Why rationing is a dirty word, and can we ever limit care in America?

Peter Singer confronts rationing of medical care head-on two weekends ago in a piece in The New York Times.

It’s gained plenty of traction within the blogosphere, but none better than hospitalist Bob Wachter’s opinion on the issue. In his take, he channels Joseph Stalin, saying, “A single death is a tragedy, a million deaths is a statistic.”

And that’s really the driving force behind the mindset against rationing medical care in the United States.

Dr. Wachter goes on to cite an example from Oregon, who initially denied having Medicaid cover a questionably beneficial bone marrow transplant procedure. When it comes down to “a hard-boiled tradeoff between a single identifiable life – in this case, a cute child with a determined mother – and many unidentified lives,” more than likely it will be that single life that takes precedent in America.

And that’s why, to the dismay of many health policy experts, an entity comparable to the UK’s NICE, who makes acturial decisions on what medical treatments gets covered, or not, will never happen Stateside. “An American ‘NICE,’” he writes, “isn’t going to limit ICU care for 80-year-olds with metastatic cancer.”


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  • Doc99

    NICE takes the concept of oxymoron to another level. The nine most terrifying words in the English language are, “I’m from the government and I’m here to help.” – Ronald Wilson Reagan.

  • http://www.motionphr.com Jeff Brandt

    We have rationing in our current system today, it is based on one’s “ability to pay”. We all need to change the way we look at healthcare in the US. We need to get back to basics and reduce spending. Maybe we can do without the grand piano in the lobby of our hospitals or all the advertising of the latest drug that in most cases in not any better the what it is replacing.

    In the USA about 80% of a person total healthcare cost is spent in the last 2 year of life. One of your Dr writers mentioned that he has been working on a 101 yr old woman that is on a vent. This is absurd. People in the US need to rethink end of life.

    Jeff Brandt motionPHR for the iPhone
    MyMedBox for Android

  • http://www.thehappyhospitalist.blogspot.com Happy Hospitalist

    Perhaps we could bundle the care of that 101 year old and physicians would not offer intubation in 101 year olds.

    As they shouldn’t. Unmanaged expectations have consumed Americans.


    It is really hard to let go of loved ones. Sometimes it takes multiple trips to the ER, hospitalizations, stays at skilled nursing facilities, and readmissions before everyone comes to terms with the fact that aggressive care is “futile.”

  • NoVA doc

    We ration care stateside in other ways as well: I’m thinking dialysis in patients with dementia, organ transplants in most patients age >65. The H1N1 vaccine in the US will be administered very differently from the seasonal flu vaccine, given to those who would benefit the most. The article is a much needed eye-opener for those who aren’t in the know.

    Agreed, the end-of-life approach to health care in the US approaches ridiculousness. Grossly oversimplified, medical care is about ultimately forestalling death with the best quality of life possible, we hope (cue the “life is a 100% fatal sexually transmitted disease” joke.).

  • Stalwart Hospitalist

    If we can’t ever limit care, then we might as well sit back an enjoy the ride as long as it lasts. Since the system is financially unsustainable, rationing will occur at some point.

    The question is whether we should actively design and debate the process now, or whether we should wait until the system implodes from lack of funding and then try to make these decisions in that environment.

    Those who argue for the status quo — “we have the best healthcare here in America” — tend to leave part of that statement out: “for now.”

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Rationing is alive and well in America. Resources are finite. Since people do not have access to every available medical benefit, then rationing exists. The concept of restricting services will become strengthened, as it should, through successful health care reform and comparative effectiveness research. It won’t be called rationing, however. Obama will convene a council of linguists to craft the most palatable euphemism to soothe us.

  • Med Student

    “We” do not ration care. What you are all citing is not rationing. True rationing will exist however when the government takes control of health care and runs the private insurer’s out. Then Uncle Sam will be the only game in town and we will actually have true government mandated rationing. In fact the republicans recently proposed a bill in the house that would have made rationing illegal. Its not a surprise that not one democrat voted for it. Wake up people and smell the BS coming in the form of a “health care bill”. I should have went to law school.

  • http://www.motionphr.com Jeff Brandt

    Med Student, are you suggesting that we have no control over spending in health care? I think you are wrong that private insurer will be run out, It definitly is not the current plan. Argentina has many private health medical groups/insurance companies that work along side of the government provided care. http://www.swissmedical.com.ar/, Hospital Italiano http://www.hospitalitaliano.org.ar

    Not sure what “BS” you are referring to, please explain. What is your suggestion that we do nothing about health care reform.

    I look forward to your response, me nephew is planing on going to med school.

    Jeff Brandt

  • http://pankajkaranmd.blogspot.com Pankaj Karan,MD

    The inherent meaning of HMO medicine is rationed medicine for whole polulation. As an Internist we hget denial for necessay medicines and services on daily basis. Rationing is there for different level of consumers. Fo rmedicaid pts, rationing is rampant but not so mcuh for Medicare pts. For Medicare advantage rationing is done to make sure there is enough profit for HMOs and IPAs.
    Le’s not be disallusioned that we have the unrationed and uncontrolled healthcare delivery system.When a healthcare deliver is based on profitabilty, then profitabilty depends on rationing.
    Pankaj Karan,MD

  • Med Student

    I apologize. I should have been clearer. I meant that “we” as in the government shouldn’t be the deciding power in regard to medical issues. I want the government as far away from this as they can be. Look at the Indian Health Services or even the VA. They are a perfect example of inept government management. Canada and England continually demonstrate why government should stay far away from this issue. Some disagree and are willing to accept the problems that come with government run health care in place of the problems we have now. I’m not. I didn’t go into medicine to have the government tell me how to practice. But that is what will come from this junk proposal. Its only a matter of time.

    Normally I would explain my thoughts regarding rationing, in my own words, but I think this time I will just insert this link to a Forbes article. It is explicit. http://www.forbes.com/2009/07/21/rationing-health-care-opinions-contributors-scott-atlas.html

    One last thing; I do agree that we have a problem but I do not agree that the proposed bill is a solution.

  • psytrist

    If we all paid for our own care out of our own pockets we would ration it for ourselves, especially by being more critical of the unnecessary things we are given now, and be more satisfied with the result. We could do that if we all had a well regulated health care savings account where we put the money we are now giving to insurance companies.

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