To ration or not

[Baruch Menachem]

To ration or not is not a real question. All goods are in supply less than total demand, so that they get rationed either by price or favor. Ration by price means that the more you are willing to give up for the good, the more chance you will get it. Rationing by favor essentially means that the more and bigger friends your have, the more you will get of the goods.
Rationing by favor also disconnects the production of a good from demand for the good. Rationing by favor means some goods will be in desperate short supply because no one gets paid enough to supply it.

So there is no "ration or not." there is only ration by good sense or by fear.

 

[AllieBaba]

Let's try to use speech patterns of adults. That post makes no sense.

Which part was too tough for you?

The part that didn't make sense. Which would be all of it.

 

[Cecilie1200]

And think about all those American seniors who won't go to Canada because they can't afford American prescriptions. Won't someone think of the business Canada will lose?

I'm a lot more interested in the fact that if the US tries to imitate the way that Canada and other countries get cheap pharmaceuticals, the entire world will stop getting new drugs developed to treat illnesses.

Huh? A few years ago, the winter flu outbreak that occurred in the U.S. was a strain that all of our own flu drugs didn't affect, so we had to import the effective drug from Great Britain. Many "new" drugs are first tested, approved, and marketed in Europe before our slow-moving FDA begins similar regimens here. The bird flu vaccine also came from overseas. Seems to me they are much more open to drug experimentation across the pond than in the United States, and they do it more effectively and cheaper. Why would that change?

Uh, dear, it doesn't matter where they test and approve things. What matters is where they make the profits to cover the cost of R & D on new drugs, and that would be here. That's why pharmaceuticals often cost so much more in the US: since we don't allow our government to set price controls like other countries do, it allows the drug companies to make up their initial outlay. In effect, we are footing the bill for other countries. And if we stopped, the drug companies would simply stop spending money to research and develop new drugs.

 

[Cecilie1200]

This is simply not true. You must have the resources to do so, and many many people don't.

Which is the way it always has been. The government is not responsible to make sure you get all the perks of people who have more money than you do.

And just because some people can't afford it doesn't mean we need to stop providing decent care for those who can.

Yes, just let the poor ones die. How compassionate and Christian of you.

It's so much more compassionate and Christian to decree that everyone else die alongside them, right?

 

[editec]

It is my understanding that 50% of all HC dollars are spend on the last year of life.

I expect that sooner or later HC rationing will be standard operating practice.

The demand for HC is practically infinite.

The amount of HC any society can afford is finite.

I'm sure most of you can do the math.

 

[auditor0007]

I'm a lot more interested in the fact that if the US tries to imitate the way that Canada and other countries get cheap pharmaceuticals, the entire world will stop getting new drugs developed to treat illnesses.

Huh? A few years ago, the winter flu outbreak that occurred in the U.S. was a strain that all of our own flu drugs didn't affect, so we had to import the effective drug from Great Britain. Many "new" drugs are first tested, approved, and marketed in Europe before our slow-moving FDA begins similar regimens here. The bird flu vaccine also came from overseas. Seems to me they are much more open to drug experimentation across the pond than in the United States, and they do it more effectively and cheaper. Why would that change?

Uh, dear, it doesn't matter where they test and approve things. What matters is where they make the profits to cover the cost of R & D on new drugs, and that would be here. That's why pharmaceuticals often cost so much more in the US: since we don't allow our government to set price controls like other countries do, it allows the drug companies to make up their initial outlay. In effect, we are footing the bill for other countries. And if we stopped, the drug companies would simply stop spending money to research and develop new drugs.

Would they really? Without any new drugs to develop, these companies would go out of business. What is more likely is that the drug companies would put more pressure on the rest of the world to pay more. Don't you find it funny that these drug companies have no problem selling their drugs at discounted prices to the rest of the world. Top that off with the fact that they sell more of their drugs to US citizens than to any other individual country in the world, it seems like we ought to be the ones getting the discount. Isn't that how free markets are supposed to work?

 

[auditor0007]

It is my understanding that 50% of all HC dollars are spend on the last year of life.

I expect that sooner or later HC rationing will be standard operating practice.

The demand for HC is practically infinite.

The amount of HC any society can afford is finite.

I'm sure most of you can do the math.

Healthcare is and will continue to be rationed even more as the costs continue to increase. The question now is how will it be rationed? Those against any type of government involvement want to assure that they can get the best treatment available. However, no matter what we do, the percentage of those who can actually afford the best treatment will continue to decline, until eventually, less than half of Americans will be able to afford any healthcare other than paying for it out of pocket. The closer we get to that point, the more likely it is that services will be rationed and controlled by the government.

So those who fight universal coverage and controlling costs will eventually find services cut in a much more drastic way down the road. All that is happening currently is that we are delaying the inevitable. If we don't deal with this now, eventually, the rest of the world will end up in much better shape than the average American when it comes to healthcare. The only ones who will actually be able to afford it here will be the truly wealthy. And when that happens, it will lead to a complete change not only in our healthcare system, but quite possibly in the way we do everything.

When the most basic of services are denied to the majority, it will lead us directly to a much more socialistic form of governance.

 

[MaggieMae]

I'm a lot more interested in the fact that if the US tries to imitate the way that Canada and other countries get cheap pharmaceuticals, the entire world will stop getting new drugs developed to treat illnesses.

Huh? A few years ago, the winter flu outbreak that occurred in the U.S. was a strain that all of our own flu drugs didn't affect, so we had to import the effective drug from Great Britain. Many "new" drugs are first tested, approved, and marketed in Europe before our slow-moving FDA begins similar regimens here. The bird flu vaccine also came from overseas. Seems to me they are much more open to drug experimentation across the pond than in the United States, and they do it more effectively and cheaper. Why would that change?

Uh, dear, it doesn't matter where they test and approve things. What matters is where they make the profits to cover the cost of R & D on new drugs, and that would be here. That's why pharmaceuticals often cost so much more in the US: since we don't allow our government to set price controls like other countries do, it allows the drug companies to make up their initial outlay. In effect, we are footing the bill for other countries. And if we stopped, the drug companies would simply stop spending money to research and develop new drugs.

Ohhh, nice spin!!! Of course the tens of billions to place television ads has nothing to do with their high cost, eh? Dear?

I invite you to go to Page 8 of this 2002 report. Since the Prescription Drug Plan was adopted, the profit margin has risen 8% of the numbers shown here.

http://www.citizen.org/documents/Pharma_Report.pdf

 

[MaggieMae]

It is my understanding that 50% of all HC dollars are spend on the last year of life.

I expect that sooner or later HC rationing will be standard operating practice.

The demand for HC is practically infinite.

The amount of HC any society can afford is finite.

I'm sure most of you can do the math.

I worked as a nurse's aid in a nursing/rehabilitation facility during college to help pay for tuition, and later did some volunteer work reading to the residents. I can't recall a single one who was not actually looking forward to what they would find on "the other side." When people become old and frail and subject to debilitating physical and mental disorders, they want to be free from pain, period, and simply allowed to die.

 

[Baruch Menachem]

It is my understanding that 50% of all HC dollars are spend on the last year of life.

I expect that sooner or later HC rationing will be standard operating practice.

The demand for HC is practically infinite.

The amount of HC any society can afford is finite.

I'm sure most of you can do the math.

by rationing, do you mean euthanasia? I don't think you do... but what do you want to do about it. You want to set a limit on how much health care a person uses over their life, and when they reach the limit, the plug comes out?

As I noted up topic, we already ration by price. Those who can afford, spend. Of course, a lot of the spending is now done by the government, so government has to re align the spending pattern to what the citizens can afford. Do we cut education dollars to move them to keep old folks on respirators? When we move spending from private sector to the public sector, then we give the public sector the authority to make these choices. If a person is too broke for health care, well, that is the way world works. But a government is never to broke. The government makes positive choices in this regard.

Also worth noting is that much of the expense of health care is behavior related. Some of the most expensive parts are random disaster, but the vast majority of what constitutes health expenses is related to things like obesity, lack of exercise, drug use (including in this, alcohol and tobacco) If I exercise regularly, don't smoke and keep my weight down, I subsidize the health expenses of the slob down the street. Now when you move health care to the public sector becomes my problem.

Same way with abortion. You want to be sexually incontinent, then I am obliged to pay for your operation, then your morality is my dollars. And I think I should have a say in that.

 

[Coyote]

It's not an either or situation. It's not limited to either a government bureaucrat or an insurance company.
Nice try at another strawman, but you failed again.

Really? Whats the third choice?

First of all, there are well over 1000 companies that provide health insurance. As an individual, you can pick a company that meets your needs, it's not like there is one book of rules that all the insurance companies follow. Each insurance company also offers different types of plans.
That gives you 1000's of options.
Or, you could just pay for health care as you need it.

You don't have 1000's of options if you have any of a number of "pre-existing" conditions. The few plans that will cover you will do so at rates so high as to be unaffordable to many people if not matched by an employer. I'm not sure how it works in the private sector - because I work for a state university - but we are offered a limited number of plans to choose from where the employer also contributes. Sure...you could just pay for it as you need it and if you are young, healthy, and don't have a family you can afford the risk. But what if you have a pregnancy or children? What if you need prescription medications to stay healthy? The costs of those without insurance can be horrendously high.

 

[Coyote]

It's not an either or situation. It's not limited to either a government bureaucrat or an insurance company.
Nice try at another strawman, but you failed again.

Actually, I agree with that but, maybe not in the way you mean.

If it's not a government agent or an insurance company agent - who would decide what gets rationed?

In the current system rationing is controlled by: Insurance, what the individual can afford privately, and the government (for those eligable).

A fact of life - regardless of what system you are under is -if you can afford it, you can get any kind of medical care you want. Unrationed. Putting a public plan on the table in competition with private plans won't change that.

So, other than me now having to pay for somebody else's insurance via a new tax, what changes?

More people have some sort of coverage then before. I have no issue with a new tax for it. I pay taxes for education though I have no children. I pay taxes that keep the roads in good shape. I pay taxes that cover our military, police and emergency service people. I think health care - particularly with the emphasis on prevention is more cost effective for the public then emergency healthcare.

 

[Coyote]

Incorrect on a couple of points. NHS's handling of British health care became such an open scandal a while back that, while they're not talking about abolishing it, they DID start incorporating market-based practices in it to improve it. In other words, they started moving AWAY from the bullshit you people are now recommending for us.

Second, I'm not impressed that people who've been thoroughly indoctrinated in and acclimatized to a system aren't looking for a massive overhaul. You can get used to anything. And the majority of Americans aren't clamoring for a complete and total change of OUR system either, the media's false advertising notwithstanding.

That is also incorrect. Almost no one is supporting a stand alone public plan as the opposition keeps claiming. That's the real bullshit here (and strawman) here. While Britain might be moving towards more of a public/private mix (which is what most of the proposed U.S. plans are, and what Germany has for example) - they DO NOT want anything like what we have now.


The majority aren't clamoring for a "complete and total change" - you are right, and the numbers are down from 1993 but a substantial number are still clamoring for more then "minor" change.

From: Obama's Ratings Remain High Despite Some Policy Concerns: Section 2: Opinions About Health Care - Pew Research Center for the People & the Press
Most Americans believe that the nation’s health care system is in need of substantial changes. Four-in-ten (41%) say the health care system needs to be completely rebuilt, while 30% think it needs fundamental changes. About one-in-four (24%) believe that the health care system works pretty well and needs only minor changes.

41% say "completely rebuilt" - while not a majority, it is significant.
30% say "fundamental changes"

That's 71% that want, at a minimum "fundamental changes".

 

[alan1]

Really? Whats the third choice?

First of all, there are well over 1000 companies that provide health insurance. As an individual, you can pick a company that meets your needs, it's not like there is one book of rules that all the insurance companies follow. Each insurance company also offers different types of plans.
That gives you 1000's of options.
Or, you could just pay for health care as you need it.

You don't have 1000's of options if you have any of a number of "pre-existing" conditions. The few plans that will cover you will do so at rates so high as to be unaffordable to many people if not matched by an employer. I'm not sure how it works in the private sector - because I work for a state university - but we are offered a limited number of plans to choose from where the employer also contributes. Sure...you could just pay for it as you need it and if you are young, healthy, and don't have a family you can afford the risk. But what if you have a pregnancy or children? What if you need prescription medications to stay healthy? The costs of those without insurance can be horrendously high.

Yes, and if you have pre-existing auto accidents your auto insurance is more expensive to. If you don't believe me, call agent and tell them you've had 4 accidents in the last year, all deemed to be the other persons fault, and I promise you the rate quote will be higher than if you have none. You still have the options, it just costs more.

 

[auditor0007]

First of all, there are well over 1000 companies that provide health insurance. As an individual, you can pick a company that meets your needs, it's not like there is one book of rules that all the insurance companies follow. Each insurance company also offers different types of plans.
That gives you 1000's of options.
Or, you could just pay for health care as you need it.

You don't have 1000's of options if you have any of a number of "pre-existing" conditions. The few plans that will cover you will do so at rates so high as to be unaffordable to many people if not matched by an employer. I'm not sure how it works in the private sector - because I work for a state university - but we are offered a limited number of plans to choose from where the employer also contributes. Sure...you could just pay for it as you need it and if you are young, healthy, and don't have a family you can afford the risk. But what if you have a pregnancy or children? What if you need prescription medications to stay healthy? The costs of those without insurance can be horrendously high.

Yes, and if you have pre-existing auto accidents your auto insurance is more expensive to. If you don't believe me, call agent and tell them you've had 4 accidents in the last year, all deemed to be the other persons fault, and I promise you the rate quote will be higher than if you have none. You still have the options, it just costs more.

There is a huge difference between choosing to drive wrecklessly and having pre-existing health conditions, many of which people have no control over. Bad drivers should pay more for auto insurance. But should people who develop health problems due to genetics be made to pay more? Maybe we should set up our society in a caste system where only the healthy are treated and cared for.

 

[Cecilie1200]

Really? Whats the third choice?

First of all, there are well over 1000 companies that provide health insurance. As an individual, you can pick a company that meets your needs, it's not like there is one book of rules that all the insurance companies follow. Each insurance company also offers different types of plans.
That gives you 1000's of options.
Or, you could just pay for health care as you need it.

You don't have 1000's of options if you have any of a number of "pre-existing" conditions. The few plans that will cover you will do so at rates so high as to be unaffordable to many people if not matched by an employer. I'm not sure how it works in the private sector - because I work for a state university - but we are offered a limited number of plans to choose from where the employer also contributes. Sure...you could just pay for it as you need it and if you are young, healthy, and don't have a family you can afford the risk. But what if you have a pregnancy or children? What if you need prescription medications to stay healthy? The costs of those without insurance can be horrendously high.

Well, gee whiz. You mean insurance depends on your circumstances? I guess that explains why my car insurance is higher if I get into an accident than it is if I don't. And I don't notice anyone grousing about what a horrible crime THAT is. It's just reality. Some things happen in life that just suck. Why is it MY job to foot the bill to make YOUR life suck less?

Sounds to me like what we need is more incentive for companies to offer policies for those with pre-existing conditions, so that competition brings the prices down some. What we DON'T need is for the government to take over so it can just tell those people to die quietly because they cost too much.

 

[Cecilie1200]

You don't have 1000's of options if you have any of a number of "pre-existing" conditions. The few plans that will cover you will do so at rates so high as to be unaffordable to many people if not matched by an employer. I'm not sure how it works in the private sector - because I work for a state university - but we are offered a limited number of plans to choose from where the employer also contributes. Sure...you could just pay for it as you need it and if you are young, healthy, and don't have a family you can afford the risk. But what if you have a pregnancy or children? What if you need prescription medications to stay healthy? The costs of those without insurance can be horrendously high.

Yes, and if you have pre-existing auto accidents your auto insurance is more expensive to. If you don't believe me, call agent and tell them you've had 4 accidents in the last year, all deemed to be the other persons fault, and I promise you the rate quote will be higher than if you have none. You still have the options, it just costs more.

There is a huge difference between choosing to drive wrecklessly and having pre-existing health conditions, many of which people have no control over. Bad drivers should pay more for auto insurance. But should people who develop health problems due to genetics be made to pay more? Maybe we should set up our society in a caste system where only the healthy are treated and cared for.

I believe auto insurance also costs more if you're in certain age groups, or male, neither of which is your fault or your choice.

And if you're wanting a caste system where those with serious illnesses are shuffled off to die because they're too expensive, you can't do better than a government health bureaucracy.

 

[American Horse]

Denying someone healthcare because it will cut into profits is the ultimate in rationing.

Or how about denying healthcare because of pre existing conditions?

Health care is not denied because of pre-existing conditions. Not even health insurance is denied because of pre-existing conditions. Every state has an agency with assigned risk health insurance policies available for virtually any pre-existing condition.

 

[Political Junky]

Denying someone healthcare because it will cut into profits is the ultimate in rationing.

Or how about denying healthcare because of pre existing conditions?

Health care is not denied because of pre-existing conditions. Not even health insurance is denied because of pre-existing conditions. Every state has an agency with assigned risk health insurance policies available for virtually any pre-existing condition.

You should talk to some of those who have been denied.

 

[American Horse]

Denying someone healthcare because it will cut into profits is the ultimate in rationing.

Or how about denying healthcare because of pre existing conditions?

Health care is not denied because of pre-existing conditions. Not even health insurance is denied because of pre-existing conditions. Every state has an agency with assigned risk health insurance policies available for virtually any pre-existing condition.

You should talk to some of those who have been denied.

Have you? Do you know that they have been to the State agency, or are they simply lacking in information? Have you asked those questions? If you did you might be able to offer to help them find coverage they don't know is available.

And if they are financially unable to afford the state rates for people with pre-existing conditions, they might be in a position to qualify for Medicaid. All children qualify. I'm sure there are people who earn too much to qualify for Medicaid, but couldn't come up with the money to pay a policy assigned by the state, a donut hole, if you will. My wife had to go that route and it was not much more than my own "healthy" rate.

But as the government has tampered by adding mandates, the rates have steadily risen. If the government had left the market place alone to make available those coverages that would've been offered because the market would’ve demanded them, people with only a few health concerns would not have had to pay for those they are certain would not ever have applied to them.

Even high deductible policies for catastrophic illnesses were not allowed until the Medical Saving Accounts came into being, and then they were authorized only for that purpose. That was another case of the government looking to keep people from having deductibles that were to high by the politician's reckoning; in reality it was the government levelling out the system. That is the extent of government tampering in the health insurance industry.

Personally I blame the government for almost every bit of the distortion we see in today’s health care market place. First they break it, then they trash it, then they replace it with an inferior product. It will matter to you in the end; just wait and see. Rationing will be the outcome. If at 65 you need a knee replacement so that you can remain productive for another 10 years because you can't live on inflated dollars, thus adding to your social security check so that you can remain a productive citizen; you may be relegated to a "power chair"(if one is considered cost effective). Keep some good reading handy for the boredom....because you may not be able to afford your broadband computer link and your Cable TV. I know, probably 75% of the people here think that will never happen to them. I didn't, but I see it coming now.
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