An American Editor

September 28, 2010

Rationing: An American Conundrum

The election season is now in full swing with the primaries over and only a few weeks to a shorter-than-usual campaign season. I guess there are still some things one can be thankful for.

But this campaign season differs from past seasons in one major respect — not since the Civil Rights legislation of the 1960s can I recall a campaign in which so many candidates are running on the vote-for-me-to-repeal issue, which, in today’s case, means repeal of the recently enacted healthcare legislation.

An underpinning argument made by opponents to healthcare is that it will result in Xyz-style (substitute country of your choice for Xyz) rationing of medical resources. I guess I must live on a different planet because of all the possible arguments against the healthcare legislation and of all the possible reasons to support its repeal or modification, this is the weakest argument. But, then, we need to consider the circumstances of those who are making the argument of rationing — it is hard to see millionaires like Mitch McConnell who also happen to have gold-plated medical insurance at someone else’s expense (yes, I know he pays a monthly contribution, but that is all it is — a contribution; the bulk of the cost is borne by those of us who do not have access to that gold-plated plan, and often have no access to any plan, gold-plated or lead-plated) even knowing what medical rationing really means.

What brings this to mind is a story in yesterday’s newspaper titled “$93,000 cancer drug: How much is a life worth?” This article demonstrates the conundrum of medical rationing in America.

Provenge is a new, unique cancer drug. A patient receives it once and that one-time treatment costs $93,000. In return, a patient, on average, gains 4 months of life. The patient interviewed in the article who received the treatment put the issue out front: “Bob Svenson is honest about why he got it: Insurance paid. ‘I would not spend that money’ because the benefit doesn’t seem worth it, [said] Svenson, 80,….” The insurance that is paying for it is his supplemental Medicare plan — until Medicare itself decides whether the drug will be paid for and for whom.

Provenge has several problems as regards rationing: (1) the drug is in short supply because it has to be made uniquely for each patient; it can’t be mass produced, and (2) it is an all-or-nothing $93,000 gamble because it can only be given once and there is no assurance it will work in a particular patient. As regards the short supply, doctors at the University of Texas’ M.D. Anderson Cancer Center plan a lottery to see who of the otherwise eligible patients will receive the treatment (there are approximately 150 eligible patients at the Center but only 2 can receive treatment).

None of this rationing is brought about by the new health legislation; in fact, if anything, the new health legislation has broadened the pool of people who will be eligible for such treatment because it will broaden the number of insured. So exactly how does the healthcare legislation cause rationing?

The usual focus once one gets past drugs is on access to doctors. You might have to wait to see your doctor. Hmmm — I believe we already see that. Try getting in to see a specialist, or even your primary care doctor immediately. Except in an emergency (and then they usually tell you to go to the emergency room at the hospital), appointments are made 2 to 4 weeks or even longer down the road. I suffer this wait, my neighbors suffer this wait, my friends suffer this wait. Maybe the problem is that I don’t have Republican branded on my forehead because if I listen to the Republicans, I don’t have to wait unlike in Britain or Canada. Again, I think the problem is that they have immediate access to Walter Reed Hospital as VIPs, something I can’t get.

I’m also told that part of the rationing will be a loss of choice of doctors. Huh? The only way such a statement makes any sense whatsoever is this: Either the government-sponsored and taxpayer-funded health plans they have will pay for treatment given by any doctor or hospital on the planet or they are paying the full cost out of pocket. I know in my case, my plan limits me to doctors who participate in the plan. Doesn’t matter if another doctor is better or less expensive, if the doctor isn’t in the plan, my insurance doesn’t cover any visits. As for paying out of pocket, well I’m already paying out of pocket $1500 a month between insurance premiums, doctor copays, and drug copays, which stretches my budget; I just don’t have the resources our elected representatives seem to have.

The rationing is being done by the “private” marketplace — the insurance company who tells me who I can see based on whether or not the insurance company was able to cut a financial agreement with a doctor and by how much money I can earn and devote towards medical treatment and bills. And before the new healthcare legislation, if I found that my financial circumstances had changed and I could no longer afford insurance premiums, I could have been excluded from ever getting insurance again because of preexisting conditions. Seems to me that that is much more egregious form of rationing than what is done in the more level playing fields of Britain and Canada and what is feared by healthcare opponents in the United States.

When really analyzed, the rationing argument boils down to this: The people trying to convince us of the evils of government legislation on healthcare are the people who will always walk outside the restrictions of any such legislation because of wealth and connections. They are the people who stand to gain personally from the failure to provide the majority of citizens with decent healthcare. Why is it alright for the private marketplace to ration Provenge but not for the government?

I don’t mind their being opposed to healthcare legislation; I just want them to be honest about why. Treat us more like equals than like sheep; give up their perks and privileges so that they have to deal with the situation as ordinary folk do. Take us back to our founding roots — “All men are created equal” except those that have and those that have not.

2 Comments »

  1. You raise the very issue that has puzzled me most about the opposition to any kind of regulated health care: why is it so unacceptable to have “government-run” healthcare (which is not, actually, what’s being proposed), but perfectly okay to have for-profit-insurance-company-run healthcare? Could it be that the private companies don’t have to be as accountable about what people get for their money? The “free market” means never having to say you’re sorrry?

    Like

    Comment by Darryl Hamson — September 28, 2010 @ 9:39 am | Reply

  2. Over the years, I’ve known a lot of freelance editor colleagues who felt forced to take a job with benefits in order to provide health insurance to family members. Consider across the economy how many people must have not started that new business or tried a new venture because health insurance was unavailable or unaffordably priced. Or consider how corporations that responsibly provide health insurance to employees take a hit on their international competitiveness. As a nation, we’re paying a high price to retain our for-profit health insurers.

    Like

    Comment by JoyfulA — November 8, 2010 @ 8:19 pm | Reply


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