Conservatives and health care rationing

Great Debates
1

The prospect of brutal rationing being included in Democratic proposals for health care reform has become a major bugaboo on the right. Some recent developments on the broader health care front, such as a recent change in recommendations for breast cancer screening, have led some to warn that rationing is already upon us.

First of all, I would like to know where current health care bills call for rationing or which Democratic politicians are supporting it and what the details are.

But more basically the question is, isn’t rationing conservative? Isn’t the problem with socialism that increasing and unsustainable costs would be imposed by a system that is overly-generous?

If costs are to be kept under control in a system designed for people who by all rights shouldn’t be getting any help from taxpayers at all, then shouldn’t priorities be set according to how serious a particular health care problem is?

Otherwise, what?

2

If I take your question to mean, “Shouldn’t there be a system for apportioning health care resources instead of just handing things out willy-nilly?”, the answer is…

Um… yes. Glad we got that straightened out.

So I’ll throw the ball back to you - how would YOU suggest it be done? As it stands now, a number of entities have a say in the apportioning of resources. Insurance companies are a big player, and some feel they wield this power inappropriately at times. The reforms currently under debate may transfer some of the decision making to other entities. I personally think that might be a good thing.

But SOMEONE is going to make decisions about how resources are directed because there isn’t an inexhaustible supply. You can call that rationing if you like. You can even call it the function of death panels. I won’t take you seriously if you do, but you can if you’d like.

3

Perhaps the OP could give a cite as to this rationing? The mammogram controversy has nothing to do with rationing - it is just an attempt to do the most effective tests, agree or disagree. Is evidence based medicine rationing? Would refusing to pay for a primitive healer shake bones over a patient get anyone annoyed?

A few years ago conservatives were ranting and raving about how a UHC plan or anything close to it would break the bank by giving everyone all the treatments they want. Now they are ranting and raving about not doing so. Quite odd, really.

4

Of course not. But I gathered it was a talking point on the right that this was the onset of rationing.

5

Don’t we already have health care rationing? Many people do not receive treatments or medication they need because their insurance companies do not cover them or they have exceeded their benefits quota.

6

Disagree. It’s an attempt to save money by cutting back on mammograms.

Not really. The idea is that the government will give everyone all the treatments they want – until it starts to run out of money. It is then that rationing and what has been referred to as “death panels” (or what certain of our liberal brethren will undoubtedly refer to as ‘just an attempt to allocate government funds more effectively’) will likely come into existence.

7

So you disagree with assertions that “rationing” already exists with the current system?

8

Medicare covers everyone over 65 and is government run. And since the majority of people who die in this country are over 65, they have been dying in a public plan for over 40 years. So far no death panels. I don’t see why that would change.

There are death panels in private industry though. There are many examples of private, for profit health insurance companies depriving needed care from people on technicalities. Either they refuse to cover people due to pre-existing conditions, or they deny coverage for a medical event, or they rescind policies after someone gets sick.

So the concept of ‘death panels’ doesn’t really scare me. We know that private health care has death panels, and we know most people who die have died in a public medicare plan w/o death panels.

9

Yes, I do. There is certainly evidence that coverage is being withheld sometimes by insurance companies, and certainly people who can’t afford coverage aren’t getting it, but neither of those is ‘rationing’ by any commonly understood meaning of the word. Rationing takes place when resources are limited and the entity doing the rationing decides that beneficiaries are only entitled to a certain amount of what’s being rationed in an attempt to allocate those resources equitably or sparingly. And that is what the government UHC will have to do once it reaches the point that demand for health care exceeds its ability to pay for it.

It’s usually the case at this point in the discussion that Canada and Europe are brought up as evidence that this will not happen, but those countries haven’t been at government health care all that long themselves; nor do most of them have cradle-to-grave, 100% government-paid healthcare (which, let’s face it, is what most UHC proponents here in the U.S. want). And every one of them I’m aware of have lengthy wait times, which is a form of rationing in itself.

There’s no comparison. Medicare covers a relatively small percentage of the population that is in the latter stage of life (i.e., people who only need coverage for a decade or so, if that). It’s a horse of a completely different color entirely than a program that would seek to cover the entire population from cradle to grave.

And Medicare as it is now is no great shakes itself. A great many excellent doctors won’t accept Medicare patients because of low fees, bureaucratic red tape, and restrictions on the tests and care they’re allowed to order or provide. Plus much of it still has to be paid for by its beneficiaries, most of whom are on Social Security and barely making it already and who still have to pay $100 or so out of their roughly $900 or so monthly income just to have coverage. And then there are still deductibles and copays and so forth. The only thing good about Medicare is that it’s better than nothing.

And now a personal anecdote that illustrates perfectly one of my greatest fears when it comes to having the government in charge of people’s health care, which is that the individual patient has no control at all over what care he gets or when he gets it. Last year my former brother in law fell and badly injured one of his hip joints. He is in a lot of pain and has to swing his leg in a very exaggerated way when he walks in order to be able to move at all. He has a lot of trouble sitting, as well.

He was unemployed at the time and had no insurance, and thus he qualified for hip replacement to be paid for by the state I live in. When he was told last spring that he qualified for hip replacement surgery he was told that he was #59 on the list for that surgery. He called a couple of weeks ago and was told that he is now #159 on the list for hip replacement surgery. He asked what was the deal; he had been told all summer that he was #58 and now all of a sudden over the course of one month he was now at #159. The person he talked to said something along the line of “Well, all I can tell you is that now you’re number 159”, and of course he has no recourse but to suffer and wait until whenever he finally able to get his surgery.

Now, it’s true that he’s still better off than if he’d had no way of getting treatment at all, but it’s also true – if the experiences of my family members and acquaintances are to be believed – that if he’d been employed and covered by insurance he would have had his surgery months ago and probably within days or weeks after he’d injured himself.

So yeah, I don’t want to live in a country where everyone has to go begging hat in hand to the government for treatment to ease their pain and suffering, and being told, in effect, “Tough shit, you’ll get it whenever we get around to it, and we have no way of knowing when we’ll get around to it”.

Most of the people in this country have perfectly good coverage, and to the extent that insurance companies are operating fraudulently or dishonestly, laws should be passed that crack down on them and put a stop to it. And some dispensation needs to be made for people who have no coverage but are in dire need of care. But bringing everyone under the umbrella of an uncaring and chronically underfunded government bureaucracy to provide for their health care will result in the vast majority of its citizens receiving care that is nothing less than atrocious compared to what they have now.

10

That is an overly narrow definition of rationing that I reject. Rationing occurs by private insurance companies to decrease benefits paid and to increase profits. I would rather be the victim of neglect than avarice.

No bill under consideration now would bring everyone under such a government bureaucracy.

11

Everything (other than freee goods) is rationed. The first thing I told students when I taught economics was that the price mechanism is a form of rationing. It’s actually a very efficient form of rationing that works very well in the majority of situations. Just at times it produces results we don’t like, so we supplement it with another form of rationing. Such cases include times of great shortages (like meat and butter in the UK during the last war, where price rationing only would lead to all for some and none for the poor), and also where the good is considered fo such social importance that inequitable distribution is not acceptable.

To claim health care isn’t rationed all of the time is either a blatant lie or a misunderstanding of basic economics.

12

No, SA, what is being rationed by the insurance companies isn’t “benefits” (definitional quotes) but money-- the insurance company’s money.

Some portion is allocated to purchasing “benefits”, or actual health care for paid insured clients. Another portion is allocated to internal administrative expenses including salaries. And yet another portion is allocated to shareholders, that being the profit motivation behind private enterprise.

The difficulty is that the companies are free to make decisions about this portioning almost entirely at their own discretion. And so it is hardly surprising that the compensation of those making the decisions, and the “bottom line” of shareholders whose votes determine the persons receiving that compensation and the amounts they are compensated, take precedence over the faceless and nameless paid insured clients. The companies have a vested interest in denying coverage through whatever means possible, thus reducing the actual amount portioned to “benefits” and maximizing the money available to salaries and general profit.

As has been shown, these means include but are not limited to refusing to sell insurance in the first place (pre-existing conditions and other limitations) and by denying and/or delaying coverage (delay long enough and the point becomes moot- the patient no longer needs that procedure, the patient needs a coffin not covered! instead) for procedures recommended by physicians.

And yet again with the anecdotes! This time your example is a friend who would have no medical care at all, let alone a hip replacement, were it not for a government program, because he has no insurance!! And you offer this as an argument against UHC, instead of complaining about lack of sufficient funding for the government program that **is **providing for him.

13

You’re clearly right, if we accept that definition of “rationing;” however, that’s not what most people think of when they think of rationing. Prices are flexible, and serve as a signal of where to increase supply to meet demand. When you take flexible pricing out of the equation and replace it with government fiats, there’s a whole different dynamic going on. That may make sense in wartime when the supply is fixed anyway; but that isn’t the situation we’re in now, either with food or healthcare.

14

Well that shows the insidious nature of some of the conservative arguments. Defining the price mechanism as ‘not rationing’ is a moral statement. It is based on a belief that the market system, and in particular the market system for health care, is the natural baseline. That’s not necessarily something I am willing to concede.

Given the apparent emotive importance of the word rationed, it is important to stress it is rationed, and restricted to those with cash to pay for it.

15

Do you realy think that we’ll ever get to a point where, no matter how much money you have, it will be impossible to get prompt care? If the care under a government-run plan is abysmal, then that will be a selling point for private insurers.

And of course if care under a government-run plan is tightly rationed, it will be a result of the conservative impulse to keep funding to a minimum. And since we’re only talking about the currently uninsured, why is rationed care worse than no care at all?

16

Conservatives hamper funding? Just looking at the last 9 years of governmental spending, FUNDING knows no bounds with either party. It surely isn’t “Conservative” by any stretch of the word.

The arguments arise in what exactly the funding goes towards.

17

Considering that the price system is what we use for just about everything else (including food and water, which are more essential to life than healthcare), I think it’s fair to say that is the default system for our society. Whether that’s most efficient or morally right is of course another question, and there are those that would argue it’s not (for healthcare or anything else).

But if a price system is “rationing,” then bubblegum and yachts and velvet Elvis paintings are all equally “rationed,” as of course is everything in centrally-controlled economies … at which point the word becomes meaningless. Sorry, I’m not a fan of trying to redefine problems out of existence.

If “ration” offends your sensibilities, you can offer up another term which means “limiting the distribution of goods based on administrative decree instead of via market pricing.” It doesn’t change the underlying economics, though.

18

The breast screening was not about rationing. The statistics they had showed that the screening, false positives and unnecessary invasive procedures procedures do more damage than good. Their stats told them you are more likely to be damaged if you get screened too often and too young. The breast tissue is denser when you are young and the results are not trustworthy.
An occasional person will get breast cancer when they are far away from the demographic. That has always happened. Men die of breast cancer. Should we start screening all men? It might save a few lives.

19

http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_male_breast_cancer_28.asp?sitearea=
Should we start testing men?

20

But there’s a difference between food and healthcare. There are always cheaper ways to get sustenance, and stores and restaurants will lower their prices to compete with one another and to boost consumption.

But doctors and insurance companies don’t need to lower prices to attract customers because they have little choice. You are, in effect, being tortured into doing business with people who can charge whatever they want.