Tag Archives: rationing health care

Who Decides What Medical Care You Receive At End of Life?

In Forbes, Paul Hsieh, MD writes:

Any government-funded health care system must necessarily set limits on medical spending. No government can issue a blank check for unlimited medical care for everyone. The only issue is where and how it draws that line.

This is an inherent part of any socialized medical system, such as in Canada or the UK. Put simply, if you expect “somebody else” to pay for your health care, then “somebody else” will ultimately decide what care you may (or may not) receive. …

Who should decide what care you receive towards the end of your life — you or an “administrative tribunal” of “experts and wise community members”? If you want to retain control over your medical care, you must retain control over your medical dollars. He who pays the piper calls the tune. Make sure the tune being called is the one you want.

via Who Decides What Medical Care You Receive At End of Life?.

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Thank U.S. medical care for extending Steve Jobs’ life

John Goodman writes:

Had Jobs been under the care of the British National Health Service (NHS) or the Canadian Medicare system, he almost certainly would have died two years earlier. That would have been a major loss for the world, by anyone’s reckoning.

Here’s the back story. In 2004 Steve Jobs was diagnosed with pancreatic cancer. He reportedly underwent successful surgery. Then, in 2009 he received a liver transplant. …

[N]owhere else in the world would a pancreatic cancer survivor be considered an appropriate candidate for a liver transplant. In Jobs’ case, the transplant apparently bought him only about two more years of life. In no other developed country would a patient get a liver transplant in order to live two more years.

In Britain, the National Institute for Health and Clinical Excellence (NICE) is charged with deciding which treatments the British NHS will pay for and which it will not. NICE considers a treatment cost-effective only if the cost per quality adjusted life year (QALY) is £20,000 or less (about $31,000). Since the cost of a liver transplant plus two years of follow-up care are greater than that number, in Britain Jobs would not have made the cut.

Overall, the British Medical Journal estimates that 25,000 British cancer patients die prematurely every year because they do not get access to life-extending drugs readily available on the European continent and in this country. The British government reasons that the extra months of life the drugs will allow is not worth their cost.

Plus, Jobs’ end-of-life care enabled him to keep pushing the envelope. Because of his never-ending devotion to innovation, we got the iPhone after he was diagnosed with pancreatic cancer and the iPad after his liver transplant.

Goodman also points out that making it legal “compensate people for donating their organs in the case of an unforeseen death” [or before their death with kidneys] would decrease the “average of 20 people die each day waiting for transplants that can’t take place because of the shortage of donated organs. ”

Read the while post: Thank U.S. Health Care for the Life of Steve Jobs.

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How Obamacare will decrease health care access for the poor

John Goodman explains very important aspects of health care rationing on his blog, healthblog.ncpa.org:

Here is the conventional wisdom in health policy:

  • In the United States, we ration health care by price, whereas other developed countries rely on waiting and other non-price rationing mechanisms.
  • The U.S. method is especially unfair to low-income families, who lack the ability to pay for the care they need.
  • Because of this unfairness, there is vast inequality of access to care in the U.S.
  • ObamaCare will be a boon to low-income families — especially the uninsured — because it will lower price barriers to care.

As it turns out, the conventional wisdom is completely wrong. Here is the alternative vision, loyal readers have consistently found at this blog:

  • The major barrier to care for low-income families is the same in the U.S. as it is throughout the developed world: the time price of care and other non-price rationing mechanisms are far more important than the money price of care.
  • The U.S. system is actually more egalitarian than the systems of many other developed countries, with the uninsured in the U.S., for example, getting more preventive care than the insured in Canada.
  • The burdens of non-price rationing rise as income falls, with the lowest-income families facing the longest waiting times and the largest bureaucratic obstacles to care.
  • ObamaCare, by lowering the money price of care for almost everybody while doing nothing to change supply, will intensify non-price rationing and may actually make access to care more difficult for those with the least financial resources.

Read the whole post: How We Ration Care | John Goodman’s Health Policy Blog | NCPA.org.

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Filed under myths & fallacies, Policy - National

How Medicare vouchers could bypass health care rationing

Should Medicare cover costly cancer medications that add, on average, only four months to a person’s life?  This is the debate behind Provenge, a prostate cancer vaccine. Michael Cannon at Cato points out how this debate would vanish:

If the government stayed out of health care, or just subsidized Medicare enrollees with a voucher, then [some people] could purchase coverage for expensive cancer treatments.  [Others] could buy lower-cost insurance and donate the savings to scholarships.

Yet politicians and government bureaucrats dictate what type of insurance Medicare enrollees get, which means they also decide what enrollees will not get.  And no matter where they draw the line, someone loses. …

The only way out is Medicare vouchers.  In addition to being the most plausible way to reduce Medicare spending, vouchers are the only way to protect Medicare enrollees from government rationing.

Read the whole post: Provenge Controversy Argues for Medicare Vouchers.

A minor quibble I have is that the term “government rationing” is redundant. Continue reading

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Donald Berwick won’t answer critics

Via Human Events, Donald Berwick, head of the Center for Medicare and Medicaid Services,  “won’t, engage critics, grant interviews, or testify before Congress about his views on health-care rationing.”

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The FDA, Avastin, and your life

Paul Hsieh, MD of Freedom and Individual Rights in Medicine writes:

The Food and Drug Administration (FDA) is on the verge of taking the highly unusual step of “decertifying” the cancer drug Avastin that it had previously approved. In addition to sparking concerns that this is another step towards medical rationing, the FDA’s proposal will worsen another important but less-frequently recognized danger of government-run health care — namely, the politicization of health benefits. Both problems will accelerate under ObamaCare unless our politicians repudiate the principle of government-run health care. …

If you had terminal cancer, who should decide what treatments you may receive during your last few irreplaceable months of life? You, in consultation with your doctor? Or politicians and bureaucrats in Washington, D.C.?

Unless we repeal ObamaCare [HR 3590], get ready for the latter choice.

Read the whole article at Pajamas Media: Avastin and Your Life.

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Medicare head Donald Berwick: rationing for thee, not for me

David Catron points out more ruling class elitism from Medicare & Medicaid head Donald Berwick:

Berwick praised the heavy-handed rationing methods of Britain’s National Institute for Health and Clinical Excellence (NICE) and said, “The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open.”…

Before Obama picked him to be our new Medicare czar, Berwick was the chief executive officer of an outfit he founded called the Institute for Health Care Improvement (IHI). IHI bills itself as a nonprofit charity, but it seems to do an awful lot of work on behalf of for-profit entities. As CEO of this enterprise, Dr. Berwick earned a cool $2.3 million in 2008. But, more to the point, IHI will provide him with private health care coverage during his declining years: “The Institute created a postretirement health benefit plan for its chief executive officer (CEO). It provides the CEO and his spouse medical insurance from retirement until death.”

In other words, Dr. Berwick has made sure that he and his wife will never be subjected to the tender mercies of Medicare, the health care program for seniors over which he now has control. Thus, even after he has implemented rationing programs modeled after those of NICE, he won’t have to worry about his wife suffering for lack of drugs deemed too pricey by some obscure comparative effectiveness calculation.

Read the whole article: Donald Berwick’s Motto? Rationing for Thee, but not for Me.

Paul Hsieh, MD connects this to a larger trend:

The arrogance of government officials like Berwick is astounding in a two-fold way.

First, they believe they are qualified to set draconian rules over the lives of the citizenry, because we are unable to make such decisions for ourselves. The typical excuse given is that it’s for our own good or for some nebulous “common good”.

But by exempting themselves from their own rules, they recognize (at some level) that these rules are actually bad for the individuals involved — but they don’t care.

Paul mentions environmentalists who jetset around the globe advocates of gun control who have bodyguards or exempt themselves from gun bans.  Read more here. To add to Paul’s examples, there are the politicians, like president Obama, who support the government school monopoly but send their kids to private schools.

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