Rep Bachmann is concerned that the Democratic Party/Obama administration would hasten the death of old/sick people as a way to save money; that health insurance reform will lead to compelling people to kill themselves as a cost savings measure. Where is this coming from? This seems plausible to you?
The US spends more money on healthcare, per person, than any other country in the world. If other countries, that spend considerably less per person, can manage to avoid killing off their elderly/disabled why would the US be forced to kill people who are sick? Instead of killing sick people why wouldn’t the Democrats/Obama administration just pay less for pharmaceuticals? Why wouldn’t we use the federal government’s market power to cut Part D spending by 50% and Part A and Part B drug spending by significant margins. Does Bachmann seriously believe that an elected body - the body she serves in - would choose to kill voters instead of cutting pharmaceutical spending? Come on. I really don’t think she believes what she is saying.
Cutting pharmaceutical spending would have consequences but having to find a another way to fund research is a minor inconvenience compared to killing off dialyzors and/or old people.
All the current health insurance reform bills working their way through Congress reflect the agreement Obama made with pharmaceutical manufacturers - the negotiate the price of pharmeceuticals cost saving measure isn’t even on the table. Taxing employee health insurance benefits is off the table. Malpractice insurance reform? that’s not on the table either. Increasing Medicare premiums isn’t even on the table. Means testing Medicare Premiums isn’t on the table. All these ways to pay for Medicare’s current benefits are as available as killing people yet they are off the table. But despite all that Bachmann is still a concerned that in the name of saving costs lets start killing people.
You know what another route to Medicare solvency is? Extending the FICA tax to people making more than 250K a year. In order for Bachmann to believe the US is going to start hastening sick people’s deaths to save money she has to believe that killing her father in law is more politically appealing than extending FICA to millionaires.
Bachmann’s floor speach doesn’t stand up to the least bit of thought.
[QUOTE=Bill Peckham;18259]Rep Bachmann is concerned that the Democratic Party/Obama administration would hasten the death of old/sick people as a way to save money; that health insurance reform will lead to compelling people to kill themselves as a cost savings measure. Where is this coming from? This seems plausible to you?
The US spends more money on healthcare, per person, than any other country in the world. If other countries, that spend considerably less per person, can manage to avoid killing off their elderly/disabled why would the US be forced to kill people who are sick? Instead of killing sick people why wouldn’t the Democrats/Obama administration just pay less for pharmaceuticals? Why wouldn’t we use the federal government’s market power to cut Part D spending by 50% and Part A and Part B drug spending by significant margins. Does Bachmann seriously believe that an elected body - the body she serves in - would choose to kill voters instead of cutting pharmaceutical spending? Come on. I really don’t think she believes what she is saying.
Cutting pharmaceutical spending would have consequences but having to find a another way to fund research is a minor inconvenience compared to killing off dialyzors and/or old people.
All the current health insurance reform bills working their way through Congress reflect the agreement Obama made with pharmaceutical manufacturers - the negotiate the price of pharmeceuticals cost saving measure isn’t even on the table. Taxing employee health insurance benefits is off the table. Malpractice insurance reform? that’s not on the table either. Increasing Medicare premiums isn’t even on the table. Means testing Medicare Premiums isn’t on the table. All these ways to pay for Medicare’s current benefits are as available as killing people yet they are off the table. But despite all that Bachmann is still a concerned that in the name of saving costs lets start killing people.
You know what another route to Medicare solvency is? Extending the FICA tax to people making more than 250K a year. In order for Bachmann to believe the US is going to start hastening sick people’s deaths to save money she has to believe that killing her father in law is more politically appealing than extending FICA to millionaires.
Bachmann’s floor speach doesn’t stand up to the least bit of thought.[/QUOTE]
Wrong. The problem is that I have heard these types of policies advocated at the University level, time and time again, by one of the largest Democratic constituency groups on the planet. Does the name Richard Lamm mean anything to you? Extending the FICA tax to individuals making $250K per year is not going to save any government program, remember the 1983 Greenspan commission? In addition, what gives you the right to take money that has been earned by the labor of another individual to give to an individiual that has not earned it, it is called legalized theft. If there is an a lady in her 80’s laying on a park bench, she is hungry and needs medical attention, you as the government use a firearm and take $200.00 from me, to service the needs of that woman and calling it compassion. What entitles you to live at my expense?
The individuals who are calling for compassion by taking money from the United States taxpayer that they did not earn, donate very small amounts to charity, themselves. In other words, they are compassionate with the money of other people. By the way, what have been the end results of these government policies of “compassion?” A public debt of $10-$13 trillion, high unemployment, billions of dollars wasted each and every year? Bill, you believe that the government knows what is best for us, I believe that the average individual with freedom and liberty is the answer to the issues of our society. What incentive does the government have to arrive at the correct decisions in medical care? How has the management of the clunker car program worked, would you like to discuss the results? Do you want the same people running the government schools to manage your health care? How would you suggest we pay for the future obligations of Social Security and Medicare estimated to have unfunded mandates of $50-$100 trillion? I am curious, how will we have economic growth with tax rates of 50-70 percent? In Obamacare, you will have to register your purchased medical device with the government, regardless if the goverment did or not did not pay the bill, nothing like a little big brother?
I never said or implied that individuals would kill themselves. However, government will waitlist, refuse to pay for treatments, or not provide medication in a reasonable time span, In fact, in many national health care systems, seniors are prohibited from paying for the newest medicatons with their own money. Many of you fail to realize that this is issue is not about care, it is about control. Individuals like Obama look at individuals like us and the rest of the United States as too stupid to know what is best for us, in health care, buying a car, paying taxes and running our own independent lives, sound familiar from a certain industry and clinics?
Sorry, the prescription of high taxes, government control, and regulations have been a pathetic failure over the past 30-40 years. We need a very low flat tax, elimination of almost 2,000 insurance regulations by vote buying politicians, and consumer control to lower costs and eliminate waste. In addition, we need malpractice and tort refrom that takes from the needy(patients) and gives to the greedy, trial lawyers.
I thought you would find this post interesting:
"I have a friend who is Dutch with a chronic illness. She often speaks of wanting to come to the US in order to get better treatment–she cannot afford to purchase the higher tier insurance that would cover physical therapy for her chronic illness. The basic plan, in addition to not covering “unproven therapies” also doesn’t cover some proven ones either. Like any socialized system, there is rationing, only it is under the veil of this “tier” system. Basic insurance is required to be purchased by everyone, but what “basic” coverage includes seems to be something that is changing the longer the system is in place. My friend has spoken of certain things being covered initially, but then they were only offered in the higher premium plan later on. She also describes waits of up to three months for a specialist visit.
Personally, I think insurance has to be wrestled away from employers. People should be able to buy what suits their needs and geographic location. I never liked the idea that I am limited by what coverage my employer offers. Americans probably change jobs more frequently than the Dutch do, and we also have a much larger country with lots of regional differences in populations, diseases, and state laws to contend with. So while the Dutch system may be working on the small scale of 4 million people all with a similar value system and a less diversified population—it remains to be seen if such a system could really work in this country. There are perhaps some good ideas here, but it is still a work in progress from what my friend tells me."
Did you watch the video you posted? Are you Bachmann? I didn’t say anything about your crazy ideas.
The ironic thing is that the only time in U.S. history when there really WERE life and death committees deciding who would and would not get essential medical treatment was the 1960s when there wasn’t enough dialysis to go around. This was so difficult for everyone involved that the U.S. government stepped in and Congress passed the Medicare ESRD Program in 1972.
If healthcare reform passes, it would not be the Obama administration that would push people toward death rather than costly healthcare–it would be insurance companies. The consumer protections that are being pushed would prevent them from:
– “Cherry picking” by only offering healthcare to healthy young people (mostly men)
– Refusing treatment (or raising costs) for pre-existing conditions
– “Rescission” – changing their minds about payments up to 2 years later and coming after people to pay back the money
The purpose of health insurance companies is to make money for shareholders. They do this by taking in premiums and trying their level best not to pay claims. With all of their previous loopholes closed, the only way they will be able to make money is to encourage people who will need a lot of healthcare to die. I predict that they will start encouraging a “death with dignity” legalized suicide movement. This is not necessarily a bad thing on its own–I’ve had cats that have had far better deaths than some people I know. But the thought of this happening for profit is repugnant.
The lesson here is not that the Obama administration is pushing people to kill themselves. The lesson is that profit does NOT belong in the provision of healthcare services. Equipment and medications (to a reasonable extent), sure. But not services.
Bill…did you try and look for Dr. Emanuel’s work? Here’s some of his words:
All of this is from his Lancet 2009 article:
From the abstract:
We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates
prognosis, save the most lives, lottery, and instrumental value principles.
Later:
Although not always recognised as such, youngest-first
allocation directs resources to those who have had less
of something supremely valuable—life-years. Dialysis
machines and scarce organs have been allocated to younger
recipients first, and proposals for allocation in pandemic
influenza prioritise infants and children. Daniel Callahan
has suggested strict age cut-off s for scarce life-saving
interventions, whereas Alan Williams has suggested a
system that allocates interventions based on individuals’
distance from a normal life-span if left unaided.
And later yet:
Unlike allocation by sex or race, allocation by age is not invidious
discrimination; every person lives through diff erent life
stages rather than being a single age. Even if 25-year-olds
receive priority over 65-year-olds, everyone who is
65 years now was previously 25 years. Treating 65-yearolds
differently because of stereotypes or falsehoods would
be ageist; treating them diff erently because they have
already had more life-years is not.
And then look at p428 where the authors show the nominal odds of receiving a treatment with Age. It starts low (ages less than 10), reaches a Maximum at 25 and tapers off.
Here’s the rationale:
Consideration of the importance of complete lives also
supports modifying the youngest-fi rst principle by
prioritising adolescents and young adults over infants
(fi gure). Adolescents have received substantial education
and parental care, investments that will be wasted without
a complete life. Infants, by contrast, have not yet received
these investments. Similarly, adolescence brings with it a
developed personality capable of forming and valuing
long-term plans whose fulfi lment requires a complete
life.
At age 60 the odds are about 1/5th the odds of getting treatment at 25. The line kinda stops at 75, so I guess we know what that means.
Now, Bill, if you are a young person that might be good for you, a better chance to live. You may support this approach, more for you, less wasted on people over 60 and the very young. (I have a feeling Trig Palin wouldn’t fair too well if he gets sick)
But let’s be straight about it…that’s what he’s saying.
This whole discussion seems like dorm room navel gazing to me because the people impacted by Medicare changes are the most potent political force in the country. there will never be legislation that significantly disadvantages seniors.
But to your specific concern about Dr. Emanual I couldn’t say it any better than Harold Pollack on the New Republic:Dr. Emanuel’s oncology career provides more than passing familiarity with the consequences of devastating, sometimes life-ending illness. He has written widely about the dilemmas of relying on medical care proxies in caring for desperately ill patients, chemotherapy at the end of life, and other intimate clinical concerns. There is nothing Orwellian about him. He has prominently opposed legalization of euthanasia and physician-assisted suicide, for example.
Emanuel’s work offers a model of sustained achievement that both Governor Palin and Representative Bachmann would be wise to emulate. He deserves better than to be trashed in this way. So do the rest of us.
The whole post is worth reading.
What I hear the conservative right saying is: We can’t have a public plan for people in difficult to insure groups e.g. people with chronic illnesses and the working poor because there are limited resources and therefor the government will have to ration the procedures the policy covers, so rather than risk a government coverage decision on a public policy we’re better off leaving these people without health insurance.
I have a feeling this is going to be like the Stimulus bill, the Sotomayor confirmation, cash for clunkers - there is all this fury on the right and in the end two thirds of the country’s Senator’s vote for passage and the angry 30% gets another grievance to add to their growing list of ways the whole world is now wrecked.
We had an election less than a year ago. Healthcare reform was a major topic. The House bill and what sounds to be coming out of Senate Finance is pretty much exactly what Obama proposed during the campaign. Obama has partnered with the pharmaceutical companies, he has the AMA - the guy thinks ahead. Remember he was the one who knew how Texas allocated their delegates years before the actual primary.
The only question is can he whip 60 or more votes in the Senate or does the bill just go through reconcilation. They’ll get a bill to the floor and if Kennedy and Byrd make dramatic appearances you could see 66 to 70 votes in favor. Look what happened last year in the Senate on HR6331 which passed with a veto proof majority because, it is said, Kennedy made a dramatic entrance.
Bill…Thanks for your reply.
Indeed this is a complex area and one that should be of strong interest to dialysis patients.
But I think a Lancet article by a respected medical ethicist (MD/PhD) goes a little beyond “dorm room” discussions. Dr. Emanuel was comparing three approaches to distribution of health care interventions (mainly in the context of scare resources). He compared QALY, DALY to his “complete lives system”.
Once you get past the ad hominem in the TNR piece, we find a couple of distractions.
The authors first point is about end-of-life care:
“Like other forms of care, end-of-life care is sometimes wasteful or ineffective, but nobody is looking to skimp on or ration such care to finance health reform. Nor should they.”
The 2009 Lancet article is not about end-of-life care. It is about how to distribute medical procedures to a population of people. He argues that we should mainly focus on those that are between the ages of 15 and 40.
The second point: “…millions of people’s lack of access to basic care. Many of these people are disabled or live with chronic illnesses” With Medicaid/Medicare I’d be interested to see his data.
But, still, the Lancet article would say that care to these “millions” would be distributed to them based on Age and Prognosis. If you are 25 with a curable condition you’d be in great shape. Over 60? Not so much.
The 3rd point has to do with CER. Again not the point of the Lancet article, but interesting that the author can’t resist saying: “Better approaches to palliative care often look very good when evaluated against the standard benchmarks of medical cost-effectiveness.” So palliative care kicks in when the QALY is 40K? 50K? 60K?
In point 4 he seems to want to go back to the safety of the ad hominem.
BTW, Pollack does admit that Dr. Emanuel has made some “incautiously blunt commentary regarding the pathologies of American health policy”
Now Harold Pollack tells us what he really thinks about the US…or to quote Nancy Pelosi “Americans have been waiting for nearly a century for quality, affordable health care”
Maybe that’s why Rasmussen reports that only 32% of voters support a national single payer plan.
What Pollack should have said is the truth. Emanuel is an academic who has explored different allocation strategies for scare resources. And now he is a Health Policy advisor for Obama. Academic theories may not be applicable or desirable in the real world.
The reason it is just dorm room navel gazing is because of the politics. In the US people vote for their members of Congress. No Bill is going to have Death Committees because it isn’t political feasible. Without political feasibility it’s just navel gazing.
Right now the only people facing death committees are the people with private insurance. There is a direct correlation between denying expensive end of life coverage and profits; health insurance industry profits have been soaring.
We in dialysis have actual real world experience with life and death committees and as Dori pointed out that experience was so disagreeable that Congress decided to shoehorn dialysis into Medicare.
A national single payer plan isn’t on the table. The result of opinion surveys depends entirely on how you ask the question - if you ask “Would you favor or oppose the government offering everyone a government administered health insurance plan – something like the Medicare coverage that people 65 and older get – that would compete with private health insurance plans?” 2/3 say Yes.
Two thirds is a substantial majority in American Politics.
Looking through the CBS/NYT poll you should keep in mind that the Democrats who say they are not happy with the way health insurance reform is unfolding are mostly unhappy because single payer is not being discussed. You should not count them as supporting no action.
Bill…you have to be careful with polling data. look at the internals of the CBS poll (esp. p15). The percentage breakdown of respondent by party was: 20% R, 34% D and 46% Ind. That sounds a little low on the R side.
btw, we’ve been talking a lot about the Lancet article, here’s a link
http://www.ncpa.org/pdfs/PIIS0140673609601379.pdf
There’s a lot in there about UNOS and some of the early days of dialysis.
I dion’t think the concerns are coming only from right-wing wackos:
Here’s another POV (from a TNR guy)
“Make no mistake about it. Determining which treatments are “cost effective” at the end of a person’s life and which are not is one of Obama’s priorities. It’s one of the principal ways he counts on saving money and making universal healthcare affordable.”
And here’s Charles Lane (Washington Post) on end-of-life concerns
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html
I know the thought of Free Healthcare is alluring, but it comes with a cost.
As Pres. Obama said himself today…UPS and FedEx are doing fine…its the Post Office that’s alway in trouble.
The USPS is thinking about cutting back delivery days and closing hundreds of POs.
Here’s my hunch: in-center dialysis will continue as is with low rates of re-imbursement. Nothing will change wrt home dialysis. I do note that the CER for this is in the second quartile of important studies, so maybe there’ll be extra money to pay for the home dialysis over an extended period.
Last I saw about 21% of the US is affiliated with the Republican Party, so 20% looks about right.
This question of how to reign in Medicare spending will be an ongoing effort but again the fact is that politically no law will be passed in the United States that disadvantages seniors. And no treatment will be denied to seniors if people think that denial is unfair. Death committees Will. Not. Happen. (outside of private insurance)
But there is clearly excessive spending and this article by Atul Gawande in the New Yorker is informing discussions far more than something that appeared in the Lancet
The discussion is how to discourage the practice of medicine as it is in McAllen Texas and encourage the practice of medicine as it is in the Kaiser system or at the Mayo?
That’s the heart of the discussion. How do we stop the McAllens?
Bill…you say: “And no treatment will be denied to seniors if people think that denial is unfair.”
Huh? But daily home hemo is already denied, and I thought the argument was that mortality and morbidities decreased with daily home hemo.
I thought that most of the people on this board wanted Medicare to expand coverage to daily home hemo. I’ve been hoping that eventually Medicare would cover the procedure so when the time comes for me I can go on it rather than in-center (I dread going back to in-center)
Obama is cutting 500B from Medicare to help pay for the expansion of healthcare.
Also, the more I hear about the $$$$$ he plans to direct to “preventative” healthcare and other things, I think the hemo community will be worse off than it is now.
oh, btw, Gallup has had R affliation @ 27.6 for all of 2009, vs. 35.8 for D…most recent is 26…like I say, a little low. But you’re totally correct on the question wording.
I know there’s a sleight of hand with the wording of single-payer, but we all know where most of the Dem leadership (and most Dems overall) wants to go sooner or later (and preferably sooner)
I was able to watch a few minutes of the video and then the computer blacked out. I was not able to view anything for a few days. In addition, had a very bad thunderstorm in the area. In all, a few horrible days of weather.
Having worked in the private sector, government, and the non-profit sector, every sector has to show a profit at some point or in the case of the feds, not rack up too much debt to unnerve investors in U.S. Government bonds. How I would like to ask the question, where is the $1 trillion dollars of revenue coming from, the magic tree in the backyard or the overtaxed United States taxpayer? In addition, where are we going to get the money for the interest on this debt that we do not have?
If the medical consumer chooses to pay a medical provider with a profit, why does the government or self interested elites have any say in this private transaction? Profit in the medical sector is labeled as “GREED.” Again, at what price point does a profit become “GREED” $5.00, $10.00, $20.00, $50.00, $100.00? What might be “affordable” to me, is not affordable to you. If I want to pay a profit to my medical provider, of my FREE CHOICE, then, it is the job of the government and self interested elites to get out of my face. My medical transaction is a free transaction between me and my medical provider, not between the individuals in the government or self appointed elites.
By the way, who died and left these self appointed elites in charge of our medical care? I hear so many people express anger about the control freaks of the dialysis system. Do you not realize if you leave these people in charge you are going to get much more of this control freak mentality? I know more about my health than anyone, end of the discussion.
How would you feel about the government coming to your place of employment to tell you that you are making too much money and we have decided to cut your salary and benefits because we think the compensation that you are demanding is GREEDY.
The first goal of any corporation and non-profit is to make money or to make a profit. By the way, I would like for you to provide examples where private insurance companies have encouraged people with a chronic illness to die, I have never heard of such nonsense. The problem with your claims is that people on the Left such as Richard Lamm, Peter Singer, and whole list of others have been pushing the “Death with Dignity” issue for years and years.
Yet, it is extreme arrogrance that individuals in this crowd believe that they and only they can decide when a life is worth living, only they can play God. Many of these individuals have endorsed experiments on individuals with mental and physical challenges, Sound familiar to you from somewhere in the past, try like the 1930’s? To many in our society, especially at the university, people with physical and mental challenges are to be looked at with pity, to be put out of their misery and reduce the financial expense on society. Yes, I have heard these types of comments, time and time again. It is amazing to me that they believe they know how the life of a Down’s syndrome child is going to turn out, years after their birth, no one knows the future, only the man upstairs.
You want to know how they respect human life and treat human life with compassion, they allowed and suported millions upon millions of abortions of unborn children, the most vulnerable members of our society. They claim that money and profits should not be involved in health care, yet, when a woman is talked out of an abortion, they flip out. They tell me that money should not be involved in health care as they count the billions they have made from abortion. Obama, Pelosi, Reid, and Hoyer claim that we should protect the most vulnerable in our society, then, they support and fund the most liberal abortion regime in the world. It is amazing how compassionate Obama, Pelosi, Reid, Hoyer, and Kennedy are with an other individual’s money. If they think this cause is so important, they should fund it with their own private money.
– “Cherry picking” by only offering healthcare to healthy young people (mostly men)
– Refusing treatment (or raising costs) for pre-existing conditions
– “Rescission” – changing their minds about payments up to 2 years later and coming after people to pay back the money
"I’m an ordinary citizen, now retired, and I must admit that none of what Obama says about health care applies to me, and I don’t think I’m alone.
I was employed in the private sector for over 50 years and never had a problem getting health care since I always participated in my employer’s group plan and paid premiums.
Now, because I’m over 65, I have mandatory Medicare. My out-of-pocket costs are more than I paid during my working years, but that’s understandable, because any government program costs more.
Overall, I continue to be satisfied with my health care.
If Obama wants to give coverage to people who don’t have it, why doesn’t he just put them on Medicaid and be done with it?"
Leave the rest of us alone.
Jane Kenny
Sun City, SC
Your otherwise excellent article overlooks what is quite a perverse incentive in the plan.
The plan imposes an 8 percent tax on small businesses that don’t have coverage for employees.
I have a $150,000 annual payroll, and I pay $36,000 per year in health-insurance premiums for my employees. Under Obama’s plan, I am better off canceling the health plan, paying the $12,000 penalty for not having a health-insurance plan and telling my employees to get their healthcare from the new government program.
I’d save $24,000. In effect, Obama’s plan encourages greed on my part.
And if enough employers do this, won’t there be an end to private health insurance entirely? Then again, that may be the whole objective.
Dave Wilkes
Manhattan
By JEFFREY H. ANDERSON
Last updated: 3:26 pm
July 19, 2009
Posted: 12:20 am
July 18, 2009
THE testimony by Congressional Budget Office chief Douglas Elmendorf that the health-care legislation in Congress “significantly expands” costs shocked Capitol Hill. Yet the evidence shows that government-run care has always been more costly than private-sector care.
In claiming that the solution to skyrocketing health costs is more government-run care, President Obama has relied on a myth – the belief that Medicare and Medicaid have restrained the growth in health expenses, relative to private care.
My new study, published by the Pacific Research Institute, shows that – across four decades – the costs of government-run health care have risen far more than the costs of private care.
My study compares the cost increases of Medicare and Medicaid with those of all other health care in the United States. The key finding: Since 1970, Medicare and Medicaid’s costs have risen one-third more, per patient, than the combined costs of all other health care in America – the vast majority of which is purchased privately.
Since 1970, Medicare and Medicaid’s combined per-patient costs have risen from $344 to $8,955, while the combined per-patient costs of all other US health care have risen from $364 to $7,119.
Medicare and Medicaid used to cost $20 less per patient than other care. Now they cost $1,836 more. (And that’s even without the Medicare prescription-drug benefit.)
In fact, if the costs of Medicare and Medicaid had risen only as much as the costs of all other health care in America, then, instead of costing a combined $807 billion last year, they would’ve cost a combined $606 billion. That savings of $201 billion would have amounted to more than $1,750 per American household last year alone.
These conclusions are true despite very generous treatment of Medicare and Medicaid. My analysis counts all Medicare prescription-drug expenditures as part of privately purchased care, rather than as part of Medicare. It doesn’t adjust for billions of dollars in cost-shifting from Medicaid to the SCHIP program. And it counts health care purchased privately by Medicaid and Medicare patients (including Medicare co-payments and Medigap insurance) among the costs of private care, without counting those patients among the recipients of private care – thereby magnifying private care’s per-patient costs.
Despite such generous treatment, since 1970, Medicaid’s per-patient costs have risen 35 percent more, and Medicare’s 34 percent more, than all other health care in America.
President Obama says we must expand government-run health care to contain costs and that we don’t have a minute to lose. But nearly 40 years of evidence shows that government-run care has succeeded only in raising costs.
During an economic downturn in which we are already running higher budget deficits than at the height of the Great Depression (even as a percentage of our gross domestic product), wishful thinking and empty rhetoric shouldn’t be allowed to trump empirical evidence.
In truth, there’s only one reliable pursuer of value in American health care: the American consumer. If Congress and the president are serious about improving our nation’s health care, they should end the tax discrimination against the uninsured – that is, allow others to purchase care with pre-tax dollars in the way that we now permit only for those with employer-provided insurance. They should promote a more vibrant private market with greater competition across state lines, greater consumer freedom and greater incentives for consumers to pursue value. These are the changes we need.
The empirical evidence is in, and the verdict could hardly be plainer: Government-run health care limits choice and is more expensive. Privately purchased care offers choice and is more affordable.
Only the federal government could struggle to choose between these two alternatives.
Jeffrey H. Anderson is a senior fellow in health-care studies at the Pacific Research Institute.
With all of their previous loopholes closed, the only way they will be able to make money is to encourage people who will need a lot of healthcare to die. I predict that they will start encouraging a “death with dignity” legalized suicide movement. This is not necessarily a bad thing on its own–I’ve had cats that have had far better deaths than some people I know. But the thought of this happening for profit is repugnant.
Any proof you would like to provide to prove your claims?
But the thought of this happening for profit is repugnant.
Subjective moral judgement.
Mark, you CANNOT post to yourself in these boards; I will ban you for another week if I see this behavior again. Think through your entire argument and make it in ONE post, or wait until someone else posts.
Bill…you say: “And no treatment will be denied to seniors if people think that denial is unfair.”
Huh? But daily home hemo is already denied, and I thought the argument was that mortality and morbidities decreased with daily home hemo.
Guest, daily home hemo is NOT denied to anyone on the basis of age. If it is denied, it is because Medicare will only pay for 3 treatments per week (for anyone), so the insurance plans can follow suit. So, that argument doesn’t hold up in this case.
Dialysis is not denied based on age.
Just Came Across This, In their own words:
The LancetDepartment of Ethics
The Lancet, Volume 373, Issue 9661, Pages 423 - 431, 31 January 2009 <Previous Article|Next Article>doi:10.1016/S0140-6736(09)60137-9Cite or Link Using DOIPrinciples for allocation of scarce medical interventions
Original Text
Govind Persad BS a, Alan Wertheimer PhD a, Ezekiel J Emanuel MD
Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.
In health care, as elsewhere, scarcity is the mother of allocation.1 Although the extent is debated,2, 3 the scarcity of many specific interventions—including beds in intensive care units,4 organs, and vaccines during pandemic influenza5—is widely acknowledged. For some interventions, demand exceeds supply. For others, an increased supply would necessitate redirection of important resources, and allocation decisions would still be necessary.6
Allocation of scarce medical interventions is a perennial challenge. During the 1940s, an expert committee allocated—without public input—then-novel penicillin to American soldiers before civilians, using expected efficacy and speed of return to duty as criteria.7 During the 1960s, committees in Seattle allocated scarce dialysis machines using prognosis, current health, social worth, and dependants as criteria.7 How can scarce medical interventions be allocated justly? This paper identifies and evaluates eight simple principles that have been suggested.8—12 Although some are better than others, no single principle allocates interventions justly. Rather, morally relevant simple principles must be combined into multiprinciple allocation systems. We evaluate three existing systems and then recommend a new one: the complete lives system.
Simple allocation principles
Eight simple ethical principles for allocation can be classified into four categories, according to their core ethical values: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness (table 1). We do not regard ability to pay as a plausible option for the scarce life-saving interventions we discuss.
Some people wrongly suggest that allocation can be based purely on scientific or clinical facts, often using the term “medical need”.13, 14 There are no value-free medical criteria for allocation.15, 16 Although biomedical facts determine a person’s post-transplant prognosis or the dose of vaccine that would confer immunity, responding to these facts requires ethical, value-based judgments.
When evaluating principles, we need to distinguish between those that are insufficient and those that are flawed. Insufficient principles ignore some morally relevant considerations. Conversely, flawed principles recognise morally irrelevant considerations: inherently flawed principles necessarily recognise irrelevant considerations, whereas practically flawed principles allow irrelevant considerations to affect allocation. Principles that are individually insufficient could form part of an acceptable multiprinciple system, whereas systems that include flawed principles are untenable because they will always recognise irrelevant considerations.
Treating people equally
Many scarce medical interventions, such as organ transplants, are indivisible. For indivisible goods, benefiting people equally entails providing equal chances at the scarce intervention—equality of opportunity, rather than equal amounts of it.1 Two principles attempt to embody this value.
Lottery
Allocation by lottery has been used, sometimes with explicit judicial and legislative endorsement, in military conscription, immigration, education, and distribution of vaccines.10, 17, 18
Lotteries have several attractions. Equal moral status supports an equal claim to scarce resources.19 Even among only roughly equal candidates, lotteries prevent small differences from drastically affecting outcome.18 Some people also support lottery allocation because “each person’s desire to stay alive should be regarded as of the same importance and deserving the same respect as that of anyone else”.20 Practically, lottery allocation is quick and requires little knowledge about recipients.18 Finally, lotteries resist corruption.18
The major disadvantage of lotteries is their blindness to many seemingly relevant factors.21, 22 Random decisions between someone who can gain 40 years and someone who can gain only 4 months, or someone who has already lived for 80 years and someone who has lived only 20 years, are inappropriate. Treating people equally often fails to treat them as equals.23 Ultimately, although allocation solely by lottery is insufficient, the lottery’s simplicity and resistance to corruption suggests that it could be incorporated into a multiprinciple system.22
First-come, first-served
Within health care, many people endorse a first-come, first-served distribution of beds in intensive care units24 or organs for transplant.25 The American Thoracic Society defends this principle as “a natural lottery—an egalitarian approach for fair [intensive care unit] resource allocation.”24 Others believe it promotes fair equality of opportunity,25 and allows physicians to avoid discontinuing interventions, such as respirators, even when other criteria support moving those interventions to new arrivals.26 Some people simply equate it to lottery allocation.19
As with lottery allocation, first-come, first-served ignores relevant differences between people, but in practice fails even to treat people equally. It favours people who are well-off, who become informed, and travel more quickly, and can queue for interventions without competing for employment or child-care concerns.27 Queues are also vulnerable to additional corruption. As New York State’s pandemic influenza planners stated, “Those who could figuratively (and sometimes literally) push to the front of the line would be vaccinated and stand the best chance for survival”.28 First-come, first-served allows morally irrelevant qualities—such as wealth, power, and connections—to decide who receives scarce interventions, and is therefore practically flawed.
Favouring the worst-off: prioritarianism
Franklin Roosevelt argued that “the test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little”.29 Philosophers call this preference for the worst-off prioritarianism.30 Some define being worst-off as currently lacking valuable goods, whereas others define it as lacking valuable goods throughout one’s entire life.8 Two principles embody these two interpretations.
Sickest first
Treating the sickest people first prioritises those with the worst future prospects if left untreated. The so-called rule of rescue, which claims that “our moral response to the imminence of death demands that we rescue the doomed”, exemplifies this principle.31 Transplantable livers and hearts, as well as emergency-room care, are allocated to the sickest individuals first.21
Some people might argue that treating the sickest individuals first is intuitively obvious.32 Others claim that the sickest people are also probably worst off overall, because healthier people might recover unaided or be saved later by new interventions.33 Finally, sickest-first allocation appeals to prognosis if untreated—a criterion clinicians frequently consider.14
On its own, sickest-first allocation ignores post-treatment prognosis: it applies even when only minor gains at high cost can be achieved. To circumvent this result, some misleadingly claim that sick people with a small but clear chance of benefit do not have a medical need.13 Sick recipients’ prognoses are wrongly assumed to be normal, even though many interventions—such as liver transplants—are less effective for the sickest people.34
If the failure to take account of prognosis were its only problem, sickest-first allocation would merely be insufficient. However, it myopically bases allocation on how sick someone is at the current time—a morally arbitrary factor in genuine scarcity.16 Preferential allocation of a scarce liver to an acutely ill person unjustly ignores a currently healthier person with progressive liver disease, who might be worse off when he or she later suffers liver failure.8, 22 Favouring those who are currently sickest seems to assume that resource scarcity is temporary: that we can save the person who is now sickest and then save the progressively ill person later.8, 22 However, even temporary scarcity does not guarantee another chance to save the progressively ill person. Furthermore, when interventions are persistently scarce, saving the progressively ill person later will always involve depriving others. When we cannot save everyone, saving the sickest first is inherently flawed and inconsistent with the core idea of priority to the worst-off.