Message #154

[GordMay]

Balderdash!

Further to: Pg 29 lines 4-16 in the HC bill - Your healthcare will be rationed (as it is in Canada and Britain ).

In the current debate over health care reform, “rationing” has become a dirty word. But, health care is a scarce resource, and all scarce resources are rationed in one way or another.  In the US, your health care is rationed by your private (for profit) insurer.

It’s common for opponents of health care rationing to point to Canada and Britain as examples of where you might end up if you get “socialized medicine.”
On a blog on Fox News earlier this year, the conservative writer John Lott wrote, “Americans should ask Canadians and Brits — people who have long suffered from rationing — how happy they are with central government decisions on eliminating ‘unnecessary’ health care.”
As it happens, last year the Gallup organization did ask Canadians and Brits, and people in many different countries, if they have confidence in “health care or medical systems” in their country.
In Canada, 73 percent answered this question affirmatively.
Coincidentally, an identical percentage of Britons gave the same answer.
In the United States, despite spending much more, per person, on health care, the figure was only 56 percent.

Health Insurer Rationing

Health insurers ration care, but they don't call it rationing, and they don't even want you to realize that it is rationing. Dr. Rich Fogoros, the About.com Guide to Heart Disease gave this its own term. He calls it "covert rationing."

When insurance companies ration care, it's a money-saving measure, in part for the greater good, but also to preserve profits or raise salaries or other reasons that their customers disdain.

Rather than dwell on the reasons that frustrate us, suffice it to know that some of their rationing does keep premiums from getting any higher than they do, and does allow insurers to stay in business.

Health insurers ration your care by limiting the doctors you may visit because they negotiate fees with those doctors. They will only pay for you to visit the ones they have negotiated the lowest fees with.

Health insurers ration care through co-pays, deductibles and caps. In fact, what they are really doing is encouraging you to self-ration. Knowing that a certain amount of your care will have to be paid from your pocket, you may choose not to get the care or drug you need.

Health insurers deny services or reimbursements for services. Denial of care is perhaps the most understood form of rationing, because it causes outrage and frustration. What most patients don't understand is that this is also the aspect of rationing that is most affected by laws and regulations, too.

In many cases, those denials may be based on science or evidence that a treatment won't work, doesn't work well enough, or is too new. For example, many patients get frustrated that insurance won't reimburse for an alternative treatment. What the insurer will tell you is that there isn't enough evidence to prove that treatment will work.

In other cases, experimental, off-label drugs or new surgical approaches are too new to show enough evidence of success, so the insurance company will not reimburse for it.

In still other cases, a doctor may recommend a treatment that is shown to only benefit a small percentage of the people who have used it (usually in very difficult medical cases), and may also be very expensive, so the insurance company will decide it's not worth the high cost for so small a probability of success.

Remember, of course, the insurer isn't denying permission for the treatment. Rather, payment for the treatment is being denied. The patient can still participate in the treatment if she can pay for it herself.

Government Healthcare Rationing

Even the government rations healthcare. The difference between the government's rationing and the rationing conducted by health insurers is that there is no profit motive. The government, through Medicare or state Medicaid or other programs, keeps costs lower as much as possible in order to keeps taxes lower, or to expand care to others, both considered to be the greater good.