I published the last post at Open Salon also, where a
jerk irresponsible person named neilpaul commented,
I think the NYT article on Sunday [the Peter Singer piece I wrote about here] about rationing has to be mentioned here. Jindal is relying on irrational fear of rationing among his followers to blind them to the bullshit aspects of his arguments. When people are terrified, they will believe any damned argument.
When I say fear of rationing is irrational, it is not because there won’t be any in the future. There will be. The fear is irrational because it will happen under any system and because rationing isn’t all that bad. It will actually make the system work better. As for the rationed, it will mostly be the elderly and they already had a good shot at life and have less to complain about than those who died young.
So this genius, have correctly understood that fears of rationing are irrational, goes and ahead and suggests that the right way to go about it is to withhold care from older folks. Yes, that will calm everyone down.
However, since I could not persuade him to STFU about killing off the old folks, let’s talk about rationing.
First, as Singer wrote, we in the U.S. have rationing now. Health care is rationed by ability to pay. As Singer said, we have more rationing here than in nations with government health care plans. There is utterly no reason to think that the plan Obama wants to put forward to make rationing worse, and lots of reasons to think there will be less rationing than there is already.
As I wrote recently in “Ir-rationing Health Care,” the Medical-Industrial Complex is pouring obscene amounts of money into medical treatments that doctors themselves do not believe will provide better outcomes than older, cheaper treatments. The for-profit health industry chases profits, not cures, which may be the biggest reason as a nation we get the worst outcomes for money spent on the planet.
I read in the Los Angeles Times this morning that our wonderful pharmaceutical industry has a new prescription drug out that grows longer, darker eyelashes. Also in the same article is the little tidbit of information that pharma spends more than $11 million a day advertising prescription drugs directly to potential patients, a practice that is absolutely unnecessary to the nation’s health.
The Obama Administration has declared it intends to leave choice of treatments in the hands of physicians, using Comparative Effectiveness Research not to ration, but to see to it that doctors get information on the effectiveness of treatments not from sales reps but from objective sources.
We also need to find ways to discourage doctors from over-prescribing and over-treating patients just to make money.
There are all manner of ways that the health care belt can be tightened. However, one thing is not being considered by anybody (well, except the insurance industry) is making choices about where to put our health care dollars based on the relative “value” of the patient. No industrialized democracy with national health care is denying care to older people as a form of “rationing.”
What nations might be doing is choosing not to treat conditions when treatment provides no real benefit, and prostate cancer is a prime example. As I wrote in the “ir-rationing” article, diagnosis of a slow-growing prostate cancer in an older man usually doesn’t warrant aggressive treatment, because the odds are the gentleman will die of other causes before the cancer becomes a problem. But this is not “rationing”; it’s logical medical practice. The treatments for prostate cancer have side effects that likely will cause more problems than the cancer and not lengthen the patient’s life by even ten minutes.
The important point is that the patient is not being denied care just because he is old. If the same elderly patient had another disease, even another form of cancer, in which treatment would improve the quality or length of his life, then he would get that treatment.
Peter Singer is an interesting guy, but he’s a philosopher. He’s not an economist or a policy wonk. As I wrote in the post about his article, I don’t disagree with Singer but I think his rhetoric was unnecessarily inflammatory. Yes, there are limits to health care as a commodity, but the cost-effective limits we are talking about now do not fit the definition of rationing, which is:
A fixed portion, especially an amount of food allotted to persons in military service or to civilians in times of scarcity; To restrict to limited allotments, as during wartime.
And that is not what we’re talking about. Nobody is saying any one group of people should have limits put on how much health care they receive. Rather, we’re talking about taking health care decisions away from profiteers and putting it into the hands of medical professionals who will make decisions based on what patients need. That is not “rationing.”