Showing posts with label rationing. Show all posts
Showing posts with label rationing. Show all posts

Saturday, June 7, 2014

VA scandal is an indictment of US health care, not Big Government

Bravo, Mr. Wapshott!  Conservatives too often employ a version of the following syllogism: John is bad; John is a government employee; thus all government employees are bad.  

Here's a good 'graph:

Cannot those employed on salaries by private companies, particularly employees of corporate behemoths who operate near-monopolies, also ration their customers and say they have been put them on waitlists that do not exist? Can employees of commercial firms not also be corrupt and lazy? Does the free market not employ salaried workers? This muddled thinking is simply partisanship posing as intellectual rigor.

Intellectual rigor mortis, yes, but intellectual rigor among conservatives? Heck, no!  

Waitlists, Charles Krauthammer laments?  Gee, I called my primary care physician in January; he said the earliest he could see me was April.  Rationing, he says?  Gee, what do you call preferred providers networks, approved lists of procedures, payment ceilings, and the whole list of restrictions that private insurance companies put on our health care to cut costs and increase their profits?Private health insurance is all about rationing, because that's the only way they make money!


By Nicholas Wapshott
June 3, 2014 | Reuters

For some, the veterans hospitals scandal is a human tragedy pure and simple. Those who loyally served their nation in uniform, putting their lives on the line, were shunned when they sought medical help.

For others, however, the troubles at the Department of Veterans Affairs have provided what one pundit called “A gift from God.”

For those commentators, the scandal confirmed their worst fears. The logic runs like this: The VA provides a government-run health service; the failures of the VA are a disgrace; ipso facto, all government-run health systems are a disgrace; proving that all government-run bodies are a disgrace. So all government should be sharply reduced — if not abandoned altogether.


The VA troubles, however, prove no such thing. The poor treatment of veterans has nothing to do with funding and everything to do with administrative incompetence combined with craven deceit.

Anyone who has been kept waiting inordinately by a doctor or hospital, or who has had their treatment or prescription drugs denied by their health insurance company, knows that. Anyone kept hanging on the line for an ill-named “customer service representative” and told by an automaton, “Your call is important to us,” knows that private companies treat customers with equal disdain.

The difference is that in the VA scandal, democratic accountability eventually — it took far too long, we know — kicked in. The top man resigned and top managers who presided over the incompetence and subterfuge were fired. It is a further scandal that it took President Barack Obama himself to push the wrongdoers into admitting responsibility. But at least the problem was ultimately addressed.

When can you remember a chief executive officer of an aberrant cable TV company or phone or utility company or even a health insurance company — fill in your favorite offender here — falling on their sword for keeping their customers waiting?

This is the full quote from the “Gift from God” analyst, former neurosurgeon Ben Carson: “What’s happening with the veterans is a gift from God to show us what happens when you take layers and layers of bureaucracy and place them between the patients and the healthcare provider.”

Perhaps, as a brain surgeon, Carson is given special treatment when he visits the doctor. But the rest of us endure “layers and layers of bureaucracy” whenever we try to access the healthcare we have so expensively bought.

One reason American healthcare is two-and-a-half times more expensive than in comparable countries is because of the “layers and layers” of insurance sales agents, ID checkers, referral faxers, hospital debt collectors from insurance companies and all the other expensive bureaucrats with no medical knowledge who are employed to administer and police the system. Add to that routine over-charging by doctors and Americans seeking healthcare are being ruthlessly abused and exploited by a commercial scheme that offers them little real choice.

Why do even the smartest free-market dogmatists, who like to paint the world in black and white, fail to see the flaws in commercial companies? Here is the dean of conservative commentators, Charles Krauthammer: “If there’s ever been evidence that a government-run system of healthcare is a disaster, it’s here,” he said. “It’s rationing, it’s waitlists, and corruption and laziness — as you get when people are salaried, rather than working in the free market.”

Cannot those employed on salaries by private companies, particularly employees of corporate behemoths who operate near-monopolies, also ration their customers and say they have been put them on waitlists that do not exist? Can employees of commercial firms not also be corrupt and lazy? Does the free market not employ salaried workers? This muddled thinking is simply partisanship posing as intellectual rigor.

The public-private divide is a red herring that used to distract the left from clear thinking. For a century or more, socialists and communists believed that the world’s problems would be solved if only the “commanding heights” of an economy and the “means of production” were brought into state ownership. Many otherwise smart people fell for an ideology that failed to fulfil its promise the second it was put into practice.

State socialism is now as extinct as the broad-faced potoroo and few except die-hard ideologues dare suggest the government should run everything. Yet the government, tempered by democracy, still has an important role to play when the private sector is found wanting.

It is not merely in treating veterans — whose profound mental and physical wounds can often be so expensive to treat that private insurance companies cannot offer an affordable rate. In many Western European countries taxpayer-funded health systems keep down the skyrocketing costs of treating their ageing populations, just as here in the United States the Social Security system provides an equitable, and relatively inexpensive, way of providing a decent standard of living for retirees.

Other essential services, too, are best administered by the state. Such as the armed services and the police. Schooling, too, is too important to the nation to be left solely to the private sector. State education too often fails, but it is not because taxpayers fund it — it is because the money is spent unwisely.

The question is not whether to have the government provide services the private sector cannot supply. It is a matter of where to draw the line between public and private.

Wednesday, May 4, 2011

GOP's Cantor: Health rationing OK if by done private sector

So gee, it turns out that "rationing" is just another way of saying that we can't have everything we want.

As I've pointed out many times before, private insurance's main job is to ration care. They give you a whole list of what's covered and what isn't. That's rationing. But when the government does it -- it's godless socialism!


By Julian Pecquet
May 3, 2011 | The Hill

House Majority Leader Eric Cantor (R-Va.) said Tuesday that private healthcare plans ration care for profit but that consumers should be free to buy whatever coverage they can afford rather than depend on government rationing.

In remarks to the College of American Pathologists, Cantor warned that Democrats' healthcare reform law mandates benefits that are too generous and will bankrupt the country as the government ends up having to offer ever increasing subsidies. That can only lead to government rationing, he said.

"That doesn't mean those kinds of decisions aren't being made now by the private sector," Cantor added, "because they are."

The solution advanced by Republicans is to increase private-sector competition, by allowing health plans to sell their coverage across state lines, for example. Most experts say that's unlikely to significantly drive down America's record-high healthcare costs, however, and risks leaving in place the current problems of uninsured and underinsured patients that the healthcare reform law attempted to address in the first place.

Cantor appeared to go further than Republicans have in the past by acknowledging that not all patients are certain to get optimal healthcare under a system of private insurance.

"I think that the fundamental nature of our system of third-party payer is the problem," he said. Patients, he added, too often are left with "no decision about what they want and what they can afford."

Later, Cantor said Republicans want a safety net for people who can't afford care but that "we're not for everyone having the same outcome guaranteed."

Saturday, August 29, 2009

We already ration health care. We do.

We Ration. We Ration. We Ration. We Ration.
By Ezra Klein
August 28, 2009 Washington Post

"Look at Canada," says Charles Krauthammer. "Look at Britain. They got hooked; now they ration. So will we."

So do we. This is not an arguable proposition. It is not a difference of opinion, or a conversation about semantics. We ration. We ration without discussion, remorse or concern. We ration health care the way we ration other goods: We make it too expensive for everyone to afford.

I've used these numbers before, but let's repeat them. A 2001 survey by the policy journal Health Affairs found that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent. This, Americans will tell you, is the true measure of our system's performance. We have our problems. But at least we don't sit in some European purgatory languishing without our treatments. That's rationing.

There is, however, a flip side to that. The very same survey also looked at cost problems among residents of different countries: 24 percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22 percent said they didn't get a test or treatment. In Britain and Canada, only about 6 percent of respondents reported that costs had limited their access to care.

The numbers are almost mirror images of each other. Twenty-seven percent of Canadians wait more than four months for treatment, versus only four percent of Americans. Twenty-four percent of Americans can't afford medical care at all, versus only 6 percent of Canadians. And the American numbers are understated because if you can't afford your first appointment, you never learn you couldn't afford the medicine or test that the doctor would have prescribed.

We ration. And if the numbers and the surveys don't convince you of the point, this is what it looks like when we ration.