Tuesday, August 25, 2009

Health Care Rationing

Yesterday Teri Gross offered an excellent interview with writer T.R. Reid, who visited health care providers in several countries to assess their provision of health care. Among other things, he compares and contrasts their responses to a shoulder problem he presented. I have yet to hear the entire thing, but I'm going to try to listen today.

The section that struck me: his assertion that we, too, already ration health care ~ in response to the argument raised against reform to the effect that we will follow other countries by imposing a rationing system.

True enough, a country like great Britain rations specialized care, as he discovered when he sought advice about his shoulder. However, the trade-off is that basic care is available to everyone across the board.

We do somewhat the opposite. For some of us ~ my husband and I for example, thanks to a corporate health care package that costs us out-of-pocket "only" about $4,000 a year plus deductibles and co-pays ~ extensive and sophisticated medical care is easily available. We live within two miles of two internationally recognized and university-affiliated hospitals and we have eye and dental coverage. Our daughter's minor surgery last spring, for which the bill ran $14,000, added about $1,000 to our annual out-of-pocket costs, but it was performed by a world class surgeon who was easily accessible to us, as he had been when she had had the original surgery 18 years ago.

We as a nation are able to achieve the above because we ration health care at the outset: we simply eliminate entire groups of people from even the most basic preventative care. Our son, a restaurant server in a job in which his supervisors carefully ensure that he not work the hours that would require his employer to provide benefits, pays about $100 a month for a catastrophic plan that provides no well-person care and covers no pre-existing conditions, including any that occue under a period in which he has been covered by said plan. Actually, I'm sure that any serious illness or injury in one six-month payment period would ensure (pun intended) the loss of his minimalistic coverage and prevent him from obtaining it anywhere else. If he gets an infection that requires antibiotics, he will no doubt be out another $200 for the urgent care visit and meds. Despiter those two fabulous hospitals down the hill, he has no regular doctor as, I have heard, is the case for a huge percentage of Americans in their 20s without fulltime employment with one employer. Why would he? He can't afford the $200 I (or rather, our plan) was charged for an introductory visit to a new internist.

And he's actually in great shape ~ he lives at home and has parents who, even if he didn't, would foot the bill for his care to the extent that we could. (As we are probably about to do for flu shots, but could not do for, say, cancer.)(When my brother was 21 and uninsured, he was treated surgically for cancer; no chemo or radiation involved. The total bill at that time, more than 30 years ago, was $15,000. What might it be today?) Our city is full of people, young and old, who can't afford the $100 a month and have no one to pick up the slack for extras.

So yes, we do ration. Extensively.


Joan Calvin said...

I shouldn't get started on rationing health care. We do. Period.

In terms of costs for cancer treatment, mine last year ran about $100,000 (after negotiated reductions by BC/BS). Surgery, four chemos (two different chemos each time). Without negotiated reduction in price, at least twice that. (My later hernia surgery the surgeon's charge was $5000, for which BC/BS negotiated down to less than $1000.)

My wonderful coverage, paid for by people like you, is limited by the PCUSA to a lifetime total of $3million.

I read about a woman who had gone to MD Anderson with only catastrophic coverage (I think she and her husband had a small business) and MD Anderson refused to treat her unless she paid a huge amount up front. This was in late April last yera.

Daisy said...

Funny you should post this today. I was watching the news this a.m. and some segment triggered thoughts about the difference in health care systems. Here in Canada, everyone has access to health care; the problem is that we are short of doctors and waiting times can be long for important procedures or scans, etc. It may cost us more in taxes (not sure about that though as I don't know how it compares to other countries) and abuse of the system likely occurs but no one's going to go broke from a doctor's visit.

I suspect that if we ever did end up with privatized health care, we'd still be paying the same taxes anyway. Funny how that never seems to change even when services are cut.

Michelle said...

A friend, an MD with a masters in public health points out that even high end private plans ration - they ration by "burden". Every hoop that gets put in the way, reduces the number of people who will use that benefit and hence their costs.

Lisa :-] said...

...And when they talk about "death panels," do they understand that our system already basically does to geriatric patients what any death panel would do, but it's not official and they don't come right out and call it that.

Cynthia said...

Our health care is simply survival of the wealthiest.

Jennifer said...

I heard the Terri Gross interview-- it was fascinating.

Stratoz said...

the world and how folk respond to things will always amaze me. you would think health insurance was deadly. a good friend, who already was a fan of Obama's plan, just experienced the scary and expensive life of the uninsured.