This week the Congressional Budget Office projected enormous cost increases under the current congressional plan for national health care. It was promoted as saving taxpayers money, but the CBO estimates a cost over $1 trillion and it is likely to raise the tax burden for many Americans to close to 60% of their already dwindling incomes, as government bureaucrats balloon the cost of what is already the most expensive health care system in the world. The devastating financial impact of ObamaCare for the nation and every citizen is now overwhelmingly clear. But just in case you still harbor any illusions about how disastrous current proposals for national health care would be, I thought it was time to revisit the other cost — the cost in human suffering and loss of life under socialized medicine.
A key element of the cynically misnamed Affordable Health Choices Act, which is the plan currently being rushed through congress to meet deadlines and criteria set by President Obama, is rationing health care using Comparative Effectiveness Research (CER) methodology where government bureaucrats would set up schedules by which treatment would be allocated based on statistics and cost to benefit ratios rather than the interests and needs of the specific patient. Decisions on care would be matters of policy based on group effectiveness rather than on a case by case basis and doctors would have to abide by these decisions without regard to the welfare of the patient.
The impact of rationing in other nations where it has been introduced as part of the national health care system has been horrendous. It attempts to reduce the financial cost of the system by a trade-off which increases the cost in lives lost and individual suffering. Two nations with many similarities to the United States which have resorted to rationing health care are Great Britain and Canada. In both nations the human cost has been high and the results are easily quantified.
The failure of rationing comes down to two basic problems — denial of treatment and very long wait times. Both of these can result in suffering and death for patients, especially those with critical and chronic conditions which are treated easily and routinely in the United States today, but which often result in death in Great Britain and Canada.
Article comments
— go to most recent comments1 - Jordan Richardson
Yep, we're droppin' like flies up here. God help us all.
2 - Dave Nalle
And Jordan, the welfare you Canadians enjoy as a group is pretty meaningless to the individuals who suffer and wait and die because of healthcare rationing.
Dave
3 - roger nowosielski
I think you're making good points about rationing healthcare. The problem is, it already exists under the present system. So why do you suppose the problem will become exacerbated once the universal healthcare comes into effect - to cover the presently uninsured. How will their situation become worse? Or for that matter, how will the situation of those who are presently insured become worse than it already is? I believe the kind of connection you're pressing for remains to be substantiated.
4 - Clavos
...how will the situation of those who are presently insured become worse than it already is?
If you add 50 million more patients to the pool and simultaneously institute significant cost control measures, from whence will you get your reductions?
Bliffle and a few others claim that the government-run system will be more efficient in terms of overhead, as demonstrated by the allegedly low Medicare overhead, but several of us have demonstrated that this is simply not so; on a per patient basis, Medicare is in fact less efficient than the private insurance system -- surprise, surprise.
Nope, rationing will increase, not decrease.
5 - roger nowosielski
I'm presuming that those already insured will hold on to their premium insurance plans. And if so, their healthcare wouldn't be jeopardized by the influx.
6 - Clavos
Except that those premium health plans will be unable to compete with the free government insurance, which will also impose much lower fees for service than they (the insurance companies) can afford to pay (the government insurance doesn't have to be profitable), so they will inevitably disappear.
And most middle class folks, particularly those working for small firms (the majority) don't have premium plans to resort to; they will see a significant decline, because Obamacare also proposes putting a significant tax on those who don't buy into the government plan.
Because for the lower fees for services, don't be surprised to see a lot of foreign doctors practicing in US hospitals in short order, either.
7 - Clavos
"Because of"
8 - roger nowosielski
Again, I'm supposing that those who are aware of the dangers of rationing will maintain their premium policy for that very reason. And those who don't, well ... they were already in the cold somewhat. So yes, some dilution in quality will occur, but not to those who can afford to pay.
9 - Clavos
No, As I explained in #8, with the so-called "public option" the time will come (and in very short order) that there will be no other option than the government one, except for those rich enough to pay all fees out of their own pockets, and even they will be thinned by the degree to which they are sick. Some chronic patients' medical bills exceed $500K a year for years on end.
The majority of the US population will see a decrease in the quality and availability of their medical care under the "plan" currently being ramrodded through the congress.
10 - roger nowosielski
What you're saying, the present proposal will eliminate private insurance if not now then in the near future. That remains to be seen.
11 - Bliffle
Everything that Clavos and Nalle say about the Public Option is guesswork. for example:
"...with the so-called "public option" the time will come (and in very short order) that there will be no other option than the government one, except for those rich enough to pay all fees out of their own pockets,..."
Says who? How can you draw that conclusion? looks to me like you're just guessing.
12 - Bliffle
The USA medical system is not only overpriced, it is downright dangerous:
death by Medicine
"ABSTRACT
A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million.1 Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics.2, 2a The number of unnecessary medical and surgical procedures performed annually is 7.5 million.3 The number of people exposed to unnecessary hospitalization annually is 8.9 million.4 The total number of iatrogenic deaths shown in the following table is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251."
13 - Dave Nalle
Everything that Clavos and Nalle say about the Public Option is guesswork. for example:
Bliffle, I didn't say a single word about the public option in this article, actually. Part of the deal is that CERs will be used increasingly by private insurers in an attempt to cut costs. When they should be cutting costs by reducing overhead and unreasonable expenses they will be instead be cutting costs by rationing and limiting care.
As for the private insurers gradually dying out under this system, I don't see it. They are effectively being subsidized with draconian mandatory insurance rules, and their service will still be better than whatever public option there is, so they will keep being propped up by the state.
Dave
14 - Bliffle
But profits of insurance companies go up at the same time the med business becomes more deadly:
Medical loss ratios
"Health plans make more, spend less in 2005
By Jonathan G. Bethely
American Medical News
March 6, 2006
If physicians needed any more indication of tightening reimbursement, how about this - not only did profits for the biggest health plans go up last year, but those plans also continued to cut the percentage of revenue they spend on care.
The medical-cost ratio - also called the medical-loss ratio or medical-care ratio - is the key number for health plans in terms of their level of profitability. That ratio, simply, is the percentage of dollars the companies spend on health care.
Whereas 10 years ago many plans had medical-cost ratios in the high 80s or 90s, now the highest percentage among large, publicly traded health insurers is Health Net, at 83.9%. Aetna, which had a medical-cost ratio well into the 90s when CEO John Rowe, MD, took over in 2000, recorded a ratio of 76.9% in 2005, Dr. Rowe's final full year before his retirement. That was the lowest medical-cost ratio for the nation's largest publicly traded plans.
Medical-loss ratios for 2005 (Source: Company 10-K, year-end filings with the Securities and Exchange Commission):
76.9% - Aetna
82.3% - Cigna
83.9% - Health Net
83.2% - Humana
78.6% - UnitedHealth Group
80.6% - WellPoint
Source
Comment: By Don McCanne, M.D.
Clearly, one-fifth of health insurance premium dollars are not being spent on health care, but are consumed by the insurers. What does not show up in these numbers is the cost of the administrative burden that these insurers place on the health care delivery system. The billing and insurance related functions for physicians and hospitals burn up another 12 percent or so of the premium dollar (Kahn et al, Health Affairs, Nov/Dec 2005). Add these together, and that is about one-third of the premium dollar.
We are very concerned about the continued escalation of health care costs. New technology and pharmaceuticals are adding to the spending on physicians, hospitals, laboratories and other health care services. We fret about these expenditures within the two-thirds of the insurance premium that actually makes it down to the health care system, yet we are ignoring the one-third that is wasted on administrative services that provide no health benefit for the patient.
We are enriching this industry for providing coverage for the healthy workforce and their young, healthy families, and for covering the healthy sub-sector of the individual insurance market. We taxpayers are footing the bill for the population subgroups with greater health care needs.
We certainly are not receiving much value from the insurers - letting them have the easy stuff at a very high cost. Wouldn't it be more logical to target their waste, rather than slowing spending growth by making health care unaffordable for those who do have needs?
Why do we keep hearing that eliminating this industry isn't feasible? You would think that anyone with a modicum of business sense would believe that keeping them in charge is no longer feasible."
Please take note of the comment by Don McCanne, M.D., above.
15 - Dave Nalle
Bliffle, we've been over this subject before, and it is completely separate from the issues raised in this article. You're essentially spamming here and attempting to distract from the real issues with this irrelevant canard about relative administrative/overhead costs.
Dave
16 - roger nowosielski
He's not spamming insofar as your claims are concerned. It is guesswork.
17 - Clavos
I linked to this article in another thread about three weeks ago.
It incontrovertibly refutes the administrative cost myth that says that Medicare's administrative costs are far below those of the private insurers.
18 - Lumpy
Are administrative costs even an issue when comparedwith all of the other problems in this bill? Seems like a red herring.
I have reasonably good health insurance already. What worriese isthe damage to individuals and small businesses forced to buy insurance they can't afford.
19 - handyguy
The NY Times today ran a very useful table outlining the plans that have passed through committee.
Read it. It disproves some of the silliness passing for argument around here. And describing these plans as entirely written by lobbyists for the insurance and healthcare industry is laughable.
Dave's ridiculously alarmist rhetoric adds nothing useful at all to the discussion.
The main reason we spend so much more on health care than nearly all other countries is not the superiority of the care. It's that we pay for each test and examination separately. This incentivizes doctors to order more tests.
Caricaturing the attempt to differentiate between beneficial and wasteful tests and treatments as 'rationing' that will kill patients comes pretty close to being immoral. Oversimplify much?
There are certainly flaws in the current bills, which will not be the final bills. Constructive discussion rather than dumb 'sky is falling' articles might possibly get us somewhere.
The fact that Dave thinks the public plan option is basically irrelevant, while Clavos and congressional Republicans decry it as the end of private insurance, shows that this discussion is far from clear cut, on either side.
And the president did vow today to reject any plan that adds to the federal deficit.
It will be interesting to watch this play out.
20 - Clavos
It is a red herring, Lumpy; one that's constantly brought up by supporters of UHC.
They say that Medicare's low overhead (which they claim is lower than that of private insurers), is proof that a government-run UHC plan will be cheaper than, and actually save money over, the present system.
The article points out that, on a per patient basis (the only way to make a comparison, in light of the huge difference in the number of patients covered by Medicare vs those covered by private insurers), Medicare's admin costs are actually considerably higher than the private sector's.
And your reasonably good insurance is in danger of suffering the fate of the dodo if the UHC with "public option" (Obamacare) is what we wind up with.
21 - Clavos
And the president did vow today to reject any plan that adds to the federal deficit.
Oh good, we're not going to have UHC after all!
22 - Lumpy
Obama's ability to ignore budgetary reality is astounding. In lesser men such delusion would end in a padded cell.
23 - handyguy
BC's rightist commenters' ability to crack wise yet say nothing is not exactly astounding.
It does, however, induce much eye-rolling in anyone more interested in having an actual back-and-forth discussion, as opposed to lobbing ideological caricatures, cliches, and unproven/outdated ideas back and forth.
24 - Glenn Contrarian
Dave -
I can go point-by-point with your references and refute them - and you've seen me do so.
So to make a long story short, the error of your article - some of which is based on articles which themselves do not give a solid reference for their claims - is obviated by the fact that we're thirtieth on the list of countries by life expectancy, that the only two other countries without UHC on that list are third-world countries Jordan and Bosnia (28th and 29th, respectively), and our government spends significantly more per capita than ANY of the top twenty-seven countries on the list...ALL of which have UHC in one form or another.
Yes, you've seen me post this many times...and I will continue to post it because it is true and it obviates the errors (and some outright lies) by the HMO's and Big Pharma who are spending $1.4M a DAY in lobbying Congress to protect their cash cow.
25 - Clavos
Quite.
Your own trenchant, cogent arguments in favor of UHC certainly have us all dazzled.
Well, one assumes they will, when you present them.