the big worries is rationing.
"I don't think many Americans want to start having to wait in line [or] start getting government permission for procedures," Senate Republican Leader Mitch McConnell said last month on CBS's Face the Nation.
Americans might be justifiably nervous about losing control of their health care decisions, especially if they think government bureaucrats will be in charge. But some doctors and economists argue that, in effect, the U.S. health care system is already rationing, in the most unproductive ways.
"In America, we strictly ration health care. We've done it for years," says Dr. Arthur Kellermann, professor of emergency medicine and associate dean for health policy at Emory University School of Medicine. "But in contrast to other wealthy countries, we don't ration medical care on the basis of need or anticipated benefit. In this country, we mainly ration on the ability to pay. And that is especially evident when you examine the plight of the uninsured in the United States."
Groceries Or Medicine?
Kellermann still remembers the young mother of two who came into his emergency room more than 15 years ago, suffering from a hemorrhagic stroke.
"We worked for 90 minutes to save her life, but basically she had burst a blood vessel in her head. She didn't have a chance," he says. "She had no health insurance, and when the money got tight, she had to make a choice — she could either buy the groceries for her kids, or she was going to buy the three blood pressure medicines she had to take every day."
Sadly, Kellermann says, for less than the cost of that futile, 90-minute effort in the ER, the woman could have had all the blood pressure medication she needed for the rest of her life. It was not a government bureaucrat who decided she should forgo treatment until it was too late — it was her own lack of health insurance that led her to make that choice.
A few years ago, Kellermann served as co-chairman for an Institute of Medicine committee that looked at the kind of care people get when they don't have health insurance. On average, he found, the uninsured get only about half the care that people with insurance do, and they tend to wait longer and get sicker before seeing a doctor.
"The cost of staying home and feeling a lump grow in your breast, to feel a squeezing sensation become more and more evident with shorter and shorter walks every day, hoping beyond hope that it will go away — that's an incredibly expensive choice to make when, had you been able to get the care you needed early, it could have been quickly and easily and simply taken care of," he says.
It's not only the uninsured who are affected. Americans who do have health insurance tend to get a lot of procedures after they're sick — not because bureaucrats dictate that, but because that's what insurance and Medicare pay for.
Five-Minute Visits
"We do lots of joint replacements, back surgery, cardiovascular procedures, imaging procedures, and we do lots of those because they're well remunerated," says Dr. Elliott Fisher, director for population health and policy at Dartmouth's Institute for Health Policy and Clinical Practice.
Fisher says those high-cost services are not necessarily the best way to improve people's health. And as the cost of providing those services rises, insurance companies often cut the very primary care that could keep people healthier.
"I think there's a very real sense that we are rationing payments to primary care, and what that leads to is poor care. It leads to five-minute visits that many patients are experiencing," Fisher says. "Many primary-care physicians feel like hamsters running on a wheel. And they have to run harder each time Medicare or the private payers cut their fees."
Wider Rationing
Rationing is not limited to the health care industry. No other country devotes as much of its economy to health care as the United States. While Americans might not think of that as a choice, it means they have less to spend on everything else. Government payments for health care come at the expense of schools, roads and other services. The extra money that employers have to pay for rising health insurance premiums is money they cannot put into workers' paychecks.
"No worker gets to say, 'You know what, make my premium $1,000 lower by getting me a more efficient health insurance package, and at the same time, give me $1,000 more in take-home pay,' " says Harvard economist Katherine Baicker, who has studied the impact of rising health care costs on employee compensation.
So while there is no government rationing board handing out coupon books for heart surgeries, more and more of the nation's resources are being gobbled up by health care, often with little choice for individuals, and often in ways that no sensible person would choose.
http://www.npr.org/templates/story/story.php?storyId=106168331
In the debate over how to fix the nation's health care system, one of the big worries is rationing.
"I don't think many Americans want to start having to wait in line [or] start getting government permission for procedures," Senate Republican Leader Mitch McConnell said last month on CBS's Face the Nation.
Americans might be justifiably nervous about losing control of their health care decisions, especially if they think government bureaucrats will be in charge. But some doctors and economists argue that, in effect, the U.S. health care system is already rationing, in the most unproductive ways.
"In America, we strictly ration health care. We've done it for years," says Dr. Arthur Kellermann, professor of emergency medicine and associate dean for health policy at Emory University School of Medicine. "But in contrast to other wealthy countries, we don't ration medical care on the basis of need or anticipated benefit. In this country, we mainly ration on the ability to pay. And that is especially evident when you examine the plight of the uninsured in the United States."
Groceries Or Medicine?
Kellermann still remembers the young mother of two who came into his emergency room more than 15 years ago, suffering from a hemorrhagic stroke.
"We worked for 90 minutes to save her life, but basically she had burst a blood vessel in her head. She didn't have a chance," he says. "She had no health insurance, and when the money got tight, she had to make a choice — she could either buy the groceries for her kids, or she was going to buy the three blood pressure medicines she had to take every day."
Sadly, Kellermann says, for less than the cost of that futile, 90-minute effort in the ER, the woman could have had all the blood pressure medication she needed for the rest of her life. It was not a government bureaucrat who decided she should forgo treatment until it was too late — it was her own lack of health insurance that led her to make that choice.
A few years ago, Kellermann served as co-chairman for an Institute of Medicine committee that looked at the kind of care people get when they don't have health insurance. On average, he found, the uninsured get only about half the care that people with insurance do, and they tend to wait longer and get sicker before seeing a doctor.
"The cost of staying home and feeling a lump grow in your breast, to feel a squeezing sensation become more and more evident with shorter and shorter walks every day, hoping beyond hope that it will go away — that's an incredibly expensive choice to make when, had you been able to get the care you needed early, it could have been quickly and easily and simply taken care of," he says.
It's not only the uninsured who are affected. Americans who do have health insurance tend to get a lot of procedures after they're sick — not because bureaucrats dictate that, but because that's what insurance and Medicare pay for.
Five-Minute Visits
"We do lots of joint replacements, back surgery, cardiovascular procedures, imaging procedures, and we do lots of those because they're well remunerated," says Dr. Elliott Fisher, director for population health and policy at Dartmouth's Institute for Health Policy and Clinical Practice.
Fisher says those high-cost services are not necessarily the best way to improve people's health. And as the cost of providing those services rises, insurance companies often cut the very primary care that could keep people healthier.
"I think there's a very real sense that we are rationing payments to primary care, and what that leads to is poor care. It leads to five-minute visits that many patients are experiencing," Fisher says. "Many primary-care physicians feel like hamsters running on a wheel. And they have to run harder each time Medicare or the private payers cut their fees."
Wider Rationing
Rationing is not limited to the health care industry. No other country devotes as much of its economy to health care as the United States. While Americans might not think of that as a choice, it means they have less to spend on everything else. Government payments for health care come at the expense of schools, roads and other services. The extra money that employers have to pay for rising health insurance premiums is money they cannot put into workers' paychecks.
"No worker gets to say, 'You know what, make my premium $1,000 lower by getting me a more efficient health insurance package, and at the same time, give me $1,000 more in take-home pay,' " says Harvard economist Katherine Baicker, who has studied the impact of rising health care costs on employee compensation.
So while there is no government rationing board handing out coupon books for heart surgeries, more and more of the nation's resources are being gobbled up by health care, often with little choice for individuals, and often in ways that no sensible person would choose.
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of course, there are those who believe that well...at least we have *choice* still in the equation. :? sure as shit doesn't seem that way to me.
and yes, it has been said time and again that PREVENATIVE CARE is the cheapest, most affordable care and more than likely, the BESt long-term care...b/c we can prevent/forestall many diseases, and therefore many costly procedures....sure sounds win-win, if only it was put into practice fr more often.
Let's just breathe...
I am myself like you somehow
yea...we've got it all!
Let's just breathe...
I am myself like you somehow
I love how everyone in the other healthcare threads has ignored this thread, don't you? How convenient. :roll:
The other talking point the health care lobby throws out is the scare tactic that "you won't be able to choose your doctor"....which is laughable...
in the USA the health insurance companies dictate who you can see....if they aren't in your "network" you have to switch doctors
Just like the article posted here...virtually all the scare tactics that the lobbyists use against univ care we already experience....but again the general public has the wool pulled over its eyes
the reason more people are coming around to UHC now is because more people are out of work and they are experiencing the true health care system that you don't really see when your employer is paying your premiums for you
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So, all the cries of, "We'll have rationing!" mean nothing to me. In fact, they are on the pretty funny side. We will? Oh, Jeez. Like that will be different than what we have now at astronomical prices.
And, you already can't choose your doctor. Heard of a good doctor? Have you tried to get in with that doctor? You can call on the first of the month for years, and you'll still never get in with that doctor. If you're lucky, you can get in with a partner in that practice, a doctor you will never have heard of. This doctor might be good--great even--but, you really can't choose whatever doctor you want right now.
about as 'convenient' as ignoring some questions/ideas in the whole abortion thread. and hey, i get it. when you don't have an answer, isn't is easier to just ignore it rather than admit....yea....i don't know?
but sure, it does make 'discussion' of certain topics frustrating...b/c you go round and round the same points, and when you try to step it up to another level of discussion, it just dies off. eh well...
no worries scb...some of us are still paying attention.....;)
tho definitely for something so important, to us all, it would be good to acknowledge that all is not peachy, even for those currently WITH insurance...and hell yea, "quality of care" isn't where it should be under the watch of private, for profit healthcare industry....so yea.....some NEW ideas?
anyhoo......just my check-in for hopes of philly 10.31 :P...not there.....one more day of weekend left...so goodnight and enjoy!
Let's just breathe...
I am myself like you somehow
just b/c it deserves the attention.....
Let's just breathe...
I am myself like you somehow
I think the staunch defenders of the glories of for-profit health care are pretending they don't see this one.
be careful, you're starting to sound like someone we know
I've never been so insulted in all my life. How could you jlew?
R.i.p. My Dad - May 28, 2007
R.i.p. Black Tail (cat) - Sept. 20, 2008
i'm well aware.
thus why i keep giving it a good ole bump.
same thing with the whole industry insider thread...chock-full of illuminating info, dismissed....and so it goes. and hey, it's not just healthcare....i see it happen for a few topics. 'i'll get back to this' becomes.....a thread on page 5.
but you bet....i will bring it up, even if ignored....b/c the proponents of choice and quality of care....may not see it, but i know it's here....
it's really "easy" to say we have so much choice and quality of care...when you don't have to back it up. it's "easy" to say oh, just get another healthcare carrier if you're dissatisfied! duh - why didn't anyone else think of that? :? yea...the real point is, for the VAST majority of americans WITH health insurance, they don't have 'choice.' you get what you can get, if you can get it, thru employer sponsored insurance. not much choice there. and yes, i know...i can 'choose' where i get a job too. i want to know who it is do damn 'easy' for to simply walk away from a good job, score an equally good job.....get so much 'choice' in your insurance. right. not many.
private insurance will never go completely away, even with UHC. even in the UK, scandinavia, etc...private insurance does still exist for those who still want that option. just like we still have private education if you opt for it. point is, UHC would guarantee health coverage for ALL...for LIFE.....and that to me is worth any other loss of 'choice' one can imagine in the scenario.
but hey...i realize not all agree with me. ok too. hopefully, it'll still happen someday...b/c enough people will realize, it is worth it. we pay the highest costs for healthcare...and yet....not all our citizens benefit. we all are a layoff away from having no insurance. and yea, all we need, even while insured, is one catastrophic illness....and how many people file for bankrupcy each year over health issues? excellent choice and quality of care there.
Let's just breathe...
I am myself like you somehow
As for old people, I suppose their draw is health care for those of them that doesnt have much of it. Waiting for treatment is a lot better than not having any.
A question that we should face at some point, however, is for how long life-extending treatment should be given when people are on their last stretch anyway. (I'm not talking seriously ill here, but the ones that really, hopelessly are on the brink dying) The final tardily and often painfully extended months is what is breaking health budgets now, and will do even more so in the future with more and older people. When do we just let them go, when they're heading there regardless? That's a question of resources and morality, and it doesnt restrict to universal or private health care. Rather, since we have the opportunity to extend just about everyone's life at tremendous cost, should we always do so. And break the bank in the process by binding up a lot of resources in the process?
I know that for me, I'd rather just be let go when the end was inevitable.
Peace
Dan
"Every judgment teeters on the brink of error. To claim absolute knowledge is to become monstrous. Knowledge is an unending adventure at the edge of uncertainty." - Frank Herbert, Dune, 1965