House Majority Leader Steny Hoyer has defended the appointment of socialized medicine and health care rationing fan, Dr. Donald Berwick, to head Medicare/Medicaid. As to Berwick’s advocacy of rationing, Hoyer punted, saying in essence, that care is already rationed. But it’s not. From the story:
Hoyer went to say he was not familiar with “the full quote” from Berwick and would not comment on his views, but he repeated the Democrats’ claim that health care rationing is commonplace in America through health insurers that deny care based on cost. “Clearly health care is rationed right now,” said Hoyer. “That was the whole issue in this debate: to make health care affordable and accessible for all Americans. Why is it not accessible to all Americans? Because it’s not affordable to all Americans, [and] to that extent it’s rationed by cost.”
That’s not rationing. Because some people can’t afford cars, doesn’t mean that automobile ownership is rationed. It means some people can’t afford a car and therefore have to find alternative means of transportation. Rationing occurs when a government legally imposes limits on access to a service or product–as it did with gasoline during World War II.
Health care, rationing–in the sense for which Berwick swoons–is a form of invidious discrimination, that is, some people are denied efficacious treatment under the force of law that is available to other people, based on membership in predetermined categories, e.g. age, disability, seriousness of illness, etc. For example, if a rationing board decreed no hip replacements to people age 70 and over, that would be a form of medical discrimination based on age. If a person in a permanent unconscious condition is denied a feeding tube, available to other patients, that would be discrimination based on disability.
Another form of rationing restricts efficacious treatment based on quality of life. This is the kind imposed on Oregon Medicaid, where more than 700 interventions are listed, but only 625 (say) are covered based on available money. In that kind of system, those with political clout end up covered, and those without find themselves on the low end of the stick–as happened in Oregon with late stage AIDS (covered) and some forms of late stage cancers, (not covered). Recall, that Oregon Medicaid refused life-extending chemotherapy to Barbara Wagner and Randy Stroup, offering to instead pay for their assisted suicides
We need health insurance reform–just not Obamacare. But alleviating the very real problem of opening access to insurance does not justify legalizing medical discrimination against the most weak and vulnerable among us.
June 3rd, 2010 | 10:23 pm
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June 4th, 2010 | 12:26 am
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June 4th, 2010 | 2:57 am
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June 4th, 2010 | 8:45 am
From the OED:
rationing: to restrict to limited allotments.
Doesn’t say anything about who’s doing it. I agree with Hoyer; rationing by ability to pay is covert rationing, but rationing nonetheless.
June 4th, 2010 | 11:38 am
This is a case of using weaselly definitions. An economist might say that goods are rationed by price, but most folks assume “rationing” means a formal program to limit how much of something you can buy, implemented by government or suppliers.
If people hear that “gasoline is being rationed”, they’re going to assume that it’s back to having stamps for a monthly allotment of gallons, rather than that gasoline costs money.
Wesley J. Smith Reply:
June 4th, 2010 at 1:16 pm
SparkVark: Exactly. And it is a symptom of the illness from which we are suffering that sucks the vitality and specificity out of language for relativist purposes.
June 4th, 2010 | 2:42 pm
So, if my insurer declines to pay for my treatment, it’s not rationing. But if Obamacare declines to pay for my treatment, that is rationing. That about sum it up, Wes?
Talk about weaselly definitions…
Wesley J. Smith Reply:
June 4th, 2010 at 3:57 pm
padraig: No it isn’t. If it refuses to pay for a treatment it is obligated to pay for, it is breach of contract. If they refuse knowing they owe, it is known as “bad faith,” and is a tort that can bring punitive damages and regulatory fines.
June 4th, 2010 | 2:58 pm
“An economist might say that goods are rationed by price, but most folks assume ‘rationing’ means a formal program to limit how much of something you can buy.”
Er, yes, this is precisely why it’s appropriate to use the word “rationing”: in order to disabuse them of that mistaken notion. It would be incredibly thick to pretend that people who made Hoyer’s argument were somehow unaware of the word’s meaning or intended to trick people – in fact, the far likelier scenario is that Republicans were trying to trick people by insinuating that health care would vanish behind red tape and interminable waiting lines.
June 4th, 2010 | 3:25 pm
One thing that’s confused me about this — a subject about which I know very very little — is that don’t doctors and medical institutions do some kind of “rationing” now?
Someone needs an organ transplant to survive. Some group at the hospital determines that this person, due to age, overall medical condition, other chronic conditions would likely only survive a short time, while another candidate would live much longer or whatever.
Isn’t that a form of rationing?
And what about Hoyer’s point — that the issue is health care is not affordable by some number of Americans?
Wesley J. Smith Reply:
June 4th, 2010 at 3:55 pm
Organ waiting lists are actually triage, not rationing. There is a difference.
If you read my post I agree we need health insurance reform. Not Obamacare. Not rationing Thanks, J.W.
June 4th, 2010 | 4:06 pm
In other countries where they spend roughly 60-70% less on health care based on percentage of GDP, rationing is built into the system as a reasonably effective effort at cost containment. The result is that, for the majority of cases, effective treatments are not the ones that end up being rationed. The treatments that are left unapproved are those that cost the most but provide the least benefit such as expensive treatments that might extend the lives of patients by a few months.
Stating that limited access to treatment based on cost is not a form of rationing is simply playing with words.
Wesley J. Smith Reply:
June 4th, 2010 at 4:26 pm
How is it playing with words? If a terminal cancer patient is denied life-extending chemo, that’s rationing an efficacious and effective treatment. Rationing does cut costs. And it does hurt patients.
June 5th, 2010 | 7:45 am
“If [an insurance company] refuses to pay for a treatment it is obligated to pay for, it is breach of contract. If they refuse knowing they owe, it is known as ‘bad faith,’ and is a tort that can bring punitive damages and regulatory fines.”
Right. And so they protect themselves by using terminology such as “experimental,” “reasonable” and “customary” to protect themselves, and they play fast and loose with their definitions of “pre-existing conditions.” So, all folks have to do is hire a lawyer to read all those pages of fine print to them.
June 8th, 2010 | 4:44 am
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