Rationing of Health Care

Now and with Single-Payer

Rationing Now: For-Profit + Government

Cause: the use of for-profit companies whose primary purpose is to maximize profits for shareholders

• Current rationing is arbitrary. It has nothing to do with the available health care resources, which are underutilized in the United States.
• As expressed at “Secret” and video below, there is rationing of health care now in the United States based on health insurance companies focusing on maximizing their profits.
• Examples:
  • Pre-existing conditions
  • Ability to pay: co-payments, deductibles, co-insurance, higher cost for out-of-network physicians and facilities
  • Health Maintenance Organizations (HMO’s) and other “managed care” organizations specifying what physicians and facilities can be used
  • Denial of care by changing logic/rules to maintain and/or maximize the profits of health insurance companies
  • Possible cancellation of policy based on an insurance company declaring that the original application for coverage was based on false information.
  • What profession (career) or employer a person has
  • Status of employment: working or not working

Cause: the use of multiple government programs that have day-to-day influence and decision-making by politicians

• The management of the many budgets associated with the government bureaucracy associated with health care
• Examples:
  • Persons either getting care or not getting care, depending on the current state-by-state regulations, such as the current income limits for eligibility

Rationing with Single-Payer

Purpose: Maximize the use of available resources benefit as many people as possible

• Physician-Patient Decision-Making
  • To a very high degree, medical decision-making will be made by the physician or medical team and the patient and their family. That is, there will no longer be a “middle-man” function played by the health insurance companies, deciding who lives and who dies; see more below at “Secret”.
  • Because more people will have access to health care and because the use of health care resources (people and equipment) will be maximized, there will be an order of priority. The highest priority conditions, such as various types of critical conditions, will have the highest priority for the use of health care services. The resulting potential wait time(s) can be minimized by a process called “queue management”: see Wait Times.”

Secret

Secret Kept from the American People About U.S. Rationing

An informed citizen spoke of the situation very clearly during a U.S. presidential candidate meeting in New Hampshire in April 2007, as follows:

Transcript of Citizen Telling About the Secret

I think in some ways there’s been kind of a secret kept from the American people and it keeps coming back. …

What all these stories add up to is … that the kind of system we have is actually rationing our health care …
–— is actually rationing who lives and dies
–— is actually rationing who has to go through financial ruin instead of getting the kind of care that they need to get.

That this is a consequence of (a) for-profit health care system. … — clapping — When you are talking about for-profit .. you are paying the middle-man for what should be just between the patient and the system …

But you hear people get worried about rationing if they don’t have employer-based insurance, which I don’t understand, because …

• we HAVE the rationing. It’s not explicit, but it’s there all the time.
  • The Institute of Medicine estimates that at least 18,000 Americans a year die because they have no insurance. (this number is now updated to 22,000 based on more recent data)
  • And then there are 170 million people at least in America are in HMO’s. They don’t have a choice of which doctor they go to …
  • I don’t understand … people don’t want to lose their choice of doctors.
    • Well, it is true that there are those who have very high quality medical care (and) can choose their doctors
      • … and who have power to pay.
      • But they’re a very small percentage of Americans.
  • (But) those 170 million can’t choose which doctor they go to.
    • My in-laws who lived in Chicago were in an HMO. They could never choose which doctor.
  • Even the U.S. Supreme Court … they ruled in 2004 that we cannot sue an HMO if our doctor rules that we need something and the HMO decides that they are not going to pay for it.
    • There is nothing that can be done.
    • THAT is rationing. And a single-payer system would not have anywhere near that amount of rationing. — clapping —

Video of Citizen Telling About the Secret

• Video See the 4/3/2007 video segment titled “We already have healthcare rationing” — 3:18 minutes
  • The above transcript of the video starts at 30 seconds into the video segment.

Where bolding is seen within quotes at this web page, I tried to indicate where the speaker added emphasis in her tone of voice as well as to indicate her main points.

Sources

• New Hampshire 4-3-2007 Meeting on Health Care — excerpts plus access to the video of the entire meeting

Further Reading

• United States’ health care resources are under-utilized.
• Note: racial and ethnic disparities might be considered as a topic also associated with rationing. Having automatic coverage for all people, independent of their financial status, will certainly be a contributor toward resolving health care disparities.

Who is Going to Solve this Problem?

Citizens educated about single-payer who communicate to their U.S. Representatives