Rationing Happens

The health care debate is over an as-yet-fictitious future government-run system. Instead of fighting over phantoms, why not review our current systems to see if we'd like more of the same?

I thought this piece was poignant, and a revealing example of how the government must pick winners and losers in public care schemes. They decide who or what service is "expendable." This much should be obvious, as limited resources means these kinds of choices must be made. But what happens when you don't like the government choice?

Those who support Universal Health Care (UHC) need to come to terms that publicly-provided care cannot be better than private care. This is an impossibility when one considers the inputs and outputs that such a system will be based on. Basic math informs us that there is no magic formula to providing everyone in this country with stellar, or even basic care.

In this article about public education, the woeful lack of continuing education for special needs students is highlighted. While I disagree that the solution is more public funding for programs that are not meeting people's needs, it is proof that government-run anything is no panacea. Education and care will not be treated much differently.

From HK Magazine's article Not Special Enough:

Former legislator Fernando Cheung is worried that his daughter may not be able to continue with school this September. She is one of many intellectually disabled students affected by a new policy from the Education Bureau, which requires all such students at the age of 18 to apply for special permission if they wish to continue their education at subsidized special needs schools. In what many parents are calling a case of outright discrimination, the same policy does not apply to students in mainstream schools, who will continue to enjoy unconditional subsidized education until the age of 20.

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9 Comments:

  1. I agree 100% that with any plan (public or private) that rationing will occur. Right now, that happens in two ways.

    1. Cost: We ration the access to care in our current system based on cost. The level of care you receive is directly tied to how much you can pay for, whether it's out of pocket or with whatever limitations your insurance has.

    2.The AMA: In addition to blocking almost every attempt at health care reform since the early 1900's, the AMA has restrictions on the amount of doctors that are licensed and allowed to practice, creating an artificial shortage. While this doesn't directly correlate to rationing, having more physicians available would go a long way towards increasing care.
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  2. @Norcross -

    1. I think a lot of people are misled into thinking that cost will no longer be a factor in "free" health care. No one explains that cost does not go away, even if the recipient isn't paying. Someone does, and those resources are always finite. I think it's bad form most politicians drop that minor detail when hawking their wares.

    2. The AMA is pretty bad. I don't disagree. I always thought there should be torte reform coupled with a variety of accrediting bodies so that people who wrap a sprained ankle or administer the flu shot don't require as much training as those who perform open heart surgery. There is already a model for this for those who get certified in Wilderness Medical Training or EMT training. It is bare-bones medical assistance meant for short-term emergencies until a patient can be seen by a real doctor, but in disaster situations or rural areas where there aren't a ton of doctors, people with this kind of basic training are in high demand. I haven't studied the AMA, but I'm going to guess they have a powerful lobby and they didn't get to where they are without considerable help from government friends.
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  3. I don't disagree at all that the issue of cost won't disappear with some sort of UHC. The point I was attempting to make was that too many people currently don't have the means in which to afford even basic health care. There will always be those that will have the ability to go out and obtain a higher level of care, and they'll be willing to pay for it. But our current system prices out too many people. Encouraging 'competition' between companies that have no interest in lowering their margins, and within a medical system that rewards inefficiency just doesn't make sense.

    Considering there are many different successful models of UHC to look at worldwide, with varying amounts of public / private mix, it just seems to me that we're grasping to our existing system for reasons other than the actual issue of delivering care to the people of the US.
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  4. @Norcross - maybe. I think that this point we'd need to revisit my prior post on the moral issue of UHC before attempting reform conversations. There are plenty of ways to make health care more affordable without completely socializing the system. To pretend otherwise is dishonest, in my opinion. It is not educating people about the real causes and private solutions, and it poses the government as some sort of miraculous solution.

    I do not think private solutions will work miracles, but they are just, and allow everyone to have freedom to choose.
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  5. @Milena - While there is no 'perfect' system, I think a better blended public / private system would work much better than what we've got. Extend the basics to everyone in a UHC model, while allowing the private arena to foster innovation in the areas of specialties
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  6. @Norcross - you may think a public/private mix is better. And while I happen to disagree, and would like to discuss that further, it would be a premature conversation without first addressing the issue of having no choice in the matter of participation.

    If the public option were truly an option, we could then discuss the best method and structure of care. But the issue of force is a hurdle that cannot be side-stepped.

    This goes back to the previous post's topic. What right do I have to force other people to pay for my health care?
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  7. @Milena - I don't think it's a matter of right / obligation of who's paying for what. But by that argument, why should I pay for a military that isn't defending my home state of Florida? A childless couple pay taxes that fund my child's education? Someone who lives in a rural area paying taxes for the Federal Interstate system? I could list examples ad nauseum.

    The point I'm trying to make is that as a society, we've made agreements within a social pact that we all help in certain areas, regardless of whether or not we receive a direct benefit. There are plenty of things that my tax dollars pay for that I get little or no benefit from whatsoever. But I've agreed (albeit indirectly) that it's ok because I receive other things. Now, it can certainly be discussed and debated as to WHAT things should be paid for and WHO should pay them. But if it's a service that the populous feels should be included in that social pact, then we all pitch in.
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  8. @Norcross - "I don't think it's a matter of right / obligation of who's paying for what." It is. You must address this issue before we can discuss anything else, otherwise we are not even talking about the same thing. You'd be wanting to discuss the best way to take people's things and make the world a better place. I am arguing you cannot make the world a better place by taking people's things.

    All the other things you mention, wars one doesn't support, childless paying for child education, Federal interstate, etc. are all excellent examples of things people should not be forced to pay for. I am happy to discuss any of them. The military is a difficult issue, as it is a legitimate function of the government, however, there are strong cases against fighting wars where we are not being directly aggressed against.

    Basically, if you say that you will support being taxed for things you don't like in order to have a voice for the thing you do like, all you are acknowledging is that it is theft, but when it comes to something you find morally acceptable, it evens the score? Am I right? If so, I disagree.
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  9. There is one sure-fire way to decrease the cost of health care (or anything else, for that matter) and that is market competition. The way to achieve this is straightforward; its the same way that car insurance, homeowner's insurance, and renter's insurance works. You buy insurance with some amount of deductable. High deductable insurance costs less, and low deductable insurance costs more. If you are high risk, engage in risky behavior, or simply _use_ more insurance, you pay more. If not you pay less. Your insurance belongs to you, not the company you work for, and you use it to pay your medical expenses. Because there are no negotiated reimbursement schemes, providers now have to compete in terms of both price and service to win your business. It is the same model that has consistently driven costs down and quality up on virtually every consumer product we buy today.

    UHC proponents will jump up and say "but health care is not cars or LCD TVs!" which is, of course, true. But if you look at elective health care that is not covered by typical health insurance today--Lasik, cosmetic procedures, etc.--you see that they have fallen in price compared to say, 10 or even 5 years ago.To maintain that the same thing would not happen to "general" health care is not only anti-logical, but ignores evidence as well.

    The details of such a system are somewhat variable; deductables could be annual or per use. Health savings accounts, for instance, could provide a before-tax incentive and be used to pay part of all of an annual or per-use deductable. The basic premise, however, is the same; get health spending out of the hands of businesses and HMOs and into the hands of individuals. This is the only way to achieve true market competition and well as personal control over how your own health-care dollars or spent.

    And, guess what? Cheaper, higher-quality health care results from market competition make it cheaper and easier to cover those who can't afford health care on their own.
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I'm curious to see what you are thinking...

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