# Ezekiel Emmanuel says we need to ration care **URL:** \ **Category:** Great Debates\ **Created:** [August 12, 2009, 8:01am UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153 "2009-08-12T08:01:23Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [August 12, 2009, 3:21pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/21 "2009-08-12T15:21:57Z")
> [@tagos](#): > > Why? On what basis are you making that assertion given that there are no age restrictions on pacemakers in the UK NHS system? My comment was about the proposed changes to the US system, which is what this thread is about. > [@zamboniracer](#): > > Not quite. The pacemaker in question would’ve been paid for by Medicare as it exists now, not under a future UHC system. That’s true. Medicare is a form of UHC. Those who object to UHC based on rationing grounds would have some of the same objections to Medicare. > [@C\_K\_Dexter\_Haven](#): > > \*\*Fotheringay-Phipps:\*\*First, I disagree with your verb that rationing “will” come – rationing has always been here. Medical care is a limited and costly resource, and there will always be decisions made about who can and who can’t receive care. I agree with this, as noted elsewhere. But your nitpick is with Ezekiel Emmanual and the OP, not with me, and I assumed (and assume) that they meant “a lot more rationing than we have now”. > [@](#): > > At present, in the US, those decisions are made mostly by insurance companies and partly by the medical profession, and the principle is $$$$$ – the rich get what they want, the poor don’t. I’ve already noted this, but again, I believe the rich will do well under any system, and under UHC the poor will do better at the expense of the middle class. > [@](#): > > It’s hard to generalize, but under most government-provided health care systems (to answer **Lumpy** ), the decisions are made by some medical board (including doctors, patient-representatives, and government) based on clearly established principles. It’s not “bureaucratic” – it’s administrative decision, based on defined standards. FWIW, it would undoubtedly be based on political considerations as is every other high profile government program. But more important, it would be based on these doctors and patient representatives etc. _in the context of what resources are available_, not in a vacuum. So even if you have a medically valid way of establishing priorities in how to allocate the resources available, that doesn’t mean that this is the optimum way of doing things. I guess if you object to money being a factor at all in medical care then UHC rationing would be better than insurance company rationing. But I reject this view. Sometimes money represents “effort that you put in” and there’s no reason that a person’s labor cannot be translated into better health care. ---
**Author:** ![tagos](https://avatars.discourse-cdn.com/v4/letter/t/bbe5ce/32.png) [@tagos](https://boards.straightdope.com/u/tagos)\ **Post date:** [August 12, 2009, 3:44pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/22 "2009-08-12T15:44:44Z")
> [@Fotheringay-Phipps](#): > > I guess if you object to money being a factor at all in medical care then UHC rationing would be better than insurance company rationing. But I reject this view. Sometimes money represents “effort that you put in” and there’s no reason that a person’s labor cannot be translated into better health care. No one is objecting to money being a factor. That is glaringly explicit in any concept of rationing, which we all agree exists now and for evermore. What some object to is the private profit of insurance companies and the concomitant incentive to deny and disallow cover and exclude people from any cover being a factor. And yes - in a thread that has people asserting UHC leads to old people being denied pacemakers the NHS experience is directly relevant, your Junior Thread Policeman act notwithstanding. ---
**Author:** ![athelas](https://avatars.discourse-cdn.com/v4/letter/a/5e9695/32.png) [@athelas](https://boards.straightdope.com/u/athelas)\ **Post date:** [August 12, 2009, 3:51pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/23 "2009-08-12T15:51:25Z")
> [@tagos](#): > > No one is objecting to money being a factor. That is glaringly explicit in any concept of rationing, which we all agree exists now and for evermore. It is somewhat disingenuous to use “rationing” to refer to market allocation and state-determined allocation at the same time, and then using the fact that it’s the same word to pretend that the two are equally efficient or equitable. Bananas are currently “rationed” by ability to pay, and were also literally rationed under the Soviet Union. I don’t think I’m the only one who would object to a commissar that argues that since the West is rationing its bananas, the Soviet system is just as good. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [August 12, 2009, 4:01pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/24 "2009-08-12T16:01:50Z")
> [@tagos](#): > > No one is objecting to money being a factor. I don’t know that that’s true. > [@](#): > > What some object to is the private profit of insurance companies and the concomitant incentive to deny and disallow cover and exclude people from any cover being a factor. I think the money-rationing issue we were discussing - or at least I was - is that some people have better insurance coverage than others (or at least have coverage altogether) under the current system. Insurance companies denying people payments is another issue - companies are pretty regulated for this reason (among others) and I believe employers have more leverage with the insurance companies than anyone could have with the gov. Not that it’s perfect as is, but based on my experience dealing with gov. bureaucrats, I don’t see any reason to think this might improve. You’d be less likely to be denied benefits because some employee is mandated to be aggressive about challenging payouts, but you’d be more likely to be denied because some employee interpreted the rules incorrectly and can’t be bothered to consider your case or consult with someone smarter, what are you going to do about it, next in line please … > [@](#): > > And yes - in a thread that has people asserting UHC leads to old people being denied pacemakers the NHS experience is directly relevant, your Junior Thread Policeman act notwithstanding. Sorry, not playing Junior cop - I was explaining the context of my remarks. I don’t know about NHS and have made no claims about that system. My exchange was with someone else who accepted that UHC would lead to this type of denial, and thought it was a good idea, and what I addressed was not the issue of whether this effect would actually occur but whether in fact it was an unmitigated advantage if it did. ---
**Author:** ![Mighty\_Mouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mighty_mouse/32/7776_2.png) [@Mighty\_Mouse](https://boards.straightdope.com/u/Mighty_Mouse)\ **Post date:** [August 12, 2009, 4:11pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/25 "2009-08-12T16:11:52Z")
> [@gonzomax](#): > > The system pays doctors for every procedure they do. That is why they do so many. The payoffs are not patient or results oriented. We have assembly line medical care with doctors having little time to consult with patients. Their time is money. Your time is irrelevant. > Many doctors hate what our medical care has become. The insurance companies are between you and your doctor. They are thinking profits. Doctors want to get paid $400 per hour, but they want to get it by seeing two patients per hour and billing $200 per consult. Insurance companies want doctors to make $400 per hour by seeing 5 patients per hour and billing $80 per consult. Suppose we mandated that doctors spend 20 minutes with a patient. This would make the doctors happy. Of course they would have to drop 50% of their patients. And all those extra doctors we have lying around would pick up the slack. What??? We don’t have doctors hanging about waiting for patients now? The waiting rooms are full, and doctors are working 60 hours a week? You mean it is fundamentally a supply and demand problem? In the current system, it is the insurance companies that are keeping the costs from really spiralling out of control. Of course they are like the bad parent who tells you you can’t afford something, instead of just embezzling the money so that you can afford it. But here I am thinking that we should be able to evaluate situations at a deeper level than a four year old. People don’t want to address the fundamental issues, so the “cure” is going to be worse than the disease. We have too few doctors, who each make too much money in relation to the average American. So we get less health care than we want, and pay more than we want. The only way to get doctors to take less money is to bargain them down, and there are two ways to do that: 1. Single payer who puts every doctor into a take it or leave it position for all or almost all of his potential customers (patients) as far as the fee schedule is concerned. 2. Mandates on insurance companies that they take all comers and charge a regulated premium, and provide a regulated coverage. Now \*they \*are forced to bargain aggressively with doctors. You also would need to increase the number of doctors being trained in the US because once you get doctors incomes down to only 4X the median income, you will not be able to import as many foreign trained doctors. You can only do this by subsidizing medical education, and lowering the academic standards for incoming students. ---
**Author:** ![ivylass](https://avatars.discourse-cdn.com/v4/letter/i/9de053/32.png) [@ivylass](https://boards.straightdope.com/u/ivylass)\ **Post date:** [August 12, 2009, 5:04pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/26 "2009-08-12T17:04:53Z")
> [@msmith537](#): > > All the problems with health care in this country will be solved once we can provide every single person in the US with as much medical treatment as they can ever want absolutely free of cost. This reminds me of the retail store maxim: \*1) Good Service 2) Good Product 3) Low Cost. Pick two.\* ---
**Author:** ![mswas](https://avatars.discourse-cdn.com/v4/letter/m/e99b99/32.png) [@mswas](https://boards.straightdope.com/u/mswas)\ **Post date:** [August 12, 2009, 5:51pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/27 "2009-08-12T17:51:20Z")
> [@Der\_Trihs](#): > > [Ezekiel Emanuel](http://www.time.com/time/nation/article/0,8599,1915835,00.html) however calls the accusations against him a smear campaign ( link courtesy of **RedFury** in the [Pit](http://boards.straightdope.com/sdmb/showthread.php?t=527720) ). Ahh thanks. That settles that one. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [August 12, 2009, 6:29pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/28 "2009-08-12T18:29:05Z")
> [@zamboniracer](#): > > This is exactly right. This is anecdotal evidence from a friend of mine, but he says that his 95 year old mother’s doctor recently recommended that she have a pacemaker installed. His mother refused, saying she’s led a long, full life and is ready to die. Rationing care means that she wouldn’t have been offered that option, as indeed logic suggests that she shouldn’t have been. No offense to any 95 year olds, but as a taxpayer I don’t want to pay for their brand new pacemakers, anymore than I’d want to pay for a new engine for a 1975 Ford Pinto. So…at what age would you deny funding for a new pacemaker for an elderly patient? Do you set the limit at age 95? 90? 80? How do you set a rational limit? What factors would you weigh besides chronological age, if any? Other health conditions? Level of activity and mental awareness? Value to society and loved ones? Inquiring minds, etc. ---
**Author:** ![mswas](https://avatars.discourse-cdn.com/v4/letter/m/e99b99/32.png) [@mswas](https://boards.straightdope.com/u/mswas)\ **Post date:** [August 12, 2009, 7:00pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/29 "2009-08-12T19:00:06Z")
Yes, my 84 year old Grandmother has elected not to do anything about an arterial blockage that she’s had for some years that is growing slightly worse as time goes by. She’d rather just go when she goes. ---
**Author:** ![msmith537](https://avatars.discourse-cdn.com/v4/letter/m/d9b06d/32.png) [@msmith537](https://boards.straightdope.com/u/msmith537)\ **Post date:** [August 12, 2009, 7:21pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/30 "2009-08-12T19:21:46Z")
> [@ivylass](#): > > This reminds me of the retail store maxim: > > \*1) Good Service > 2) Good Product > 3) Low Cost. > > Pick two.\* Reminds me of a Dilbery comic strip where the Pointy Haired Boss is like “We need to listen to the customers.” Dilbert replies “the customers are idiots who want all the features in the world but don’t want to pay for them.” According to my Mom, who has worked in healthcare for like 40 years, one of the biggest costs is end of life care for terminally ill patients. The problem isn’t so much \*\*zamboniracer’s \*\*friend’s grandma extending her life a few more years with a pacemaker. It’s someone who may be 80+ years old and bedridden with a terminal illness where they keep extending his or her life a few more weeks or months with various treatments and procedures that are only prolonging the inevitable. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [August 12, 2009, 7:37pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/31 "2009-08-12T19:37:15Z")
[True](http://www.usatoday.com/money/industries/health/2006-10-18-end-of-life-costs_x.htm) ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [August 12, 2009, 8:30pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/32 "2009-08-12T20:30:00Z")
> [@athelas](#): > > It is somewhat disingenuous to use “rationing” to refer to market allocation and state-determined allocation at the same time, and then using the fact that it’s the same word to pretend that the two are equally efficient or equitable. Bananas are currently “rationed” by ability to pay, and were also literally rationed under the Soviet Union. I don’t think I’m the only one who would object to a commissar that argues that since the West is rationing its bananas, the Soviet system is just as good. Bananas are not rationed, unless you can point to some people who cannot buy bananas because of the cost. Gasoline was rationed during WW II - really rationed. Do you think this was a good idea, or would it have been better for the market to decide. I’m assuming that gas needed for the military would come off the top in either case. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [August 12, 2009, 8:32pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/33 "2009-08-12T20:32:34Z")
> [@msmith537](#): > > According to my Mom, who has worked in healthcare for like 40 years, one of the biggest costs is end of life care for terminally ill patients. The problem isn’t so much \*\*zamboniracer’s \*\*friend’s grandma extending her life a few more years with a pacemaker. It’s someone who may be 80+ years old and bedridden with a terminal illness where they keep extending his or her life a few more weeks or months with various treatments and procedures that are only prolonging the inevitable. I swear reading right here, a year or so ago, about how UHC would be a horrible system because Congress, out of politics, would ensure that all 95 year olds would get expensive health care at the point of death, and thus increase costs. Now we’re seeing that UHC or even the proposed system is a horrible system because Congress won’t force all edge of death 95 year olds to be given expensive care if they want it. Sometimes you can’t win, can you? ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 12, 2009, 9:52pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/34 "2009-08-12T21:52:06Z")
We have rationing now. We have rationing by medical ethics & principles of triage; we have market rationing. The question is, what sort of rationing should we use. Here’s another obnoxious way to put it (but I think it’s fair): If we’re not going to give tax-funded medical care to the productive working class, then I think we need to take it away from retirees, the disabled, & the poor. That’s the price. You want your Medicare/caid/cal/whatever? Let the young & healthy share in it. Spend some money on the living rather than the dead. But mostly: Rationing exists because of shortage. We can address the supply issues of medicine, & no matter what plan we take on rationing, insurance, & tax policy, we will regret any failure to address those issues. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 12, 2009, 10:08pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/35 "2009-08-12T22:08:49Z")
> [@msmith537](#): > > All the problems with health care in this country will be solved once we can provide every single person in the US with as much medical treatment as they can ever want absolutely free of cost. And the shortage problems will be passé once we train enough medicos to glut the market & use competition to bring prices down. Note that what I propose is doable. ---
**Author:** ![mswas](https://avatars.discourse-cdn.com/v4/letter/m/e99b99/32.png) [@mswas](https://boards.straightdope.com/u/mswas)\ **Post date:** [August 12, 2009, 11:12pm UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/36 "2009-08-12T23:12:59Z")
> [@foolsguinea](#): > > And the shortage problems will be passé once we train enough medicos to glut the market & use competition to bring prices down. Note that what I propose is doable. People on this board like to make fun of me for calling Massage Therapy a medical profession, even though that is what it is considered legally. But I think the answer is to have a lot more of these easy professions that deal with wellness care. Perhaps the need is not for more Doctors but for more physician’s assistants. ---
**Author:** ![kaylasdad99](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kaylasdad99/32/3398_2.png) [@kaylasdad99](https://boards.straightdope.com/u/kaylasdad99)\ **Post date:** [August 13, 2009, 1:41am UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/37 "2009-08-13T01:41:17Z")
> [@mswas](#): > > What do people make of this? **We’ve been hearing that it’s absolutely ridiculous that care would be rationed,** but how can it not be? Right now it’s rationed, those who can afford it monetarily get it, whereas those who cannot don’t. Could you substantiate this please?\* Cos, personally, I haven’t been hearing anybody saying that it’s absolutely ridiculous that care would be rationed. I don’t watch the news on television, though. \*And if you do substantiate it, I’d really appreciate that you do it with something that is as contextualized as possible. Thanks. 🙂 ---
**Author:** ![mswas](https://avatars.discourse-cdn.com/v4/letter/m/e99b99/32.png) [@mswas](https://boards.straightdope.com/u/mswas)\ **Post date:** [August 13, 2009, 1:52am UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/38 "2009-08-13T01:52:41Z")
I am not sure what you are asking. Do you want me to substantiate that people receive or are denied care based on their ability to pay? Do you want me to show you evidence that people think that it is ridiculous to ration medical care? There are multiple threads on this message board about Death Panels, which are essentially criticisms that rationing will kill Grandma. What is it I am supposed to back up? ---
**Author:** ![AboutAsWeirdAsYouCanGet](https://avatars.discourse-cdn.com/v4/letter/a/22d042/32.png) [@AboutAsWeirdAsYouCanGet](https://boards.straightdope.com/u/AboutAsWeirdAsYouCanGet)\ **Post date:** [August 13, 2009, 2:24am UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/39 "2009-08-13T02:24:34Z")
> [@](#): > > but he says that his 95 year old mother’s doctor recently recommended that she have a pacemaker installed. His mother refused, saying she’s led a long, full life and is ready to die. Rationing care means that she wouldn’t have been offered that option, as indeed logic suggests that she shouldn’t have been. No offense to any 95 year olds, but as a taxpayer I don’t want to pay for their brand new pacemakers, anymore than I’d want to pay for a new engine for a 1975 Ford Pinto. You know… I know it’s not popular for a disabilty rights activist to say this…BUT I do think that some parents other representives of patients are…almost in denial about the quality of life that their kids/patients have. I mean…how do you make medical decisions for a kid who might not even be able to smile? ---
**Author:** ![kaylasdad99](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kaylasdad99/32/3398_2.png) [@kaylasdad99](https://boards.straightdope.com/u/kaylasdad99)\ **Post date:** [August 13, 2009, 3:27am UTC](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153/40 "2009-08-13T03:27:09Z")
> [@mswas](#): > > I am not sure what you are asking. > > Do you want me to substantiate that people receive or are denied care based on their ability to pay? > > Do you want me to show you evidence that people think that it is ridiculous to ration medical care? There are multiple threads on this message board about Death Panels, which are essentially criticisms that rationing will kill Grandma. > > What is it I am supposed to back up? No, I want you to substantiate that, to quote you > [@](#): > > We’ve been hearing that it’s absolutely ridiculous that care would be rationed[.] Put this way, it seems like you’re claiming that we have been receiving assurances from someone that such rationing is not going to exist once HCR has been enacted and implemented. From whom have we been hearing this? Or did you intend for this statement to be understood another way? Please clarify. [Previous page](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153.md?page=1) [Next page](https://boards.straightdope.com/t/ezekiel-emmanuel-says-we-need-to-ration-care/506153.md?page=3)