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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Peter Dierks who wrote (11862)	11/25/2009 10:07:36 AM
From: Lane3	Respond to of 42652

My point remains that having government interfere with an individual patient and their doctor's discussion about what is medically prudent for that patient is wrong. I agree that it's wrong. But whether it is or isn't wrong is irrelevant and a distraction from the issue of the use of rationing. Only if you assume government is going to pay for health care. You don't have to "assume" any such thing. Government now is paying for nearly half of the health care in this country. That's not assumption but fact. How can you possibly not be aware of that? Medicare and Medicaid aren't going away. You said yourself that you don't support ending Medicare. So why are you couching the question in terms of as "assumption" that the government is going to pay for health care? It's doing so now and will continue to do so. Pretending that it isn't real is bizarre to the max. Lane3 wants her to risk death because the government doesn't want to pay for mammograms until the patient is over 50. Gimme a break!!! You've already acknowledged the sensibleness of rationing. You agreed that an old woman circling the drain doesn't need a PAP test. You called it a "no-brainer." So all that remains is how to make the determination of what other screenings and treatments don't make sense and what to do with that information. Typically recommendations are made by panels of medical experts. They produce guidelines for sound medical practice. We just had a panel do that with PAP tests. This is SOP. Even without government rationing they would continue to do this to supply medical providers with continuing education. Based on those recommendations, doctors and patients decide what screenings and treatments to pursue. And those who pay for them, be they the patient, insurance company, or government, decide what they will pay for. All three categories of payers ration, that is, they decide what's worth paying for and what isn't. All three will read the recommendations on PAP tests and decide if they should change their rationing policies based on them. Maybe they will and maybe they won't. Maybe they decide the same, maybe they vary. The recommendations of the panel aren't binding on the payers. They are merely fodder for recommendation decisions on the part of medical providers and payment decisions on the part of individuals, insurance companies, and the government to the extent that they are payers. I have not offered any opinion on whether any payment policy should change regarding mammograms and women under 50. If I had offered an opinion it would be that payers accede to the decisions of doctors and patients on an individual basis if the doctor sees the necessity. I would not advocate a blanket stoppage of payment of claims for mammograms for women under 50. I would advocate, just as you did with PAP tests, that they be stopped for old women circling the drain. Acknowledging that rationing makes sense is not a knee-jerk approval of all rationing options. You're taking a sledge hammer to what is a delicate decision making process. Each screening and treatment needs to be examined to see what is sensible to pay and what isn't, just as it is now. Advocating not paying for PAP tests for old, dying women doesn't mean one would advocate not paying for mammograms for women under 50. Each screening and treatment is different. And each payer is different. Right now Medicare will pay for a PAP test for me. I'm 66 years old and lost my cervix to a hysterectomy in my forties. So what would you say about my chances of getting cervical cancer, for which PAP tests screen? Not hardly, right? What would you say about Medicare paying for my PAP test? Another no-brainer, wouldn't you say? If you don't think that Medicare rationing PAP tests for old women sans cervix makes sense, you have no sense. And you certainly aren't a fiscal conservative.

To: Peter Dierks who wrote (11862)	11/25/2009 11:24:47 AM
From: TimF	Read Replies (2) \| Respond to of 42652

My point remains that having government interfere with an individual patient and their doctor's discussion about what is medically prudent for that patient is wrong. Having the government control what the doctor can do (beyond the extreme cases) is wrong, but having the government decide what it will pay for? Not so much. If you assume the government will take over medical payments and actually disallow both private insurance and paying out of your pocket, than deciding what it will pay for is pretty close to deciding what the doctor can do. But the problem there is not the government saying "we will pay for X, half of Y, and not Z", the problem there is the government outlawing other forms of payment. Also you'd have a problem if the government didn't take over care, but controlled what private insurers could pay for. What about a young woman I know whose grandmothers both have a history of breast cancer? She is staring down the barrel of a loaded gun. Lane3 wants her to risk death because the government doesn't want to pay for mammograms until the patient is over 50. How expensive is a mammogram? I don't think its a huge cost. If the government won't pay, maybe she could pay out of pocket, or private insurance would pay. Also it may be that the number of mammogram's we give out is not a serious health benefit. You do some good (earlier detection of cancer), along with some harm (radiation from the mammogram can contribute to cancer or other problems), at some cost. Adding the harm and cost, and perhaps we shouldn't do as many of them. I still don't think the government should outlaw them, if someone wants one every six months from age 20, that's their business, but I wouldn't say its a great injustice if the government doesn't normally pay for it. Rationing in the broadest sense of the word will happen if you assume health care is an economically scarce good When government is the single payer it will be. It already is, always has been, and will be so for the foreseeable future. Economically scarce goods only implies that there isn't a virtually unlimited free supply. That something isn't a "free good". "The free good is a term used in economics to describe a good that is not scarce. A free good is available in as great a quantity as desired with zero opportunity cost to society. A good that is made available at zero price is not necessarily a free good. For example, a shop might give away its stock in its promotion, but producing these goods would still have required the use of scarce resources, so this would not be a free good in an economic sense." en.wikipedia.org Drinking water, steel, cars, radios, houses, concrete, roses, etc. are all scarce goods even though their pretty common. So is manual labor, even though there are about 6.7 billion people in the world, most of whom can do at least some manual labor. When government is the single payer it will be. I see your pessimistic. By single payer, do you mean that in the loosest sense of the word, that there is a national government insurance organization that dominates the market, or do you mean truly single payer, that all other forms of insurance, or perhaps even all other forms of payment, are outlawed? Canada did ban other insurance (at least for what the national insurance covered) but the trend there is towards allowing private insurance. The UK has socialized delivery of healthcare, not just national insurance, but it allows private health care and insurance on the side. Other rich countries tend to be less extreme than those two. I don't see the US jumping past Canada and really outlawing private health care payments.