Rationing: It is the future

[Sneezing]

The future of health care will be rationed. Who do you want to ration it?

*Government / Single payor / CMS, medicaid, medicare / Politicians / actuary science
*Fee for service / your own wallet / private insurance / cash only / free market

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[bronx43]

Free market won't happen, so what's the point of this poll?

 

[IvyHopeful20]

There hasn't been a free market since the Flexner report. And there won't ever be again. Unless you know of a legal way for my friend (who went to medical school in another country) to dispense with this pesky DEA licenses and medicare residencies and start undercutting physicians in the area by doing surgery for $50 in his basement....not to mention the midlevels.

And we've been rationing forever, it's just based on different criteria - and it's not the free market. No one pays out of pocket for their medical bills. Try it and the hospital charges you like 10 times what they charge the insurance company, let alone what they get paid by the government.

 

[Sneezing]

Free market won't happen, so what's the point of this poll?

You can just as easily state there will never be just a single payer. People will still seek out to leave the system to get the quality they want.

You underestimate the state of our national, and global economy. A monumental recession is looming and it will result in the complete withdrawal of all government funded healthcare.

Since no politician is willing to function as a public servant, we are on a one way track to insolvency. So, we may as well hurry up and become a single payer so we can expedite the crash and begin the process of rebuilding sooner rather than later.

There hasn't been a free market since the Flexner report. And there won't ever be again. Unless you know of a legal way for my friend (who went to medical school in another country) to dispense with this pesky DEA licenses and medicare residencies and start undercutting physicians in the area by doing surgery for $50 in his basement....not to mention the midlevels.

And we've been rationing forever, it's just based on different criteria - and it's not the free market. No one pays out of pocket for their medical bills. Try it and the hospital charges you like 10 times what they charge the insurance company, let alone what they get paid by the government.

Permitting free flux of internationals into the system has nothing to do with establishing a true free market in health care. Law is practiced by licensed individuals and has quite the free market associated with it. Electricitians are licensed. Fishing in American coastal waters is licensed, and permissible for americans only. Your logic is flawed.

The poll is not to discuss our current hybrid system, but to do what the poll states. Check the box of who you want to ration healthcare. Don't over think this one.

 

[bronx43]

Permitting free flux of internationals into the system has nothing to do with establishing a true free market in health care. Law is practiced by licensed individuals and has quite the free market associated with it. Electricitians are licensed. Fishing in American coastal waters is licensed, and permissible for americans only. Your logic is flawed.

The poll is not to discuss our current hybrid system, but to do what the poll states. Check the box of who you want to ration healthcare. Don't over think this one.

You can't have a free market where there is artificial limitation on supply - that negates one of the premises of a free market, where the only parameter which limits supply is the size of the market. Law is practiced with licensing, but as far as I know, there is no legislation or organizing body which maintains a preset number of service providers - and even if there is, their restrictions aren't very strict. That is the reason you have a glut of attorneys who can't find jobs. And I don't see how fishing in American coastal waters is even relevant.
Take any other free market in the US - electronics, automobiles, entertainment, publishing, kitchen products, etc. There are no artificial limitations on supply. If you have capital, you can try to squeeze into the market and compete with your product at a 90% failure rate.
The scenario you are trying to delineate isn't a free market. It's simply a market with a capped supply and infinite demand.

 

[Impromptu]

My goal is to be in charge of the "death panels" (comparative medicine) someday. I'll be the one deciding what to ration. I can be ice cold if it is the right thing to do.

 

[lee9786]

My goal is to be in charge of the "death panels" (comparative medicine) someday. I'll be the one deciding what to ration. I can be ice cold if it is the right thing to do.

Well it's good to have goals.

 

[Endolas]

My goal is to be in charge of the "death panels" (comparative medicine) someday. I'll be the one deciding what to ration. I can be ice cold if it is the right thing to do.

This is my town! If you live to see the dawn, it's because I allow it. I'm in charge of everything! I decide who lives or who dies!

 

[Dirt]

This just in.

Rationing is the "present" of health care.

 

[Lokhtar]

I really don't understand what people have against an organization like NICE.

 

[MOHS_01]

I really don't understand what people have against an organization like NICE.

I'm afraid that there is a lot that you seemingly fail to understand.

The problem is not the organization itself; neither its existence nor its stated purpose is in the least bit objectionable. The objection comes with the reason for its existence and the the inevitable consequences of its "findings". People want to be free to choose -- not have some supreme authority dictate their choices to them under some false pretense of paternalism. Hopefully one of these days you will come around to asking yourself a series of very simple questions: should people have the right to live their lives according to their own preferences insofar as they do no harm unto others? Is it ever right to strip someone of their freedom to act peacefully and in accordance to their beliefs and preferences? Is there any way to enforce your preferred order upon others without infringing upon these very simple rights? Is there any way to deny the gun in the room that is required to enact your (seeming) preference towards technocracy?

 

[Lokhtar]

I do not know of any insurance system that allows patients to choose whatever they want without any limits - government or otherwise. If it's the public money, and assuming the dollars aren't infinite, it makes sense to create guidelines based on efficacy, cost/benefit, etc.

No one is stopping anyone from paying out of pocket for whatever procedures. You are free to live your life that way.

 

[MOHS_01]

I do not know of any insurance system that allows patients to choose whatever they want without any limits - government or otherwise. If it's the public money, and assuming the dollars aren't infinite, it makes sense to create guidelines based on efficacy, cost/benefit, etc.

No one is stopping anyone from paying out of pocket for whatever procedures. You are free to live your life that way.

Perhaps I am mistaken about the way our neighbors to the North or friends in the UK view such practices, I don't know, but I was under the impression that offering services outside of their system was a big no-no.... and while that has not been suggested or implemented here yet, it is the direction we are heading all the same. Don't scoff at the idea, either, because it was just a few decades ago when the very thought of any State administered health plan was considered crazy talk.

Nothing of value has an infinite stock, not even public dollars. I agree that prudence is a (lost) virtue when doling out the monies absconded from others... but it is the compulsion into the system that is objectionable. I do not agree with the system, do not see the value in it for me or my family, and fail to see the justice in the conscription to funding such a low value system.

 

[IvyHopeful20]

Perhaps I am mistaken about the way our neighbors to the North or friends in the UK view such practices, I don't know, but I was under the impression that offering services outside of their system was a big no-no....

Nah, many people have supplemental insurance for many services.

 

[MOHS_01]

Nah, many people have supplemental insurance for many services.

Seriously? I mean, I have no first hand knowledge, but that was not the story / impression I was given by colleagues who practiced abroad before coming here. If a real (read sufficient size -- not supercar status) market exists, how does it not crowd out the government payers?

 

[physasst]

Seriously? I mean, I have no first hand knowledge, but that was not the story / impression I was given by colleagues who practiced abroad before coming here. If a real (read sufficient size -- not supercar status) market exists, how does it not crowd out the government payers?

On which one...Both allow private health insurance, but the structure of both systems is fairly different.

Canadians prefer the government payor route by a large margin.

The UK is a little different with their two tiered system.

If you have a specific question about either, or about any other OECD system, France is for example, rated number one, and is essentially a private system...we can certainly discuss further.

Anyway, hope you are doing well Mohs...

 

[Stitch]

Seriously? I mean, I have no first hand knowledge, but that was not the story / impression I was given by colleagues who practiced abroad before coming here. If a real (read sufficient size -- not supercar status) market exists, how does it not crowd out the government payers?

Private insurance or out of pocket payments for procedures not covered was illegal in Canada, but it got struck down in 2005 by their courts (I think, someone please correct me if I'm wrong).

I've lived but not practiced in England, and some people do carry supplemental insurance. You still have to pay the (very high) taxes that go towards the NHS however, and all in all the government system is relatively comprehensive in what it covers, though the wait times suck. But that's why there aren't tons of people flocking to private insurance. Plus it's fairly expensive, and there's much more of a culture distrust of 'for profit' health companies. The old scare of refusing dialysis to people over 65 hasn't been true for a while.

The NICE does take a lot of heat from people, but at least it's made up of physicians. Legally if you follow the NICE recommendations for treatment, you can't be sued for malpractice. It won't even go to court.

If you have a specific question about either, or about any other OECD system, France is for example, rated number one, and is essentially a private system...we can certainly discuss further.

I think this may be somewhat misleading, calling it private. I've lived but not practiced there too. Something like 70% of the population does carry/pay for private insurance, but the private sector is heavily controlled by the government. What they can charge and what they must cover is mandated. As a result, many have trouble remaining solvent and in business. I think the government has had to supplement a few of these companies to keep them in business.

One nice thing about it however is that the law requires insurance companies to pay physicians within a matter of days. Prices for services rendered are posted in the office, so you know how much you as a patient will be responsible for up front, and there generally is some sort of co pay.

Of course the French revamp the system every few years.

I'm actually a fan of the Swiss system. Tons of private plans, with some government safeguards to prevent abuse of patients.

 

[MOHS_01]

The RVU RUC is made up of physicians as well.... the problem is not the composition of the body -- it's the arbitrary authority commanded.