Why We Must Ration Health Care

[groovedaddy]

(From the NY Times Magazine - posting for comments - GD)

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting last month with five governors, President Obama urged them to avoid using the term, apparently for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform. In a Wall Street Journal op-ed published at the end of last year with the headline “Obama Will Ration Your Health Care,” Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described how in Britain the national health service does not pay for drugs that are regarded as not offering good value for money, and added, “Americans will not put up with such limits, nor will our elected representatives.” And the Democratic chair of the Senate Finance Committee, Senator Max Baucus, told CNSNews in April, “There is no rationing of health care at all” in the proposed reform.

Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. “So,” he says, “would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the price.” The man’s response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it’s immoral to apply monetary considerations to saving lives — but is that stance tenable?

http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=1&th&emc=th

[bluestateguy]

1. Rationing would actually benefit the rich

Yes, I know that we already have rationing under a private health insurance regime.

As it stands now, a wealthy person who is denied coverage for a procedure will just pay for it out of pocket. Everyone else will do without. I would call that rationing too.

If you have the government rationing care, then much of the same thing will happen: a wealthy 90 year old man who is denied a hip replacement operation will just hop a plane to another country, where he can pay top have the procedure done. Everyone else will not have that option.

[Mojorabbit]

2. It is a conversation

we need to have as a country but I don't see it happening... at least not in a rational way. I did a lot of things as a nurse that were painful and unnecessary and performed useless treatments because families wanted all stops pulled out for their loved ones no matter what when the prognosis was poor. Families need to have this discussion beforehand. Living wills need to be filled out. Some educational programs would be a big help.

[FormerDittoHead]

8. My brother's a doctor. He agrees about people needing to accept death more gracefully.

Excluding the chronically ill (diabetes, dialysis, etc) 50% of one's lifetime medical expenses come in the few months before dying.

My brother (the doctor) says, "I wish we could let someone die without having to spend $200,000 on them..."

WHILE WE'RE ON THE SUBJECT: IF I'M DYING I WANT SOME DRUGS! My mother died of cancer - she was CONSTANTLY pushing the button on that damn dosage box. BUT WE CAN'T TAKE THE CHANCE OF HER GETTING HIGH...

ON ANOTHER NOTE, if we could postpone Alzheimer's Disease for 5 years, we'd reduce nursing home occupancy by 50%.

[xchrom]

3. up and down the private insurance system -- they already ration health care.

and it's not just uninsured.

we -- well most of us -- have already encountered both major and minor ways insurance companies have 'rationed' our health care.

[Warpy]

4. Doctors already do common sense rationing

when they don't put actively drinking alcoholics on a liver transplant list or do heroic cardiac surgeries on debilitated patients in their eighties or nineties. Such patients are simply not going to do well and the surgeries will destroy what little quality of life they have left before the inevitable.

Perhaps that might be the function of for profit insurance in the future, covering such heroics in such patients who are nuts enough to want them and can find doctors with poor ethics to do them.

[sinkingfeeling]

5. I'm surprised this ran in the NY Times.

[endarkenment]

6. We already ration healthcare, we just don't have input into the process.

Real healthcare reform would make the rationing of healthcare a democratic rather than an autocratic process.

[baldguy]

7. +1

We ration on the ability to pay, rather than need.

[groovedaddy]

9. The ability to purchase additional insurance, which, I assume will still be there, should take

the sting out of this concept for the wealthy. As long as that option is there, there will always be rationing of some sort.
What is happening with this in the countries that already have a single payer system?

[jody]

15. A democratic process like in a simple majority determines who receives health care? n/t

[RC]

10. Why should any drug cost $54,000?

Is this drug or some similar available in any other county? If so how much does it cost there? If not, why is it not available?
And this begs the question; Why does the answer to the question of whether you live or not when you have a medical problem, always hinge on how much money you have access to? Isn't it about time we realize peoples worth are not always counted in the coin of the realm?

[Wednesdays]

11. K&R

:kick:

[CHIMO]

12. One Total Bunch Of Crap

Just ask the politicians to live like ordinary people.

[groovedaddy]

13. Or elect ordinary people. n.t

[jody]

14. See related DU thread “Man refused liver transplant dies” in UK (BBC News)

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6115954

[Name removed]

16. Deleted message

Message removed by moderator. Click here to review the message board rules.

[gwashington2650]

17. Ridiculous

Um, we already are rationing.