During a layover in Auckland on my way to OZ, I picked up a New Zealand Herald and read a commentary by one Gareth Morgan, an expert on the Kiwi health system. In “Best Treatment Goes to the Loudest,” Morgan complains that those able to push their weight around receive better care than others. From his column:
The way the limited resources of our public health system are allocated across those in need is increasingly ad hoc and unfair. Because of the lack of a coherent and consistent framework for allocating resources – across conditions, patients and regions – we have an ugly situation where the loudest get served first. Put bluntly, it’s an obscene abuse of universal health care.
The people who benefit most, says Morgan, are the aggressive and politically connected:
When researching our 2009 book Health Cheque, Geoff Simmons and I were told by numerous professionals inside the system that on a daily basis they are put under undue pressure from patients and their agents (family members, MPs, lobby groups) and the disturbing reality is that the squeaky wheel gets the oil. The typical scenario is when the patient’s people threaten to go to their MP, go to the media and so on unless they get the service they think they deserve, then the system is abused. Blackmail of busy health professionals like this is offensive but sadly is common, resulting in those with the loudest advocates getting served in front of others, just so the professionals can move on and attend to others.
Gee, imagine standing up for your loved ones in a system that wants them to deny care! But to a collectivist–and that term would surely apply to the New Zealand health care system as described by Morgan–that’s verboten. Patients should meekly accept the restrictions that the bureaucrats or doctors impose.
Unsurprisingly, those who get left behind tend to be politically weak and societally marginalized:
It is wrong, it is unfair but it is the reality – the needs of those without access to strident advocates are being trampled under as the loud lambast their way to the front. Hardly surprising that over-represented in those being neglected are Maori and Pacific Islanders, although in no way is it restricted to them.
This is what comes from centralized universal care–it is that in name only. Morgan goes on to urge:
The time is overdue to introduce transparency and objectivity into the process of allocating health services and ensuring the whole ethos of universal entitlement is being honoured. In order to do that, transparency over how the fixed health dollar is allocated is necessary and the process by which the allocation is made has to not just be seen by all to be objective, but has to actually be objective
That’s impossible, because rationing is inherently political, which is to say, it cannot be objective.
What Morgan really means is that it is objective to follow his views on who should be cut off, with the example he gives in this piece rationing the elderly based on societal benefit. But even that over simplifies. In rationing, it is not only the old versus the young, but also, MS patients, versus cancer patients, versus women demanding IVF, versus, perhaps one day, transgenders’ sex change operations (currently paid by the City of San Francisco for its workers, for example).
Health care rationing is medical descrimination by a polite name to let us sleep at night, and creates a system where coverage is a form of political patronage and pork. And in Morgan’s rather crassly utilitarian and it seemed to me, somewhat misanthroic piece, there is a warning for the USA. Under Obamacare’s cost/benefit panels there will be rationing. But it is not to late to learn from the travail of others and go in a different direction.
July 6th, 2010 | 4:48 am
[...] This post was mentioned on Twitter by Vince Humphreys. Vince Humphreys said: SHS: New Zealand Demonstrates Peril of Rationing to Politically Weak http://bit.ly/dqNCIv #tcot [...]
July 6th, 2010 | 6:19 am
Wesley:
Your argument is the equivalent of saying we in the US ought to throw out our entire form of government because there are some problems with campaign finance.
Morgan is not attacking the underlying concept of health care entitlement: he’s complaining about “the lack of a coherent and consistent framework for allocating resources – across conditions, patients and regions…” It’s an administrative problem in need of reform.
It’s nonsensical to compare a country like New Zealand, whose entire population of about 4.3 million is less than half the size of New York City’s, to our own (pop. 310 million). New Zealand’s taking a measure of care in allocating its limited facilities is simply prudence. They’re concerned about health care going disproportionately to the loudest. You obviously would prefer that it go disproportionately to those with the deepest pockets. Your use of the terms “rationing” and “collectivist” to describe its system of universal health care under the circumstances is just one more instance of the propagandist word-manipulation employed by enemies of American health care reform. There is NO comparison.
I could be kind and attribute your distortions of fact to the effects of jet lag, but I think we all know better.
HW
Wesley J. Smith Reply:
July 6th, 2010 at 1:58 pm
Ha! You and Jeffrey and David crack me up you are all so utterly predictable and reflexive in your reaction to this post. In the lead up to passage of Obamacare, Ocare supporters yelled–that there would not be rationing, that it was all alarmism yadda, yadda, yadda. NOW you yell that it is the only way! How else are you going to cut costs! Predictable even in my jet lagged fuzzy state. Death panels anyone?
July 6th, 2010 | 7:52 am
What is your plan to reduce healthcare costs and improve fairness and quality in the US? American citizens pay about double what citizens of NZ, France, Canada, Sweden, Japan etc pay, and we get lower quality care to boot. Each year, Americans pay an effective healthcare “tax” of about $ 1 trillion. For our extra trillion we get a healthcare system that ranks in the twenties or thirties for most healthcare measures (except cost; We’re number 1!).
Our system is bankrupting us and both Democrats and Republicans recognize this. Aside from draining the treasury and personal wealth of Americans, our approach is making America and American businesses less competitive in a global market. Presidents Clinton and Obama have each tried to improve the system.
What is your plan to cut healthcare expenses in half and make certain the poorest of Americans has reasonable access? It seems like a tall order, yet every industrialized nation on earth, save one, has done it.
Here’s a list of nations with healthcare delivery systems ranked higher than ours overall: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Japan, Luxembourg, New Zealand, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom. These nations can’t be killing too many senior citizens and babies since most have longer life expectancies and lower infant mortality than the US.
Tens of thousands of Americans die unnecessarily every year from limited access to healthcare services. Why does no one lobby for them? Why are their lives not important to bloggers?
July 6th, 2010 | 12:05 pm
I like the old rationing, whereby, for example, old, fat white guys who inherited their dad’s business get to occupy the health care system. They get to complain about back aches and tie-up doctors by purchasing extensive care, rather than lose some weight and take care of themselves. Meanwhile, it’s hilarious to watch poor people suffer with complications that could have been nipped in the bud years ago, if they could have just afforded simple, preventative care.
How dare this Morgan fellow want people to accept his views! Master Smith would never get huffy over his views.
July 6th, 2010 | 3:12 pm
Wesley: ALL health care is rationed. We get what our health care policies entitle us to, and nothing more. Them that have get, and them that haven’t don’t. It’s that simple.
Obviously you’ve never had the experience of an insurance company bureaucrat deciding that a particular course of treatment shouldn’t be undertaken, or that it won’t be paid for because it’s “experimental.” I have, so kindly spare us the BS until you’ve had similar experience.
Obviously it isn’t jet lag at work; it’s plain old thick-headedness.
HW
July 6th, 2010 | 10:30 pm
Hi Wesley,
I’ll stand with you against these nincompoops. It isn’t really surprising that rationing is happening in such a system and that those that get the largest share of this “equal” system (“4 legs good 2 legs better” anybody?) are the politically connected.
What this utopian clowns fail to realize is that no system is going to be perfect. That all systems will fail in various ways and that in reality all you can hope for (and the only sane thing to aim for) is a system with a set of trade offs you can live with.
It would be nice if they could be sufficiently economically literate to understand this, but I suspect that is a hopeless endeavor.
Jason
July 6th, 2010 | 11:07 pm
Wesley,
You miss the point. Universal healthcare reduces rationing. Tens of thousands of Americans die each year due to limited access to healthcare services, rationing at its most raw. And we pay double for this system.
As outlined by HW, insurance companies already ration care daily.
So what exactly is your point? For all your anecdotes detailing the terrible abuses in universal healthcare, why have no nations rescinded their systems?
Wesley J. Smith Reply:
July 7th, 2010 at 3:08 pm
Jeffrey: We’ve been through this how many times? That’s not rationing. And the answer to relieving that access problem is not government imposed rationing.
July 7th, 2010 | 2:45 am
I’m a Kiwi and also read Gareth Morgan’s piece with interest. My brother’s a doctor here in New Zealand and I know for a fact that our health system isn’t perfect – but if you’re in need of urgent surgery you get it, no matter who you are. There are waiting lists for non-urgent procedures and some people will try all sorts of things to further their case, but that’s just human nature.
However, everybody I know here in NZ thinks it’s crazy that the US doesn’t have a national healthcare system. It’s such an integral part of being a 1st world country – how can you not think it’s a good idea??
NM
Wesley J. Smith Reply:
July 7th, 2010 at 3:07 pm
NM: Well, we don’t want to get into the kind of crass discrimination Morgan advocates. NZ may think that’s crazy, but many Americans think we can expand access without victimizing those no longer seen as too expensive for society to bear. Been there before in the world and it leads to the worst oppression. Thanks for commenting.
July 7th, 2010 | 7:10 am
Regarding the question of arbitrary rationing based on political considerations: here it comes. It MUST accompany a plan like Obamacare.
Canada, the UK, etc rated higher than the US in health care? Are you (commenter) kidding? It begs the question, who’s doing the rating, and on what basis? The only reason Canada, for example, gets away with socialized medicine is that the bill hasn’t come due yet, to say nothing of the fact that a relatively free system–ours–has been available to fill in the gaps in theirs. In fact, the whole rest of the world has “gotten away with” socialized medicine because there was one very advanced economy in which there were still incentives for development of new procedures, devices and drugs–ours. When that goes away, let’s just see how these other places do.
What would we do instead of Obamacare to control medical costs? Plenty, that hasn’t been addressed yet, for (that word again) political reasons. We could rein in the runaway tort laws and practices, which add cost on cost far in excess of even the huge malpractice insurance premiums we hear about. We could break the monopolistic effects of the AMA, which helps limit supply of doctors, and facilitates price-fixing. We could restructure insurance to lessen “moral hazard”, the tendency to overuse resouces whose cost is hidden, and to manipulate the payment system. We could expand the use of tax-free health savings accounts and other forms of self-funding. We could, in fact, defend our borders so as to not be saddled with the cost of medical care for the outlaw who does not belong here.
None of these have yet been addressed. And somehow, one thinks that the socialized medicine whose failure and perversions are fully predictable in theory, and empirically seen already (like the brutal rationing of NICE in Britain, and the overt euthanasia in The Netherlands on the unwilling as well as the willing) will solve the problem. Outrageous.
July 7th, 2010 | 7:30 am
Jason:
Verbal [deleted--too nasty, HW] will get you nowhere.
HW
July 7th, 2010 | 10:02 am
Hi Jason,
I was surprised Wesley allowed your comment that was little more than namecalling. In any case, this nincompoop is sufficiently economically literate to recognize that the US system is worse than that of most industrialized nations and costs twice as much!
Your solution that “since no system is perfect… whatever”, is the conservative mantra. You’re correct, no system is perfect, but every system can be improved. Our system will bankrupt America. Any suggestions?
July 7th, 2010 | 3:26 pm
Smith:
I never claimed Obamacare wouldn’t ration. In fact, I claimed nearly the opposite – in economics virtually everything is rationed. I’ve stated this. In fact, I also claimed on your blog that Obamacare would raise costs some – and save in some areas. In fact, on your blog, I cited Baumol’s law as a primary reason why health care costs won’t go down, including under Obamacare.
Research the blog and look these things up. Either you clearly aren’t reading them, or you have an exceptionally poor memory.
I’m not quite sure what to make of the inability in reading comprehension.
Have you ever tried “hooked on phonics”, or some other remedial reading assistance program? Or do you make stuff up due to a psychological delusions you suffer from?
Given your demonstrated lack of analytical ability, coupled, perhaps, with compulsive delusions, I really see no difference between this and your “jet lagged state”. If travel does jet lag you, I’m sorry you are that mentally weak. I never experience it when I travel overseas.
So, Nimrod, look up Baumol’s effect in economics. Let us know if you have trouble understanding it, especially the math.
July 7th, 2010 | 8:32 pm
Joe DeVet,
In fact, your proposed solutions to the healthcare crisis have been addressed.
None have a significant impact on costs and overall quality of healthcare. For example, the CBO estimated that tort reform would save $54 billion over 10 years, or less than 0.5% of total healthcare spending per year. The healthcare reform bill specifically states that “undocumented aliens” will not be eligible for credits to help them buy health insurance, in Section 246 on page 143. HSA lower costs but also reduce overall quality.
July 8th, 2010 | 12:53 pm
Wesley: would you prefer “Onanism”?
July 8th, 2010 | 3:17 pm
From the article:
“Politicians tried, of course, to implement a rationing system via then-health minister Simon Upton’s ill-fated core services committee of 1992, but its approach – to ask the public what it wanted the public health system to provide – was as flawed as asking an infant in a candy shop which sweeties they wanted.”
Asking the public what they want out of a public health system? That’s crazy talk! There’s something about universal health care that brings out the hauteur in people.
In a democratic society, political decisions will be made through influence, argument, and political maneuvering. If health care is within the gift of government, health care decisions will be made in the same way. I’m not sure how people who want sober, technocratic rationing of health care plan to get it when a democratic government is in charge of it.
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