Friday, April 29, 2011

A Ration

Here's one of the clearest discussions of rationing of health care, the impossibilities, the need, the politics that I've read in a while.

....We want our doctors to go all-out for our loved ones and ourselves. But as voters and consumers, we send a different message. We pick politicians who promise to cut taxes, and we demand low-cost insurance. We're telling government and the health-care industry to hold the line on health-care costs, even if it means sacrificing clinical benefits. And we put doctors in the middle of this contradiction.

In recent weeks, private insurers have revealed plans for double-digit rate hikes. Our medical bills are already close to a fifth of our national income, on track to reach one-third within 25 years. Soaring Medicare and Medicaid costs are the main reason for nightmarish federal deficit projections over the long term. Yet as Republicans and Democrats battle over the federal budget to the point of threatening a government shutdown, serious health-care spending cuts remain unspeakable.

House Budget Committee Chairman Rep. Paul Ryan, R-Wis., recently proposed to cut Medicare and Medicaid by shifting their costs to poor and middle-class Americans who can't afford them. It's an unconscionable approach, but it at least acknowledges the urgency of gaining control over federal health-care spending. Neither President Obama nor congressional Democrats have put forth plausible proposals for doing so.

I'd disagree with the last sentence: the ACA calls for effectiveness research, which might well go a long way toward controlling unreasonable costs. Rs, of course, have convinced teabaggers that it's another form of death panel; as is the case with pretty much everything teabaggRs believe, the exact opposite is true.

Along similar lines, there's this thoughtful suggestion:

Andrew Sullivan has a proposal to lower health-care costs that actually makes some sense. “If everyone aged 40 or over simply made sure we appointed someone to be our power-of-attorney and instructed that person not to prolong our lives by extraordinary measures if we lost consciousness in a long, fatal illness or simply old age,” he writes, “then we’d immediately make a dent in some way on future healthcare costs. A remarkable proportion of healthcare costs go to the very last days or hours of our lives.”

His idea is voluntary. But I’d make a different suggestion. What if, to be eligible for Medicare, you had to give someone power of attorney and sign a living will? You could tell your attorney, and write in your will, that you want every possible measure employed to keep you alive. You could say cost is no object, and neither is pain or quality of life. You could make whatever choice, and offer whatever instructions, you want. You just have to do it. You have to make the decision.

The Palinites wouldn't be able to get past the "to be eligible part," of course. But, in fact, the suggestion reiterates what's always been true: living wills allow you to choose whatever you want.

Thoughtful people -- the President included -- have put thoughtful ideas on the table. Sadly, any thoughtful idea is necessarily fraught with the non-starter that realism no longer has a place in our politics. So we stumble on toward the darkening horizon, preferring to sling slime at those who actually try. No wonder birtherism, secret-Muslimism, have taken hold: when he took office, President Obama actually thought there'd be a place for give and take discussions, serious ones, about serious problems.

What planet was that guy from??? He sure as hell doesn't sound like one of us.


  1. Well, our future plan includes nationalized medicare/medicaid that are breaking our collective banks, a President that promised to lower healthcare costs while concurrently adding thousands more to Medicaid, a mandate that all insurance policies have "no cost ceilings", continued influence of public-sector unions to promise pensions/healthcare for 25+ years after many workers retire, and a finite amount of healthcare resources & staff to meet these new, continued, and soon to be increasing demands.

    Rationing is inevitable. The difference now is, instead of insurance companies being the "rationers" it will be the docs/hospitals saying, "sorry, I know Obama promised unlimited Medicaid, but we just don't have any more beds. You're welcome to take a number and sit on the floor in the ER."

    Your idea is a good one, but people will just automatically sign advanced directives that request "everything be done" to get their benefits.


  2. Sorry off topic Dr S, but where is Frank and why did he close his blog?

    I wonder what happened?

  3. Well I hope he comes back again sometime. Something must be wrong. maybe not so anonymous anymore? that is usually the reason for an abrupt blog departure. I hope I am wrong tho and he will return.

    I never believed he meant the vile stuff, but was busting you and others.

    Heh. My password is unfund. Feels like it has some profound meaning for this blog.

  4. PT- forgive me first, because I'm purdy much of a moron. However, being a moron purdy much makes me an expert on the subject- and the majority of your comments lead me to believe you are part of the club, probably one of it's foundinng members. A shining example of why we are so screwed. Congradulations on your educated, considerate, well thought out, and meaningless insight. Perhaps together, with the help of the teabaggers and Righty's, we can continue to assure the age old bias of "I got mine, and the rest of the working class can go screw yourselves". Shame on your ignorance... and mine too for thinking this comment will make a difference to you.


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