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The Looming Battle Over Health Care Rationing

The health care battle is heating up. Last week Obama and the Democrats announced that they think a health care reform bill can be passed by July 31st. Now the Republicans have introduced their ideas. What kind of reform will we get? Many expect a government run system, which could be bad news for private health care companies. Today in my AIP column I discuss what we can expect from a government run system and why it could spell disaster:

So what would a government run health care system look like? Probably much like Medicare. That's a chilling prospect since that system is now in serious financial trouble and facing a $34 trillion unfunded liability. That means it is going to have to find ways to make serious cuts in costs. How is that going to happen? The same way other countries with universal health care systems find cost savings: through rationing, waiting lists, and decreased quality of care.

The Wall Street Journal notes that Medicare is already rationing services. Just recently Medicare Trustees announced the system would not cover virtual colonoscopies, a new procedure that is faster, more comfortable, and much cheaper than the traditional colonoscopy. A CT scan of the abdomen, the virtual colonoscopy is a noninvasive procedure, so it could increase screenings, catch colon cancer much earlier, and save lives. Medicare's objection to coverage is if a virtual scan detects a cancerous lesion, a traditional colonoscopy would be required anyway, so instead of paying for a duplicate procedure, Medicare will only pay for the invasive procedure. Unfortunately, one procedure does not fit all. The traditional colonoscopy can create medical complications for the elderly, and it deters people from getting scanned at all because it's so uncomfortable. That could lead to significantly increased costs later on and possibly higher death rates.

If the Democrats pass a government-funded health care system, we can expect many such cost cutting measures like Medicare's virtual colonoscopy decision in order to pay for health care services. In fact, the rationing of health care services will much be like the rationing that occurs regularly in Canada and the United Kingdom. If you are seriously ill or have a chronic disease or disorder in Canada or the UK, you will encounter waiting lists, rationed services, and possibly outright denials of coverage.

Please read the rest. Later in the article, I discuss the Netherlands, which instituted reforms after decades of heavy government control over their health care system. The Dutch have since completely restructured and now rely primarily on free markets and competition instead of government control.


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Comments (36)

Anyone who does not believe... (Below threshold)

Anyone who does not believe that
(a) healthcare will be RATIONED and
(b) that THEY will affected negatively by that during their lives is FOOLISH!

The elite of Hollywood and Washington will, of course, be spared this rationing. But the rest of us will be LEGALLY bound by the rationing.

Two notes:1. Healt... (Below threshold)

Two notes:

1. Health care is already rationed. Those who have insurance through work get it, those who don't have insurance don't get it. For the uninsured, the waiting time to get a life saving procedure is infinite, which no one seems to average in when the compute theire so called "average waiting times".

2. I agree that virtual colonoscopies should be covered by Medicare. However, they do not identify certain types of polyps. Further note, there are some regular insurance plans that don't cover them, either.

Rance: "Health care is a... (Below threshold)

Rance: "Health care is already rationed. Those who have insurance through work get it, those who don't have insurance don't get it."

That's not "rationing", that's economics. It's not "rationing" that keeps me from driving a Rolls Royce to and from my villa in Monte Carlo...I just can't AFFORD either!

"rationing" is when you are denied something you CAN afford.

Bad enough, but even worse when you are forced to PAY for others to get something for free that you are then denied.

Rance,What you see... (Below threshold)


What you seem to forget is that in todays system it is YOUR choice whether or not to have health care insurance. Most employers offer it, not all do. Some people buy their own insurance, some buy supplemental insurance. Some people pay for their own health care.

Don't like your current health care choices? Today you have options:
Go buy insurance.
Pay for health care yourself.
Change jobs to get different health care.

But the system you want to replace it with takes all choice out of our hands and gives it to the government. You prefer a system that provides crappy health care to everyone.

I'm always surprised at those lefties who (supposedly) believe in freedom of choice wanting to take away our choices.

Healthcare is not rationed.... (Below threshold)

Healthcare is not rationed. You can still go to an emergency room to get treated.

If I had a heart condition and the best treatment would be a valve replacement, a rationing system would say that the procedure is available, but because of who you are, you are denied or must go on a waiting list. Otherwise, the alternative treatment they would allow me is inferior to the valve replacement and I likely may die, just a little later.

I have to tell you that I a... (Below threshold)

I have to tell you that I agree with Medicare on this one. If the new procedure is so wonderful, why does it have to be confirmed with a colonoscopy? There is so much duplication in the system that SOMETHING needs to be done to rein in redundant procedures and CYA testing. I'm a retiree that just experienced a request by both the primary physician and a specialist to have the same MRI simply because their computers "didn't talk to each other". What the hell is that? The provider system is totally out of control and a quick scan of a typical waiting room will quickly show you the breadth of the problem. People are overweight, whiny, weenies that want the quick fix - pills or the knife.

What I find interesting is ... (Below threshold)
Zelsdorf Ragshaft III:

What I find interesting is there are some who would ruin the whole thing for all because of a few who, for what ever reason, do not have health care insurance. I do not know if it is a crisis as the democrats frame it, but tort reform would go a long way toward cutting costs. Wonder who the attorneys who make a living off malpractice will sue when the Government runs healthcare?

Kenny,It's your ch... (Below threshold)


It's your choice whether or not to buy into the health insurance plan at work IF YOU HAVE A JOB!

And don't give me that crap about "If you don't have a job, you're either stupid or lazy". That doesn't play in this economy.

<a href="http://www.b... (Below threshold)

Tom">http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_mccaughey&sid=aLzfDxfbwhzs">Tom Daschle says health-care reform "will not be pain free." Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

Rationed health care. I hav... (Below threshold)

Rationed health care. I have had 3 immediate
members of my family die because of socialized
Massachusetts has made it mandatory that All
state residents be covered by health insurance.
They all have their cards, but not all have
a doctor and can't find one.

Rance,"And don't g... (Below threshold)


"And don't give me that crap about "If you don't have a job, you're either stupid or lazy". That doesn't play in this economy."

Actually, Rance, it does. There are people every day are are working hard, working 2 jobs, going to school part-time, volunteering, interning, etc to improve themselves. People immigrate to this country who speak no English, and yet are magically able to educate themselves, improve themselves, and get into a position to buy a car, house, and good health care. I know that none of these people are your friends, your friends just sit around and whine waiting for the government to hand them 'what they deserve'.

It's called hard work.

It's called responsibility.

It's called making choices for yourself.

It's called Freedom.

You should try it sometime.

Kenny,Volunteers, ... (Below threshold)


Volunteers, interns, and part-timers don't get medical as part of their job package. Neither do a lot of the jobs that require someone two work 2 jobs to support their family.

Back in the "Greed is God" era, my company was taken over my a Texas oil man who didn't know squat about our business. They pared down expenses by "right-sizing" people out of jobs. Then, when they found out that the company was anorexic, they hired the same people back to do the same thing they had been doing before.
Only this time, they were all "temporary", which means no benfits, no 401(k), no paid holidays or vacation. So there were a lot of people who were working the asses off, that had no insurance coverage.

Being down-sized is not an act of free will.

Rance, Companies/... (Below threshold)


Companies/businesses owe the hired help nothing
but the daily wages the hired help earned.
Kind of like the world, it owes you nothing,
it was here first.

I do not think the issue of... (Below threshold)

I do not think the issue of virtual colonoscopy (VC) is a good example of the negatives of rationing. No doubt part of the battle over VC versus traditional colonoscopy (TC) was that of the radiologists (who do the VC) against the gastroenterologists (who do the old-fashioned TC kind). I am a practicing general internist, and refer many patients for screening TC (but I don't gain from promoting one versus the other). As Doug noted, any abnormality on the virtual study would lead to the recommendation for the traditional one. In my experience, 30-50% of my patients getting TC have a polyp removed, so we can expect to automatically increase the cost of screening by that much, UNLESS virtual colonoscopy is dirt cheap. In fact, many more patients may be referred for TC after VC, due to radiologist's fear of being sued. I wouldn't be surprised if radiologists recommend patients have frequent VCs (which would of course both "cover their asses", and fill their pocketbooks). Finally, the sorts of patients who are likely to have complications from TC are also probably some who shouldn't have it in the first place--elderly, frail, with lots of medical problems. This can be like my husband's elderly demented grandmother getting a mammogram for breast cancer screening--a waste of money. She was bewildered by the procedure, and died a few years later of pneumonia.

Also, the TC is a therapeutic procedure--a polyp that is precancerous can be removed at the time of screening. So I regret somewhat that I have to agree with the Feds on this one.

However, I certainly agree care will be rationed under Obamacare. I believe the doctor shortage will increase tremendously--why would any smart student incur debts into six figures without the possibility of earning that sort of money in his/her career? What I truly fear is the POLITICAL rationing that we will see with Obamacare. Services will be paid for based on the powerful interest groups who are most effective in Washington.

Rance,You miss the... (Below threshold)


You miss the point (all of them). I'll write slowly so you can follow along.

Volunteers and intern jobs help you learn skills that make you more valuable to an employer. Part-time jobs earn you more money so you can pay for insurance or health care.

You (and others) were downsized. Then some of you went back as temporary workers. I missed the part where you were FORCED to go back to work there.

Every one of you who went back to work at lower wages/benefits MADE A CHOICE TO DO SO. You had many other options available to you. Just because you chose poorly is NOT a reason to screw over the rest of us by taking away our choice!

Ever hear of Personal Responsibility???

"Ever hear of Personal R... (Below threshold)

"Ever hear of Personal Responsibility???"

Yes, but as far as Rance seems to be concerned, it's about everyone else's responsibility to make sure his person is taken care of.

Rance"It's your choi... (Below threshold)
retired military:

"It's your choice whether or not to buy into the health insurance plan at work IF YOU HAVE A JOB!

And don't give me that crap about "If you don't have a job, you're either stupid or lazy". That doesn't play in this economy.


Ever heard of joining the military. It plays in this economy very well. IN addition, you get free healthcare for you and your family.

As long as you arent physically disabled, under about 45 years of age, dont have a murder conviction on your record, and have a GED you can most likely join.


It's your choice w... (Below threshold)
It's your choice whether or not to buy into the health insurance plan at work IF YOU HAVE A JOB!

Rance, in a way you are right. People have been taught to be stuck and reliant on a system of control. It hasn't even dawned on people that they could purchase insurance outside of work, because the two have always been tied together in the public's eye. It's expensive in the way that you have to cut back on other things, however, it is doable.

But that's the whole idea. If health insurance costs skyrocket for imaginary reasons that the govt has coughed up, without telling the American people where their money is really going. They have no choice but to fall under the mercy of nationalized healthcare. Unfortunately, this will become a reality under the guise "sharing the wealth" and "taking away for the common good". The next step will be the elimination of the middle class, the very group of people the govt was supposed to he helping by taxing the rich.

The only solution is to learn how to become self-sufficient, because really no one else can do it for you. While you are being told to shut up and get a job, just nod and think about ways to gain your independence. This is what its come down to.

"<a href="http://www.youtub... (Below threshold)

"A Nation of Suckers and Slave."

Um, well... yeah.

If you are uninsured and do... (Below threshold)

If you are uninsured and does not have insurance, you should check out the website http://UninsuredAmerica.blogspot.com - John Mayer, California

I guess I have a different ... (Below threshold)

I guess I have a different view of national health than the rest of you. I figure that I'm going to be healthier if I'm not surrounded by people who are sick. My job will be more secure if the people I work with show up healthy and sound. I don't want the guy in the restaurant kitchen, the day care worker, and the guy handling my food in the supermarket coming to work sick because they can't get that cough treated.

People who frequent Wizbang comments seem to be willing to do whatever it takes to get the country to fight terrorists overseas, but think that everybody should be on their own when it comes to fighting against the real germ warfare that nature wages against us.

I find it odd that the poli... (Below threshold)

I find it odd that the political party which abhors 'evil anglo-saxon colonial Europe' is adopting Europe's worst element, ie., National Socialist Democrat tyranny.

President Obama, his political party and their the whiny feminists detest the Old World except for when they want to impose Old World tyranny upon free America.

The Democrat Party is more than the Party of Death, it is the Party of Schizophrenia; and the Liberty-loving are stuck living in the nightmare of both.

"should be on their own whe... (Below threshold)

"should be on their own when it comes to fighting against the real germ warfare that nature wages against us."

This is a rather paranoid outlook towards nature if one accepts Al Gore's paranoia that humans are the ones killing nature; the Party of Schizophrenia.

Rance, what say you about President Obama's mandate that by raising CAFE standards this will insure that whoever drives the tin cans will most likely end up with mangled bodies in need of health care?

I would say that the Democrat Party is insisting that you end up maimed, mangled and broken to give them a reason to deny you life; The Party of Death and The PArty of Schizophrenia...killing babies in the womb and in the tin-can automobile.

Rance, what will it take for you to understand that neither President Obama, The Democrat Party or Feminists have any intention of improving and advancing life?

As a matter of fact the more pain you receive the happier are Obama, Democrat and Feminists; they want you to suffer...this makes them feel good about themselves.

the real germ warf... (Below threshold)
the real germ warfare that nature wages against us.

Its not nature, Rance. It's the CDC, FDA, and FEMA. When you get a chance, catch the film "Outbreak" again, and get a look into the future that's been planned for the U.S. The "ebola" virus that became airborne, the anti-viral serum that preexisted, that's what we're dealing with, here. Truth is stranger than fiction. National healthcare? Well, its pretty much useless when facilities and medicine are regulated according to importance, per the govt.

Hey all, this VC stuff is n... (Below threshold)

Hey all, this VC stuff is not worth the time, risk (a whole lot more people exposed to more radiation) and expense, as much better explained (minus a mention of radiation exposure) by Janemarie. No procedure is perfect - even a colonoscopy can miss things. But if you do find something, you need to do something about it, which you can during a scope and can't during a CT. If you are looking for a cause of blood loss, and the colonoscopy is negative, the imaging MIGHT find something you missed or couldn't see during the scope. If you are too sick now for a scope, have blood in the stool and ruling in or out a colon neoplasm could make a difference in treatment, then a VC might be helpful. But as a universal screening tool to replace colonoscopy? It's really not ready for prime time.

You all might remember the fuss about autologous bone marrow transplants for breast cancer about a decade ago. A very emotional press and population forced insurers to pay for what was found to be a dangerous and ineffective treatment.

True rationing is when you can't get something even if you are willing to pay for it. When Medicare says it won't pay for something, you can still have it done, you just have to pay out of your own pocket.

Please, when we start confusing rationing and not including as a benefit, we are helping out Obama and his ilk.

Rance you are the stereotyp... (Below threshold)

Rance you are the stereotypical democrat with their hand out demanding to receive things at no cost or contribution at all.

The illegal aliens are in tha t40 million uninsured number which skews it considerably.

How about if you don't feel good you pay for a doctors visit. Seems people can afford cigarettes, booze, playstations, movies but cannot pay for a doctors visit. I am unimpressed with unmotivated people demanding anything from me. ww

WildWillie,I'm not... (Below threshold)


I'm not asking for anything from you or any of the others here. I pay my own way. In fact, since I paid over $5000 in school taxes last year and have no kids in the school system, my money is being redistributed to pay for the education of kids who's parents make 10 times what I make.

If you read back through my comments, I never came out for or against the Obama health plan, since I haven't seen it yet.

What I did point out is:

a) We already have health care rationing. It currently decided by how much you make. If you are a child, it depends on how much your parents have, i.e. were you a winner in the uterine lottery.

b) It is in everybodys best interest to living among people who are healthy rather than a population that is not. You might even thing as providing minimal care to the population as a whole as an extension of the defense budget.
You are more likely to die from H1N1 than you are from a terrorists car bomb.

c) Everyone of us, whether we choose to believe it or not, could be the victim of a medical disaster at any time. Your ability pay may disappear as fast as you can say "pink slip" or "pre-existing condition".

You may feel that "I've got mine, go get your own", but what you've got can disappear in an instant.

Rance, Have you eve... (Below threshold)

Have you ever dealt with socialized medicine?
Has any of your family dealt with socialized
Three members of my family died from the
imcompetence and the filthy hospitals in
When medicine was socialized in Great Britain
the first casualty was their world class
charity hospital system.
They're all treated equally, they all get to

Maggie,Sorry for y... (Below threshold)


Sorry for your family, but does that change the facts that in the U.S. you get the care you can afford and you can lose you insurance coverage at the drop of a hat.

Not to sound rude or unfeeling, but there are any number of families in the U.S. who also lost members because they couldn't get care under the U.S. health care system.

Rance"Not to sound... (Below threshold)
retired military:


"Not to sound rude or unfeeling, but there are any number of families in the U.S. who also lost members because they couldn't get care under the U.S. health care system."

And that number will be mutliplied by thousands once Obamacare becomse reality.

Rance, I was in a ve... (Below threshold)

I was in a very bad accident back in 2000,
and I recieved medical care with out ANY
You are full of it. Socialized medicine is
an absolute walking nightmare.
I guess you are going to have to experience it
to know the truth about it after it's too late.
The first thing that will disappear are all of
our charity hospitals like St.Jude.
You are a blind fool.

Rance,I don't know... (Below threshold)


I don't know how you expect everyone to be so much healthier under the governent system. I work in a clinic and get people from the very poor to the rich. They all get sick. They all wait about 3 to 4 days before getting seen. Sometimes a week or two. During that time they are still working,at daycare,cafeterias,and whatever business they have. You don't have to be obviously sick to be contagious for some things. Do you really think you will be safer from disease or sickness just from going to socialized medicine?

Rance"People who f... (Below threshold)
retired military:


"People who frequent Wizbang comments seem to be willing to do whatever it takes to get the country to fight terrorists overseas, but think that everybody should be on their own when it comes to fighting against the real germ warfare that nature wages against us."

Because umm mother nature is a real entity. Just like Gaia right? The earth is sees us as a virus and sends out diseases to wage war against us.

Not only are you an idiot but you are green idiot.

Rance, if the uninsured can... (Below threshold)

Rance, if the uninsured cannot get medical treatment in the US, please explain the uninsured and often undocumented people the fill up so many hospital waiting rooms.
Seriously. Have you been to a major city ER? Esp someplace with a large illegal immigrant population?

The problem is that there i... (Below threshold)
Christina Viering:

The problem is that there is always so much abuse in the healthcare system.

Rance, I have worked in hos... (Below threshold)

Rance, I have worked in hospital systems for 28 years now. The ER's are full all the time with uninsured and they get treated no matter what.

If you lose your job, you have the opportunity for COBRA.

I am positive if you take away the hospital and pharmaceutical company's incentive for research, future "cures" will stop. Obama cannot afford to involve government in healthcare. Period. ww






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