Apparently some astronauts would. Choosing among them would create some interesting end-of-life-rationing problems, discussed by Tyler Cowen at his blog.
Tag Archives: health care rationing
Zeke Emanuel’s “Thinking Has Evolved” on End of Life Care, “Except in a Few Cases.”
We previously reported on Ezekiel Emanuel’s views on health care rationing. Now comes this from the Washington Times:
Emanuel said, “When I began working in the health policy area about 20 years ago… I thought we would definitely have to ration care, that there was a need to make a decision and deny people care… I’ve come to the conclusion that in our system we are spending way more money than we need to, a lot of it on unnecessary care. If we got rid of that care we would have absolutely no reason to even consider rationing except in a few cases.”
NYT Columnists Discuss Rationing
This is from the New York Times' The Conversation Blog:
Gail Collins: There have to be limits on what doctors can prescribe. The president pretends the only limit will be on useless tests and drugs that have an equally good, cheaper alternative. But useless and equally good are in the eye of the beholder.
David Brooks: As for your second point, that there should be limits on what doctors can prescribe, I say: "Amen to that."
Another Way to Ration Care
The Obama Administration doesn’t need a public plan to control costs. It can pressure private plans to ration as well. Here’s how.
They will require “accountable care organizations (ACOs),” where “teams” work together to provide care. They will require “bundled” payments that cover “packages of care,” including pre- and post-care, home health, etc. The ACO will receive one payment and then allocate the money to the team members, who will likely be on salary. All of this is held together by Health IT that is plugged in to the Comparative Effectiveness mechanism. That will help the ACO alert team members when they try to do something that is not “evidence based.”
How Care Can Be Rationed in a Health Insurance Exchange
The government will coerce doctor and patient both through their efforts at "tiering" physicians based on compliance with guidelines and rationing. This already exists through some private insurers but in the health insurance exchange government pressure will add to the tyranny. If your doctor is not compliant or complicit with the guidelines you will pay more to see that doctor. Different tiers are tied to variable co-pays patients must ante up. Since these tiers are also tied to utilization and cost, doctors who see sicker patients will be tiered lower and their patients likewise penalized with higher co-pays. This shows why (despite President Obama's promise) you may not necessarily get to keep your own doctor or your own plan.
Rationing Health Care
Obama Administration officials are saying it in every way there is to say it and the mainstream media is not paying attention.
In his speech to the American Medical Association, President Obama said what White House health advisor Ezekiel Emanuel and Office of Management and Budget Director Peter Orszag have said in print some time ago. The only way to control health care costs is to get doctors to provide less care — fewer tests, fewer procedures, fewer everything. Of course, the Administration wants to eliminate only that care that is "unnecessary." But HMOs say the same thing.
httpv://www.youtube.com/watch?v=ONXp-vpE9eU
Yesterday
Would Managed Care By Any Other Name Smell Any Better?
This is from a New York Times report on President Obama's meeting to plan health care reform strategy with the governors:
Gov. Michael Rounds (SD): "I think [the president] said what we have to do is not call it rationing, because clearly there is from H.M.O. days a concern about rationing."
Gov. Christine Gregoire (WA): The president reminded the governors that "Congress has a bad taste in its mouth from previous experience with managed care," and suggested they avoid the term. Instead, he spoke of "evidence-based care," the practice of using research to guide medical decisions.
Best News of the Day
Cheer up. According to the New York Times (which ought to know), the country’s most powerful unions are not able to stickhandle their agenda through Congress and the White House due to “internal disputes.” If true, this is good news for health reform. Note that whenever a corporate interest seeks to appease Obama on health care, it must do so through the intermediation of the Service Employees International Union (SEIU). The latest example is Wal-Mart, which caved into a “mandate” that employers cover their employees’ health care, largely because this would put competitors like Target at a competitive disadvantage. Continue reading Best News of the Day
Rationing Health Care
This is Scott Gottlieb on the proposed Federal Health Board:
Like Medicare's recent decisions to curtail the use of virtual colonoscopies, certain wound-healing devices, and even a branded asthma drug, the board's decisions will be one-size-fits-all restrictions….. In countries such as France and Germany, layers of bureaucracy like health boards have been specifically engineered to delay the adoption of new medical products and services, thus lowering spending.
In Germany…..in the past 12 months, the 15 medical products and services that cleared this process spent an average 35 months under review. (The shortest review was 19 months, the longest 51.)
Medicare can already be painstakingly slow. Appealing to it takes patients an average 21 months according to a 2003 Government Accountability Office report (17 months involve administrative processing).
Why Health Reform is Bound to Fail
Why is Washington having so much trouble reforming health care?
Why, if they do pass a major overhaul, are the problems of cost, quality and access almost certain to get worse?
Answer: Because they don't understand health care. By that I mean, almost no one in Congress understands health care as a complex system. When they campaign, most politicians claim that health care problems could be solved with a few simple reforms. Now that it's time to legislate, they are discovering that health care is very, very complicated. In fact, there is no solution that even comes close to being simple or easy.
As Nobel Laureate Frederick Hayek taught us, a complex system is a structure that is so complicated, that no one person can even begin to grasp it in its entirety. The best each of us can hope for is to master the small part of it we interact with.
The economy, for example, is a complex system. To allow us to think about it — if only imperfectly — economists have developed a highly simplified model over a period of 200 years. In fact, the only reliable model that exists to understand complex social systems is the economic model. Yet we have completely suppressed normal market forces in virtually every aspect of health care. So what we are left with is almost certainly the most complicated market of all and no reliable model with which to understand it. Continue reading Why Health Reform is Bound to Fail