Healthcare rationing in the United States
Encyclopedia
Healthcare rationing in the United States exists in various forms. Access to private health insurance
is rationed based on price and ability to pay. Those not able to afford a health insurance policy are unable to acquire one, and sometimes insurance companies pre-screen applicants for pre-existing medical conditions and either decline to cover the applicant or apply additional price and medical coverage conditions. Access to state Medicaid
programs is restricted by income and asset limits via a means-test, and to other federal and state eligibility regulations. Health maintenance organization
s (HMOs) that commonly cover the bulk of the population, restrict access to treatment via financial and clinical access limits.
The Patient Protection and Affordable Care Act
passed in March 2010 will prohibit insurers from limiting coverage to people with preexisting conditions beginning in 2014, which will alleviate this type of rationing.
Some in the media and academia have advocated rationing of care to limit the overall costs in the U.S. Medicare
and Medicaid
programs, arguing that a proper rationing mechanism is more equitable and cost-effective. The Congressional Budget Office
(CBO) has argued that healthcare costs are the primary driver of government spending over the long-term.
wrote for the New York Times Magazine in July 2009 that healthcare is rationed in the United States:
David Leonhardt
wrote in the New York Times in June 2009, that rationing presently an economic reality: "The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally." He wrote that there are three primary ways the U.S. rations healthcare:
During 2007, nearly 45% of U.S. healthcare expenses were paid for by the government. During 2009, an estimated 46 million individuals in the United States did not have health insurance coverage. Further, an additional 14,000 or more people lose coverage every day, due to job losses or other factors.
In an e-mail to Obama supporters, David Axelrod
wrote: "Reform will stop 'rationing' - not increase it.... It’s a myth that reform will mean a 'government takeover' of health care or lead to 'rationing.' To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies."
A 2008 study by researchers at the Urban Institute
found that health spending for uninsured non-elderly Americans is only about 43% of health spending for similar, privately insured Americans. These data imply rationing by price and ability to pay.
Fareed Zakaria
wrote that only 38% of small businesses provide health insurance for their employees during 2009, versus 61% in 1993, due to rising costs.
An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period. It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.
Private and public insurers all have their own drug formularies through which they set coverage limitations which may include referral to the insurance company for a decision as to whether the company will or will not approve its share of the costs. American formularies make generalized coverage decisions by class with cheaper drugs in classes at one end of the scale and expensive drugs with more conditions for referral and possible denial at the other. Not all drugs may be in the formulary of every company and consumers are advised to check the formulary before deciding to buy insurance.
The phenomena known as medical bankruptcy is unheard of in countries with universal health care
in which medical copays are low. In the United States however, research shows that many bankruptcies have a strong medical component and that many of those who go bankrupt for a medical reason did have medical insurance. Medical insurance in the United States prior to the Affordable Care Act allowed annual caps or lifetime caps on coverage and, due to the high cost of care in the United States, it was not uncommon for the insured to suffer bankruptcy due to breaching these limits.
article quoted various doctors describing how America rations healthcare. Dr. Arthur Kellermann said: "In America, we strictly ration health care. We've done it for years...But in contrast to other wealthy countries, we don't ration medical care on the basis of need or anticipated benefit. In this country, we mainly ration on the ability to pay. And that is especially evident when you examine the plight of the uninsured in the United States."
Rationing by price means accepting that there is no triage according to need. Thus in the private sector it is accepted that some people get expensive surgeries such as liver transplants or non life threatening ones such as cosmetic surgery, when others fail to get cheaper and much more cost effective care such as prenatal care, which could save the lives of many fetuses and newborn children. Some places, like Oregon for example, do explicitly ration Medicaid resources using medical priorities.
Polling has discovered that Americans are much more likely than Europeans or Canadians to forgo necessary health care (e.g. not seeking a prescibed medicine) on the grounds of cost.
. American patients, even if they are covered by Medicare or Medicaid, often cannot afford the copayments for drugs. That is rationing based on ability to pay.
argued that the reform plans supported by President Obama expand the control of government over healthcare decisions, which he referred to as a type of healthcare rationing. He expressed concern that, although there is nothing in the proposed laws that would constitute rationing, the combination of the following three factors would increase pressure on the government to ration care explicitly for the elderly: An expanded federal bureaucracy, the pending insolvency of Medicare within a decade, and
the fact that 25% of Medicare costs are incurred in the final year of life.
Princeton Professor Uwe Reinhardt
wrote that both public and private healthcare programs can ration, rebutting the concept that governments alone impose rationing: "Many critics of the current health reform efforts would have us believe that only governments ration things.... On the other hand, these same people believe that when, for similar reasons, a private health insurer refuses to pay for a particular procedure or has a price-tiered formulary for drugs – e.g., asking the insured to pay a 35 percent coinsurance rate on highly expensive biologic specialty drugs that effectively put that drug out of the patient’s reach — the insurer is not rationing health care. Instead, the insurer is merely allowing “consumers” (formerly “patients”) to use their discretion on how to use their own money. The insurers are said to be managing prudently and efficiently, forcing patients to trade off the benefits of health care against their other budget priorities."
During 2009, former Alaska Governor Sarah Palin
wrote against rationing by government entities, referring to what she interpreted as such an entity in current reform legislation as a "death panel
" and "downright evil." Defenders of the plan indicated that the proposed legislation H.R. 3200 would allow Medicare for the first time to cover patient-doctor consultations about end-of-life planning, including discussions about drawing up a living will or planning hospice treatment. Patients could seek out such advice on their own, but would not be required to. The provision would limit Medicare coverage to one consultation every five years. However, Palin also had supported such end of life counseling and advance directives from patients during 2008.
Ezra Klein
described in the Washington Post how polls indicate senior citizens are increasingly resistant to healthcare reform, due to concerns about cuts to the existing Medicare program that may be required to fund it. This is creating an unusual and potent political alliance, with Republicans arguing to protect the existing Medicare program, despite its position as one of the major entitlement programs they historically have opposed. The CBO scoring of the proposed America's Affordable Health Choices Act of 2009
(also called HR3200) includes $219 billion in savings over 10 years, some of which would come from Medicare changes.
argued for enhancing the rationing processes:
described how the cost of treating the most common form of early-stage, slow-growing prostate
cancer ranges from an average of $2,400 (watchful waiting to see if the condition deteriorates) to as high as $100,000 (radiation beam therapy):
According to economist Peter A. Diamond
and research cited by the Congressional Budget Office
(CBO), the cost of healthcare per person in the U.S. also varies significantly by geography and medical center, with little or no statistical difference in outcome.
Comparative effectiveness research has shown that significant cost reductions are possible. Office of Management and Budget (OMB) Director Peter Orszag
stated: "Nearly thirty percent of Medicare's costs could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level of low-cost areas."
President Obama has provided more than $1 billion in the 2009 stimulus package to jump-start Comparative Effectiveness Research (CER) and to finance a federal CER advisory council to implement that idea. Economist Martin Feldstein
wrote in the Wall Street Journal that "Comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost."
indicated that some form of rationing is inevitable and desirable considering the state of U.S. finances and the trillions of dollars of unfunded Medicare liabilities. He estimated that 25-33% of healthcare services are provided to those in the last months or year of life and advocated restrictions in cases where quality of life cannot be improved. He also recommended that a budget be established for government healthcare expenses, through establishing spending caps and pay-as-you-go rules that require tax increases for any incremental spending. He has indicated that a combination of tax increases and spending cuts will be required. He advocated addressing these issues under the aegis of a fiscal reform commission.
Arizona recently modified its Medicaid coverage rules because of a budget problem which included denying care for expensive treatments such as organ transplants to Medicaid recipients, including those who had previously been promised funding. MSNBC's Keith Olbermann and others have dubbed Governor Jan Brewer and the state legislatures as a real life death panel
because many of those poor people who are now being denied funding will lose their lives or have a worsened outlook as a result of this political decision.
asked "whether it is worth it", referring to the use of 30% of the Medicare
budget on 5 to 6 percent of those eligible who then die within a year of receiving treatment. In 1984 then Democrat governor of Colorado
Richard Lamm
was widely quoted (though he argues he was mis-quoted) as saying the elderly "have a duty to die and get out of the way." Medical ethicist Daniel Callahan
's 1987 Setting Limits: Medical Goals in an Aging Society achieved new heights of intellectual and professional legitimacy in discussing whether health care should be rationed by age. In Callahan's view old people are "a new social threat" whom he considers selfish and his remedy for this threat is to use age as a criterion in limiting health care. Callahan's book has been widely discussed in the America media including the New York Times, the Washington Post, the Wall Street Journal and in "just about every relevant professional and scholarly journal and newsletter." One of the major arguments against such age-based rationing is the fact that chronological age by itself is a poor indicator of health. Another major argument against Callahan's proposal is that it inverts the Western tradition by making death a possible good and life a possible evil, which means, according to Amherst College
Jurisprudence
professor Robert Laurence Barry, that Callahan's view amounts to "medical totalitarianism". One book-length rebuttal to Callahan's views from a half dozen professors who held a conference at the University of Illinois College of Law in October 1989 can be found in 1991's Set No Limits: a Rebuttal to Daniel Callahan's Proposal to Limit Health Care edited by Robert Laurence Barry and Religious studies
University of Illinois at Urbana-Champaign
visiting professor Gerard V. Bradley.
The Congressional Budget Office
reported in June 2008 that: In other words, all other federal spending categories (e.g., Social Security, Defense, Education, and Transportation) would require borrowing to be funded, which is not feasible.
President Obama stated in May 2009: "But we know that our families, our economy, and our nation itself will not succeed in the 21st century if we continue to be held down by the weight of rapidly rising health care costs and a broken health care system...Our businesses will not be able to compete; our families will not be able to save or spend; our budgets will remain unsustainable unless we get health care costs under control."
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
is rationed based on price and ability to pay. Those not able to afford a health insurance policy are unable to acquire one, and sometimes insurance companies pre-screen applicants for pre-existing medical conditions and either decline to cover the applicant or apply additional price and medical coverage conditions. Access to state Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
programs is restricted by income and asset limits via a means-test, and to other federal and state eligibility regulations. Health maintenance organization
Health maintenance organization
A health maintenance organization is an organization that provides managed care for health insurance contracts in the United States as a liaison with health care providers...
s (HMOs) that commonly cover the bulk of the population, restrict access to treatment via financial and clinical access limits.
The Patient Protection and Affordable Care Act
Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The law is the principal health care reform legislation of the 111th United States Congress...
passed in March 2010 will prohibit insurers from limiting coverage to people with preexisting conditions beginning in 2014, which will alleviate this type of rationing.
Some in the media and academia have advocated rationing of care to limit the overall costs in the U.S. Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
and Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
programs, arguing that a proper rationing mechanism is more equitable and cost-effective. The Congressional Budget Office
Congressional Budget Office
The Congressional Budget Office is a federal agency within the legislative branch of the United States government that provides economic data to Congress....
(CBO) has argued that healthcare costs are the primary driver of government spending over the long-term.
Background
Peter SingerPeter Singer
Peter Albert David Singer is an Australian philosopher who is the Ira W. DeCamp Professor of Bioethics at Princeton University and Laureate Professor at the Centre for Applied Philosophy and Public Ethics at the University of Melbourne...
wrote for the New York Times Magazine in July 2009 that healthcare is rationed in the United States:
David Leonhardt
David Leonhardt
David Leonhardt is the Washington bureau chief of The New York Times. He joined The Times in 1999 and wrote the "Economics Scene" column, and for the Times Sunday Magazine. Before coming to The Times, he wrote for Business Week and The Washington Post...
wrote in the New York Times in June 2009, that rationing presently an economic reality: "The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally." He wrote that there are three primary ways the U.S. rations healthcare:
- Increases in healthcare premiums reduce worker pay. In other words, more expensive insurance premiums are reducing the growth in household income, which forces tradeoffs between healthcare services and other consumption.
- High premiums mean smaller companies cannot afford health insurance for their workers.
- Failure to provide certain types of care.
During 2007, nearly 45% of U.S. healthcare expenses were paid for by the government. During 2009, an estimated 46 million individuals in the United States did not have health insurance coverage. Further, an additional 14,000 or more people lose coverage every day, due to job losses or other factors.
Definition
Healthcare rationing can be defined in one of two ways. Economically defined, healthcare rationing is simply limiting health care goods and services to only those who can afford to pay. In the United States this type of rationing affects about 15% of the population, who are either too poor to afford care or unwilling to buy care or simply uninsured. Defined by regulatory means, healthcare rationing involves restricting health care goods and services from even those who can afford to pay. This form of rationing would affect 85% of the American population. This second type of healthcare rationing is unfamiliar to most Americans.Rationing by Insurance companies
President Obama has noted that U.S. healthcare is rationed based on income, type of employment, and pre-existing medical conditions, with nearly 46 million uninsured. He states that millions of Americans are denied coverage or face higher premiums as a result of pre-existing medical conditions.In an e-mail to Obama supporters, David Axelrod
David Axelrod
David Axelrod may refer to:* David Axelrod * David Axelrod , Senior Advisor to U.S. President Barack Obama* David B. Axelrod , poet and educator...
wrote: "Reform will stop 'rationing' - not increase it.... It’s a myth that reform will mean a 'government takeover' of health care or lead to 'rationing.' To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies."
A 2008 study by researchers at the Urban Institute
Urban Institute
The Urban Institute is a Washington, D.C.-based think tank that carries out nonpartisan economic and social policy research, collects data, evaluates social programs, educates the public on key domestic issues, and provides advice and technical assistance to developing governments abroad...
found that health spending for uninsured non-elderly Americans is only about 43% of health spending for similar, privately insured Americans. These data imply rationing by price and ability to pay.
Fareed Zakaria
Fareed Zakaria
Fareed Rafiq Zakaria is an Indian-American journalist and author. From 2000 to 2010, he was a columnist for Newsweek and editor of Newsweek International. In 2010 he became Editor-At-Large of Time magazine...
wrote that only 38% of small businesses provide health insurance for their employees during 2009, versus 61% in 1993, due to rising costs.
An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period. It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.
Private and public insurers all have their own drug formularies through which they set coverage limitations which may include referral to the insurance company for a decision as to whether the company will or will not approve its share of the costs. American formularies make generalized coverage decisions by class with cheaper drugs in classes at one end of the scale and expensive drugs with more conditions for referral and possible denial at the other. Not all drugs may be in the formulary of every company and consumers are advised to check the formulary before deciding to buy insurance.
The phenomena known as medical bankruptcy is unheard of in countries with universal health care
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
in which medical copays are low. In the United States however, research shows that many bankruptcies have a strong medical component and that many of those who go bankrupt for a medical reason did have medical insurance. Medical insurance in the United States prior to the Affordable Care Act allowed annual caps or lifetime caps on coverage and, due to the high cost of care in the United States, it was not uncommon for the insured to suffer bankruptcy due to breaching these limits.
Rationing by price
A July 2009 NPRNPR
NPR, formerly National Public Radio, is a privately and publicly funded non-profit membership media organization that serves as a national syndicator to a network of 900 public radio stations in the United States. NPR was created in 1970, following congressional passage of the Public Broadcasting...
article quoted various doctors describing how America rations healthcare. Dr. Arthur Kellermann said: "In America, we strictly ration health care. We've done it for years...But in contrast to other wealthy countries, we don't ration medical care on the basis of need or anticipated benefit. In this country, we mainly ration on the ability to pay. And that is especially evident when you examine the plight of the uninsured in the United States."
Rationing by price means accepting that there is no triage according to need. Thus in the private sector it is accepted that some people get expensive surgeries such as liver transplants or non life threatening ones such as cosmetic surgery, when others fail to get cheaper and much more cost effective care such as prenatal care, which could save the lives of many fetuses and newborn children. Some places, like Oregon for example, do explicitly ration Medicaid resources using medical priorities.
Polling has discovered that Americans are much more likely than Europeans or Canadians to forgo necessary health care (e.g. not seeking a prescibed medicine) on the grounds of cost.
Rationing by pharmaceutical companies
Pharmaceutical manufacturers often charge much more for drugs in the United States than they charge for the same drugs in Britain, where they know that a higher price would put the drug outside the cost-effectiveness limits applied by regulatorsNICE
NICE may refer to:* National Independent Cadres and Elites in Iraq* National Institute for Coordinated Experiments, a fictional organisation in C.S...
. American patients, even if they are covered by Medicare or Medicaid, often cannot afford the copayments for drugs. That is rationing based on ability to pay.
Rationing through government control
Republican Newt GingrichNewt Gingrich
Newton Leroy "Newt" Gingrich is a U.S. Republican Party politician who served as the House Minority Whip from 1989 to 1995 and as the 58th Speaker of the U.S. House of Representatives from 1995 to 1999....
argued that the reform plans supported by President Obama expand the control of government over healthcare decisions, which he referred to as a type of healthcare rationing. He expressed concern that, although there is nothing in the proposed laws that would constitute rationing, the combination of the following three factors would increase pressure on the government to ration care explicitly for the elderly: An expanded federal bureaucracy, the pending insolvency of Medicare within a decade, and
the fact that 25% of Medicare costs are incurred in the final year of life.
Princeton Professor Uwe Reinhardt
Uwe Reinhardt
Uwe E. Reinhardt is a professor of political economy at Princeton University and holds several positions in the healthcare industry. Reinhardt is a prominent scholar in health care economics and a frequent speaker and author on subjects ranging from the war in Iraq to the future of Medicare.-...
wrote that both public and private healthcare programs can ration, rebutting the concept that governments alone impose rationing: "Many critics of the current health reform efforts would have us believe that only governments ration things.... On the other hand, these same people believe that when, for similar reasons, a private health insurer refuses to pay for a particular procedure or has a price-tiered formulary for drugs – e.g., asking the insured to pay a 35 percent coinsurance rate on highly expensive biologic specialty drugs that effectively put that drug out of the patient’s reach — the insurer is not rationing health care. Instead, the insurer is merely allowing “consumers” (formerly “patients”) to use their discretion on how to use their own money. The insurers are said to be managing prudently and efficiently, forcing patients to trade off the benefits of health care against their other budget priorities."
During 2009, former Alaska Governor Sarah Palin
Sarah Palin
Sarah Louise Palin is an American politician, commentator and author. As the Republican Party nominee for Vice President in the 2008 presidential election, she was the first Alaskan on the national ticket of a major party and first Republican woman nominated for the vice-presidency.She was...
wrote against rationing by government entities, referring to what she interpreted as such an entity in current reform legislation as a "death panel
Death panel
"Death panel", , is a term that originated during a 2009 political debate regarding health care reform in the United States. The death panel claim portrayed the health care bills then pending before the U.S. Congress as encouraging euthanasia for the elderly and as rationing health care for the...
" and "downright evil." Defenders of the plan indicated that the proposed legislation H.R. 3200 would allow Medicare for the first time to cover patient-doctor consultations about end-of-life planning, including discussions about drawing up a living will or planning hospice treatment. Patients could seek out such advice on their own, but would not be required to. The provision would limit Medicare coverage to one consultation every five years. However, Palin also had supported such end of life counseling and advance directives from patients during 2008.
Ezra Klein
Ezra Klein
Ezra Klein is a liberal American blogger and columnist for The Washington Post, columnist for Bloomberg, a columnist for Newsweek, and a contributor to MSNBC...
described in the Washington Post how polls indicate senior citizens are increasingly resistant to healthcare reform, due to concerns about cuts to the existing Medicare program that may be required to fund it. This is creating an unusual and potent political alliance, with Republicans arguing to protect the existing Medicare program, despite its position as one of the major entitlement programs they historically have opposed. The CBO scoring of the proposed America's Affordable Health Choices Act of 2009
America's Affordable Health Choices Act of 2009
The proposed America's Affordable Health Choices Act of 2009 was an unsuccessful bill introduced in the U.S. House of Representatives on July 14, 2009. The bill was introduced during the first session of the 111th Congress as part of an effort of the Democratic Party leadership to enact health...
(also called HR3200) includes $219 billion in savings over 10 years, some of which would come from Medicare changes.
Arguments for enhancing rationing processes
Peter SingerPeter Singer
Peter Albert David Singer is an Australian philosopher who is the Ira W. DeCamp Professor of Bioethics at Princeton University and Laureate Professor at the Centre for Applied Philosophy and Public Ethics at the University of Melbourne...
argued for enhancing the rationing processes:
Rationing based on economic value added
A concept called "quality-adjusted life year" (QUALY) is used to measure the cost-benefit of applying a particular medical procedure. It reflects the quality and quantity of life added due to incurring a particular medical expense. The measure has been used for over 30 years and is implemented in several countries to help with rationing decisions. Australia applies QUALY measures for its form of Medicare to control costs and ration care, while allowing private supplemental insurance.Rationing using comparative effectiveness research
Several treatment alternatives may be available for a given medical condition, with significantly different costs yet no statistical difference in outcome. Such scenarios offer the opportunity to maintain or improve the quality of care, while significantly reducing costs, through comparative effectiveness research. Writing in the New York Times, David LeonhardtDavid Leonhardt
David Leonhardt is the Washington bureau chief of The New York Times. He joined The Times in 1999 and wrote the "Economics Scene" column, and for the Times Sunday Magazine. Before coming to The Times, he wrote for Business Week and The Washington Post...
described how the cost of treating the most common form of early-stage, slow-growing prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
cancer ranges from an average of $2,400 (watchful waiting to see if the condition deteriorates) to as high as $100,000 (radiation beam therapy):
According to economist Peter A. Diamond
Peter A. Diamond
Peter Arthur Diamond is an American economist known for his analysis of U.S. Social Security policy and his work as an advisor to the Advisory Council on Social Security in the late 1980s and 1990s. He was awarded the Nobel Memorial Prize in Economic Sciences in 2010, along with Dale T. Mortensen...
and research cited by the Congressional Budget Office
Congressional Budget Office
The Congressional Budget Office is a federal agency within the legislative branch of the United States government that provides economic data to Congress....
(CBO), the cost of healthcare per person in the U.S. also varies significantly by geography and medical center, with little or no statistical difference in outcome.
Comparative effectiveness research has shown that significant cost reductions are possible. Office of Management and Budget (OMB) Director Peter Orszag
Peter Ország
Peter Ország is a Slovak ice hockey referee, who referees in the Slovak Extraliga.-Career:He has officiated many international tournaments including the Winter Olympics. He has been named Slovak referee of the year....
stated: "Nearly thirty percent of Medicare's costs could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level of low-cost areas."
President Obama has provided more than $1 billion in the 2009 stimulus package to jump-start Comparative Effectiveness Research (CER) and to finance a federal CER advisory council to implement that idea. Economist Martin Feldstein
Martin Feldstein
Martin Stuart "Marty" Feldstein is an economist. He is currently the George F. Baker Professor of Economics at Harvard University, and the president emeritus of the National Bureau of Economic Research . He served as President and Chief Executive Officer of the NBER from 1978 through 2008...
wrote in the Wall Street Journal that "Comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost."
Rationing as part of fiscal discipline
Former Republican Secretary of Commerce Peter G. PetersonPeter George Peterson
Peter G. Peterson is an American businessman, investment banker, fiscal conservative, author, and politician whose most prominent political position was as United States Secretary of Commerce from February 29, 1972, to February 1, 1973 under Richard Nixon. He is most well known currently as...
indicated that some form of rationing is inevitable and desirable considering the state of U.S. finances and the trillions of dollars of unfunded Medicare liabilities. He estimated that 25-33% of healthcare services are provided to those in the last months or year of life and advocated restrictions in cases where quality of life cannot be improved. He also recommended that a budget be established for government healthcare expenses, through establishing spending caps and pay-as-you-go rules that require tax increases for any incremental spending. He has indicated that a combination of tax increases and spending cuts will be required. He advocated addressing these issues under the aegis of a fiscal reform commission.
Arizona recently modified its Medicaid coverage rules because of a budget problem which included denying care for expensive treatments such as organ transplants to Medicaid recipients, including those who had previously been promised funding. MSNBC's Keith Olbermann and others have dubbed Governor Jan Brewer and the state legislatures as a real life death panel
Death panel
"Death panel", , is a term that originated during a 2009 political debate regarding health care reform in the United States. The death panel claim portrayed the health care bills then pending before the U.S. Congress as encouraging euthanasia for the elderly and as rationing health care for the...
because many of those poor people who are now being denied funding will lose their lives or have a worsened outlook as a result of this political decision.
Old-age-based health care rationing
In America, the discussion on rationing health care for the elderly began to take root in 1983 when economist Alan GreenspanAlan Greenspan
Alan Greenspan is an American economist who served as Chairman of the Federal Reserve of the United States from 1987 to 2006. He currently works as a private advisor and provides consulting for firms through his company, Greenspan Associates LLC...
asked "whether it is worth it", referring to the use of 30% of the Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
budget on 5 to 6 percent of those eligible who then die within a year of receiving treatment. In 1984 then Democrat governor of Colorado
Colorado
Colorado is a U.S. state that encompasses much of the Rocky Mountains as well as the northeastern portion of the Colorado Plateau and the western edge of the Great Plains...
Richard Lamm
Richard Lamm
Richard Douglas "Dick" Lamm is an American politician, Certified Public Accountant, college professor, and lawyer. He served three terms as 38th Governor of Colorado as a Democrat and ran for the Reform Party's nomination for President of the United States in 1996.He is currently the Co-Director...
was widely quoted (though he argues he was mis-quoted) as saying the elderly "have a duty to die and get out of the way." Medical ethicist Daniel Callahan
Daniel Callahan
Daniel Callahan was born July 19, 1930. Callahan is a philosopher widely recognized for his innovative studies in biomedical ethics.·In high school Callahan was a swimmer and choose to attend Yale University because of its competitive swimming program. While at Yale, he was drawn to...
's 1987 Setting Limits: Medical Goals in an Aging Society achieved new heights of intellectual and professional legitimacy in discussing whether health care should be rationed by age. In Callahan's view old people are "a new social threat" whom he considers selfish and his remedy for this threat is to use age as a criterion in limiting health care. Callahan's book has been widely discussed in the America media including the New York Times, the Washington Post, the Wall Street Journal and in "just about every relevant professional and scholarly journal and newsletter." One of the major arguments against such age-based rationing is the fact that chronological age by itself is a poor indicator of health. Another major argument against Callahan's proposal is that it inverts the Western tradition by making death a possible good and life a possible evil, which means, according to Amherst College
Amherst College
Amherst College is a private liberal arts college located in Amherst, Massachusetts, United States. Amherst is an exclusively undergraduate four-year institution and enrolled 1,744 students in the fall of 2009...
Jurisprudence
Jurisprudence
Jurisprudence is the theory and philosophy of law. Scholars of jurisprudence, or legal theorists , hope to obtain a deeper understanding of the nature of law, of legal reasoning, legal systems and of legal institutions...
professor Robert Laurence Barry, that Callahan's view amounts to "medical totalitarianism". One book-length rebuttal to Callahan's views from a half dozen professors who held a conference at the University of Illinois College of Law in October 1989 can be found in 1991's Set No Limits: a Rebuttal to Daniel Callahan's Proposal to Limit Health Care edited by Robert Laurence Barry and Religious studies
Religious studies
Religious studies is the academic field of multi-disciplinary, secular study of religious beliefs, behaviors, and institutions. It describes, compares, interprets, and explains religion, emphasizing systematic, historically based, and cross-cultural perspectives.While theology attempts to...
University of Illinois at Urbana-Champaign
University of Illinois at Urbana-Champaign
The University of Illinois at Urbana–Champaign is a large public research-intensive university in the state of Illinois, United States. It is the flagship campus of the University of Illinois system...
visiting professor Gerard V. Bradley.
Consequences of not controlling healthcare costs
Congressional Budget Office
The Congressional Budget Office is a federal agency within the legislative branch of the United States government that provides economic data to Congress....
reported in June 2008 that: In other words, all other federal spending categories (e.g., Social Security, Defense, Education, and Transportation) would require borrowing to be funded, which is not feasible.
President Obama stated in May 2009: "But we know that our families, our economy, and our nation itself will not succeed in the 21st century if we continue to be held down by the weight of rapidly rising health care costs and a broken health care system...Our businesses will not be able to compete; our families will not be able to save or spend; our budgets will remain unsustainable unless we get health care costs under control."
See also
- Health care reform in the United StatesHealth care reform in the United StatesHealth care reform in the United States has a long history, of which the most recent results were two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act , signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 , which amended the PPACA and...
- Health care reform debate in the United StatesHealth care reform debate in the United StatesThe health care reform debate in the United States has been a political issue for many years, focusing upon increasing coverage, decreasing the cost and social burden of healthcare, insurance reform, and the philosophy of its provision, funding, and government involvement...
- Public opinion on health care reform in the United StatesPublic opinion on health care reform in the United StatesPublic opinion on health care reform in the United States is mixed. Many Americans express a desire for health care reform because they see health care as too expensive and because they perceive that insurance companies avoid meeting health costs through coverage exclusions, caps, and co-pays...
- Health care in the United StatesHealth care in the United StatesHealth care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector...
External links
- Reforming American Healthcare from The EconomistThe EconomistThe Economist is an English-language weekly news and international affairs publication owned by The Economist Newspaper Ltd. and edited in offices in the City of Westminster, London, England. Continuous publication began under founder James Wilson in September 1843...
- White House Council of Economic Advisors - The Economic Case for Healthcare Reform-Report-June 2009