Category: Rationing Health Care

What Is ‘Socialized Medicine’?: A Taxonomy of Health Care Systems – Economix Blog – NYTimes.com

What Is ‘Socialized Medicine’?: A Taxonomy of Health Care Systems – Economix Blog – NYTimes.com:

“Socialized medicine refers to health system in which the government owns and operates both the financing of health care and its delivery. Cell A in the chart represents socialized medicine.

“Social health insurance, on the other hand, refers to systems in which individuals transfer their financial risk of medical bills to a risk pool to which, as individuals, they contribute taxes or premiums based primarily on ability to pay, rather than on how healthy or sick they are.”
………..
“Former Mayor Rudolph Giuliani of New York has exemplified the perennial confusion in this country over socialized medicine. In his ill-fated presidential bid, and subsequently as a supporter of Senator John McCain’s bid for the presidency, Mr. Giuliani routinely decried as socialized medicine (or “socialist”) any proposal presented by Democratic candidates, because typically the latter advocated tax-financed subsidies toward the purchase of health private insurance or expansions of public insurance programs. But technically none of them advocated socialized medicine.

“Perhaps Mr. Giuliani was unaware that Americans all along the ideological spectrum reserve the purest form of socialized medicine — the V.A. health system — for the nation’s veterans. I find this cognitive dissonance amusing. Indeed, if socialized medicine is so evil, why didn’t Republicans privatize the V.A. health system when they controlled both the White House and the Congress during 2001-06?

“Mr. Giuliani also seems to forget that, in 1996, he found social health insurance a perfect solution to the financial problems faced by former Mayor John V. Lindsay, who fell on financially hard times during the 1990s as a result of chronic illness. “

The chart in the piece is a little tough, the text is better, specifically the first two paragraphs above.

But to me, the key is do we want to continue to decide who can get health care and health insurance based upon their luck? And I don’t mean luck in being financially successful, I mean luck in not getting a chronic, life threatening, debilitating illness. And if we get lucky, and make it to Medicare without a big illness, do we really want to rely on that luck holding out for our children, our nieces and nephews, our grandchildren? I don’t.

Uwe Reinhardt: A Medicare-Like Plan for the Non-Elderly – Economix Blog – NYTimes.com

A Medicare-Like Plan for the Non-Elderly – Economix Blog – NYTimes.com:

“A public health plan, however, strikes fear in the hearts of many interest groups. There are several reasons for this.

“First, it is only human that the politically powerful private health-insurance industry opposes competition from such a plan. The industry argues, not without justification, that a public plan might be advantaged by dictating to providers lower prices for health care services and products, and it might benefit from hidden subsidies. That unfair advantage could squish the private plans to the wall.

“But even if those comparative advantages could be eliminated through careful design of the public plan, the industry probably fears the inherent appeal that a public plan might have among the American people.

“The providers of health care and health care products, to whom “national health care spending” represents “national health care incomes,” fear the market power that a public health plan might bring to the demand (payment) side of the health sector.

“Greater market moxie on the demand side, they fear, might significantly bend down the lush, currently projected, long-run growth path of America’s health spending, which has national health spending rise from the current 16.6 percent of gross domestic product to 20.3 percent by 2018 and to 38 percent of G.D.P. by 2050. Once again, it is only human that the supply side of the United States health system prefers a continuance of the weaker, more fragmented demand (payment) side that for four decades now has allowed health spending to grow in excess of 2 percentage points faster than the rest of the G.D.P.

“The most powerful ordnance lobbed at the public health plan by its opponents is the dreaded “R” word, that is, the prediction that it will lead to the rationing of health care in America. In the debate on health policy, getting slapped with the R-word has always has been the kiss of death for any proposal.

“Evidently, many Americans do sincerely believe that when a public health plan refuses to pay for a procedure it is “rationing,” while denial of health care to an uninsured, low-income individual who cannot afford to pay for that care is not. But as textbooks in economics explicitly teach, the role of prices in a market economy is precisely to ration scarce resources among unlimited demands.

“The American health system has rationed health care by price and ability to pay all along for a sizeable segment of the United States population. In its report “ Hidden Cost, Value Lost,” for example, a distinguished panel of experts convened by the Institute of Medicine of the National Academy of Sciences estimated that some 18,000 Americans die prematurely for want of health insurance and timely medical care. That is rationing life years.”

Foregoing care due to cost | New America Blogs

HEALTH CARE: If This Is An Emergency, Please Press “Can’t Afford It” New America Blogs:

From the New America Healthcare Blog …

“Imagine being sick enough or hurt enough to rush to an emergency room—and then leaving without getting the recommended tests or treatment because you can’t afford it.

“Doctors have a name for those discharges—’Against Medical Advice.’ It seems to be happening more often, both in the ER and in the rest of the hospital as health costs rise and insurance coverage falls.

“MSNBC interviewed several doctors and patients about how the economy is affecting emergency care. A patient with acute appendicitis needing emergency surgery who waited for his mother to drive him to the hospital so he wouldn’t have to pay for an ambulance. A patient with an infected kidney stone. People with chest pains who were not in the throes of a life-threatening heart attack that very minute but who couldn’t or wouldn’t follow up to find out what the pains signaled. A 31 year old knocked unconscious in a bike crash, who asked about the cost of the recommended follow up, only to be told by the ER doctor, that she was ‘a physician, not an accountant.’ Declining treatment, he still got a $600 bill.”

There’s more at New America and at MSNBC…

I would only add this, from a wise NY Times reader:

Mr. Krugman rightly notes that emergency room care cannot substitute for health insurance since the cost will be billed directly to the patient.

There is another reason emergency rooms cannot provide adequate health care. Emergency rooms are for emergencies. They can treat a patient in a diabetic coma, but they cannot provide continuing help in managing diabetes. They can treat a full-blown asthma attack, but they cannot provide the medications needed to manage asthma daily.

They can treat a woman who has gone into early labor, but they cannot provide prenatal care.Emergency rooms cannot offer any help for managing Parkinson’s, Alzheimer’s or cancer. On a more basic level, they cannot provide eyeglasses, hearing aids or dentures.

Republican claims that no American is without access to health care because “you can just go to an emergency room” are openly false as well as appallingly callous.

Charles Krauthammer – Obama: The Grand Strategy

Charles Krauthammer – Obama: The Grand Strategy:

“It is estimated that a third to a half of one’s lifetime health costs are consumed in the last six months of life. Accordingly, Britain’s National Health Service can deny treatments it deems not cost-effective — and if you’re old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures like hip replacements.”

And we ration by income, employment circumstances, insurance company whim, or genetic lottery (i.e., pre-existing conditions).

Imagine if Canada or Britain pulled 1/6 to 1/3 of their population out of the queues for these reasons. Do you expect their waiting times would be as long?

And it is also worth pointing out that the OECD has looked at waiting times and we are not alone among countries in having no significant waiting times. We are the only one of them that rations as I’ve pointed out.

So, just say it straight up: If we let the less fortunate into the system it’ll ruin things for the “good people.”

With Son in Remission, a Family Struggles to Find Coverage – NYTimes.com

With Son in Remission, a Family Struggles to Find Coverage – NYTimes.com:

“Now the Walkers face the possibility that Jake will no longer be seen at Houston’s renowned M.D. Anderson Cancer Center, which they credit for his remission.

“You realize how vulnerable you really are,” said Ms. Walker, who exhibits the maternal ferocity of a black bear. “You just — not give up — but you just feel that you’re at a loss, that you’re at your wits’ end. I ask myself, ‘Do I really have to lose my home to save my son’s life?’ ”

Neither of the Walkers has been able to land a job with the kind of large group coverage that would disregard Jake’s health status. His cancer history effectively makes him uninsurable on the individual market. He is too old to qualify for Medicaid as a child, and it is virtually impossible in Texas to qualify as an able-bodied adult.

Because the Walkers own their modest house, they have been told they do not merit other government assistance. With little predictable income beyond Ms. Walker’s $688 unemployment check every two weeks, the family cannot afford the state’s high-risk insurance pool or continuation coverage through the federal Cobra law.

To date, Jake’s treatment has cost nearly $2 million. Almost all of it has been paid by Cigna under a preferred-provider family policy that Ms. Walker paid $426.28 a month for through DHL, the troubled shipping company where she worked as a billing agent.

Until last fall, Mr. Walker was the co-owner of a business that supplied DHL with trucks and drivers, but it too fell victim to downsizing. The feed store, the last in an area where suburbs are swallowing ranchland, has been losing money.

What has made the Walkers feel most helpless, though, is that their son has been left so exposed, after all he has endured.

“Your job as a parent is to protect your children at any cost,” Ms. Walker said. “I really felt like I had let him down.””

At the beginning of the article, Mrs. Walker’s salary was noted to be $37,000. She paid, out of that, $426 a month for her health insurance (admittedly, pretty darn good insurance given the expense of Jake’s treatment). $426 x 12 = $5112 per year bringing her salary down almost 14%, not counting the subsidy on the employer side, probably close to another $5K.

The economic costs are brutal enough, but the fear, uncertainty, and skimping on care (prescriptions, skipping office visits, etc.) are just not acceptable in the richest country in the world.

Insurers shun those taking certain meds – Costs of Care – MiamiHerald.com

Insurers shun those taking certain meds – Costs of Care – MiamiHerald.com:

“Trying to buy health insurance on your own and have gallstones? You’ll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

“This confidential information on some insurers’ practices is available on the Web — if you know where to look.

“What’s more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.

“These issues are moving to the forefront as the Obama administration and Congress gear up for discussions about how to reform the healthcare system so that Americans won’t be rejected for insurance.”

No surprises here, just documenting.

But it does make an interesting contrast to a letter written to the New York times on their piece on a public insurance option by a rather alarmist (and ill informed) physician:

“The unfair competition from a public plan would destroy the private health insurance industry. The inevitable result would be the rationing and other horrors of a Canadian-style single-payer system, which most Americans neither wish nor deserve.”

Rationing, in America! God forbid.

Panorama (BBC) Documentary on US Healthcare

The episode is entitled “What Now, Mr. President?” Sadly, there is probably nothing you didn’t already know in here, but it is a good program to share with your friends who still beleive in the Best Healthcare in the World(TM) myth.

Part 1

Part 2

Part 3

Has a section on RAM Medical, which “60 Minutes” covered last year, as well as a section on wealth disparity, health care lobbying, drug pricing, and a few striking anecdotes, if you like that sort of thing. (Getting chemo in a tent, begging for Tennessee Medicaid toive a liver transplant, and thousands seeking help at RAM.)

More Americans Skipping Necessary Prescriptions, Survey Finds – NYTimes.com

More Americans Skipping Necessary Prescriptions, Survey Finds – NYTimes.com:

“One in seven Americans under age 65 went without prescribed medicines in 2007 as drug costs spiraled upward in the United States, a nonprofit research group said on Thursday.”

Medical Debt Is a Growing Worry, for Those With Insurance and Without – washingtonpost.com

Medical Debt Is a Growing Worry, for Those With Insurance and Without – washingtonpost.com:

“‘People who are underinsured end up facing almost identical problems as the uninsured,’ said Karen L. Pollitz, director of the Health Policy Institute at Georgetown University. ‘The difference is, they paid for the privilege.’

“Medical debt is likely to figure prominently in the looming national debate over reforming health care.

“Jim Eyler, 57, of Westminster, Md., says he needs help. The cement company manager said he spends about 33 percent of his take-home pay on unreimbursed medical bills, many connected with the advanced breast cancer his wife has been battling since 2005. ‘I keep wondering, where’s the money going to come from?’ he asked.”

More anecdotes here, of course, but the larger point is that our current cost structure is unsustainable.

Blue Shield to restore coverage for dropped Californians – Los Angeles Times

Blue Shield to restore coverage for dropped Californians – Los Angeles Times:

“In an attempt to settle investigations prompted by articles in The Times, the insurer agrees to reissue plans to almost 700 Californians and reimburse them for expenses that would have been covered.
By Lisa Girion [January 7, 2009 ]

“Blue Shield has agreed to reissue medical coverage to nearly 700 Californians whose policies were canceled after they got sick and to make changes in the way it handles insurance bought by individuals, officials said Tuesday.

“Blue Shield of California’s Life & Health Insurance Co. also agreed to reimburse consumers whose coverage was canceled for medical expenses they paid out of pocket.”
…
“Most of the state’s health insurers remain mired in litigation over the practice that has led to the cancellation of thousands of policies of sick patients, as well as financial losses for them, physicians and hospitals. In addition, Los Angeles City Atty. Rocky Delgadillo has sued Anthem Blue Cross, Blue Shield and Health Net, accusing all three of improperly dropping customers.”
…
“When the state’s charges were initially filed, Ross called them “grossly unfair.” Blue Shield and other insurers have maintained that state law allows them to review a patient’s old medical records after they get sick and rescind coverage if it finds something the policyholder failed to disclose on his application — whether intentionally or by mistake.

“Consumer advocates and lawyers have accused Blue Shield and other insurers of using purposefully confusing applications designed to trick people into making mistakes that can later be used against them and of failing to properly vet the applications before issuing coverage.”

God bless the American Businessman! Or woman. (Sorry, Loretta!)