In the debate over health care reform, we keep hearing the word "rationing." For Republicans, it's been one of the top talking points. Senator Richard Shelby (R-AL) said, “…rationing is underlying all of this. …If you don't get health care when you need it, you know, ultimately it's going to affect your life.”
[cnn-photo-caption image= http://i2.cdn.turner.com/cnn/2009/images/08/19/singer.peter.cnn.art.jpg caption="Prof. Peter Singer says rationing is already happening in private health insurance companies."]
Peter Singer, a bioethics professor at Princeton University, says rationing isn't as scary as it sounds. He joined John Roberts on CNN’s “American Morning” Wednesday.
John Roberts: When you talk about rationing health care, what specifically is it that you mean?
Peter Singer: Firstly, it’s the public part of health care that I'm talking about. I’m not talking about stopping people paying for whatever they can afford to pay for or paying for whatever extra insurance they can pay for. But if you have public funds going for something, you want and the taxpayer wants to get good value for that public funds.
So that means you’re going to have to say, look, at the margins, if there's a very expensive new treatment or new drug that perhaps doesn't do any good anyway – perhaps there's no good scientific studies that show it's going to help you significantly – we're not going to provide that. We're going to say, we want to get a certain standard of value for money, just like you would if you're shopping at the supermarket. That's rationing.
Roberts: Rationing goes on all the time, in the corporate world, it goes on in our personal lives. It's sort of a cost-benefit analysis – is it worth spending the money on this? Why is rationing such a dirty word when it comes to health care? Is it because people want this care and they can't get access to it?
Singer: I suppose people are reasonably worried about the idea that their doctor may say to them, “This is something that's good, but you can't get it. You can't afford it.” But, of course, we have a health care system where there's 45 million uninsured Americans who can't get it. There's also people on Medicare and Medicaid who know they can't get everything because they have quite high co-pays they can't afford. So we're already rationing health care and in a way that I think is not the best way because it means there are really effective treatments that could make a big difference to people and they can't afford it. And we should change that.
Roberts: Kathleen Sebelius, the current HHS secretary, before she was the governor of Kansas was the state insurance commissioner. Talking about rationing, she says she “…saw [rationing] on a regular basis by private insurers, who often made decisions overruling suggestions that doctors would make for their patients.” We talk about rationing potentially in the framework of a public option when it comes to health insurance, but is it not true that rationing is already taking place?
Singer: Oh definitely it is. After I wrote the New York Times article, I had a letter from someone who had multiple sclerosis. And he was both a British citizen, but living in America. And he was saying there were treatments like physical therapy that he was denied by his private insurance company, which were very effective and helpful, that he could get for free on the British National Health Service.
Roberts: Talk about this idea of best practices, which President Obama has brought up several times in town hall meetings. It begs the question - what is the price for a life? What price do we put on life? A Washington Times op-ed said, “Rationing takes place when people want more health care than is available and thus cannot get the care they need.” Is it the care they need, Peter, or is it the care they want?
Singer: This is the problem that if you have a system where if somebody says “Oh, I’ve heard of some treatment” or a doctor even says “Maybe this could help you,” perhaps to give the patient some hope, but it’s an expensive treatment and there’s no really good evidence it’s going to do them any significant good, then there is a question as to whether we should be providing that treatment. It’s not the best use of our funds. That's always the question. How do we most effectively use the money we have and the resources we have to improve people's health?
Roberts: Again, back to this idea of it being in a public plan where there's rationing. Is it not true there's rationing in private health care plans right now? How many people have had arguments with a bureaucrat and a health care provider at a health insurance company who have said no, we're not going to pay for that treatment?
Singer: Yes, absolutely. And that is rationing. In a way, the private insurance companies have to do that to keep their premiums down. If they don’t do that – I mean their premiums are already rising – but they’ll rise even faster than ever. And we’ll end up with bankrupt plans.
Roberts: The president keeps telling us that cost containment is one of the big must-haves when it comes to health care reform. The only way to get the deficits down, the overall debt down, is to reform health care. Where is the cost savings in rationing? Particularly if, and it’s not the case all the time, but we hear some of these horror stories about people who were denied care at the outset only to get it later but in that time the disease progressed to the point where it becomes so much more expensive to treat them.
Singer: Right. So there is a saving in providing the basic treatment for everyone. And then they’re not going to get to a situation where they don't go see a doctor and things get worse. But another area of saving is in the costs of pharmaceuticals. We can see the same drug that we're buying in the United States is on sale for much less money in Britain because the British National Health Service says we will not provide that at that price. So the drug manufacturer brings down the price for Britain but doesn't bring it down for the United States. Because we still don’t have that kind of scheme of saying, sorry, that's too expensive.
Roberts: The same thing just north of the border in Canada, which is why so many people go across the border. But we hear that the reason why the drug is so much more expensive in the United States is because the research money is needed to develop drugs like that.
Singer: Well, the drugs are being developed for everyone: Canadians, Britains, and Americans. If the drug companies can sell them for less money across the border, they can sell them for less money here.