American Morning
Prof: Health care 'rationing' not as scary as it sounds
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.
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Muditha,
Health care is not a right, it is a privilege. Emergency health care is provided to all because society has made a decision that in an emergency situation it is more important to provide treatment. Regular health care though is only provided through Medicare and Medicaid to those who truly cannot afford insurance because for the rest its a decision.
And yes, if I make more money than you I have more purchasing power and thus can get more than you. What that means, however, is not that I deserve better medical insurance than you, but simply that it is an easier decision for me because I don't have to give up other luxuries in order to afford it. Why should I have to pay for your luxuries. We all make personal decisions, stop and think about what non-necessary purchase you have made recently. I am sure you have seen a movie recently or bought some little gift for yourself because you deserved it. Did you need everything you have purchased? Do you have any decorations in your house (those are non-essential)? A TV in your house (this is non-essential)? Do you have cable TV (this recurring nonessential expense is one that probably costs a good percentage of a monthly insurance rate alone)? These items are all non-essential and thus luxury items. Those luxury items could have been skipped and you could have bought health insurance instead, but you didn't. So it is not the fact that I am forced to subsidize your health insurance that bothers me, but the fact that I am forced to subsidize your personal choices.
This entitlement attitude has become extremely pervasive in this country and will be our eventual downfall.
45million? Are illegals counted in this number too?
Also want to add a comment about supposedly long waiting times in the UK and Canada. I recently moved to Michigan and needed some tests. I called FOUR different GPs in my area, and not one of them was taking new patients (even though I would have been paying for this out of my own pocket). So much for our "perfect" system with no wait times. PS: I finally went to our county facility where the whole thing was scheduled, performed, and results back within a week. The cost? $15. Who says the government can't run health care!
It is facinating to here Americans put down the Canadian System. The Canadian Health system is not perfect and needs much more improvement but you can be rest assured that it is better that what America has.
For instance, I don't have to worry or keep my kids at home when they are sick because I have no health insurance or no money to pay for the service. It gives you a peace of mind to know that when you are taken to a hospital, no matter where you will get care. No one opens and searches your wallet to determine what type of insurance you have before determining which hospital to take you to. I have 100% dental insurance, drug coverage, optical coverage plus all these procedures are covered 100% if i travel even on vacation to another country such as America. Everything gets paid and all I need is to provide my plan card. I get to keep this or transfer to another plan if i leave my existing company. The reason why we have some problem in our system is because your Hospitals pluck away our qualified doctors offering triple salary and pucks. That is fine, but who pays for that expense at the end. Ordinary Americans pay for it and whether you are insured or not.
It's facinating to me that you all can't see the benefit of public options or you just don't care or are extremely selfish to allow even one person to go uninsured. If you look at it the people that are shouting the most are those who have insurance and can afford to pay higher premiums. No one is really looking at the uninsured, get there opinion and find out how many children fall into that category.
You can put down Canadian, UK or other country's health system all you want. At the end of the day America spends the most on health care that any other country in the world and you also have the most amount of people who are uninsured or cannot afford even the most basic care. THAT IS A TOTAL SHAME FOR A COUNTRY THAT PRIDES ITSELF AS THE MOST POWERFUL.
It's funny how Republicans have offered debate talking points about what to supposedly fear with Obama's health care reform. Their points are either a neurotic lie or already occured, courtesy of the private Health Insurance industry. Denial of treatment for stopping the progression of an illness based on a pre-condition that denies a policy holder from reimbursement (payment) to their health care provider (Doctors and the Hospital).....IS RATIONING OF HEALTH CARE. It's already been occuring for years.......Hello????
Yeah healthcare is rationed. Look at medicare. Washington will tell you how great it is. You can go to any Dr. and have any procedure you want. What they don't tell you is if THEY CHOOSE not to pay for it you pay all of it. Medicare is also not a "choice". If you recieve SS you have to pay the medicare premiums and accept their coverage.
Community organized clinics would help give healthcare to those that do not have insurance. Obama is a great community organizer. This is the root to go. He can accomplish his healthcare for all in this manner. If a patient needs hospitalized, community and federal grants that are now being used to cover the illegals can be used to cover the American citizens that need it.
There. Problem solved. I also just saved a million trees by not writing a bill of 1,000 pages that are useless. This will also allow us to keep our freedom of choice.
Just to alert most of you that don't realize this fact: the cost of advertising a drug is 2:1 versus R and D
http://www.sciencedaily.com/releases/2008/01/080105140107.htm
We are supposed to be a nation based on Christian values. So how can anyone justify nit picking over how many people really are uninsured. We have become a nation filled with selfish, self interested people. The attitude is if I am okay, then I don't have to be concerned about others less fortunate. If all of the effort and millions and millions of dollars being spent to derail a change in our health care system were being directed into finding solutions, then the country could come up with a fair and equitable way to handle health care.
I suggest a national day of prayer regarding the health care debate where those of us who pray ask for God' to quide us in the debate and to really believe that thoughtful prayer will lead to a health care solution that we can all be proud of and support.
This issue of health reform is nothing but a group of individuals and or parties from both sides trying to make a name for them self and their parties. If they really want to change our health care they should choose and equal number of people from all parties and examine the health care in Canada in detail. Then contact Dr. Annie Doig the incoming president of the Canadian Medical Association, and some of the people in their health care system and try an find out why their health care system is failing. Also contact some of their government people and ask them the same questions. I do not remember reading anywhere that either party has performed research on anyone's health care system and the results posted. The only thing being given out is figures with no backup test performed to acquire them and only individual and group opinion's. I want to not only see figures thrown out but how they were acquired. Show me comparisons with other health care systems that do work and do not work in other countries. I am not all that interested in figures thrown out and opinions of political leaders and scholars that have not performed detailed comparisons.
Yes rationing already happens every single day. Nothing new! A new government run system won't change that.
Who is to say that healthcare providers will opt in to provide care under another government run program?? Many do not choose to participate in the governments programs now because they pay way less than the private insurers.
Wake up folks,,,,American is suppose to be the land of equal OPPORTUNITY, not equal everything. The government already takes way too much from those who have earned it to give to those who haven't!!!!!!!!!
It brakes my heart to see all the hate that is going on over health care reform.Maybe some of the people that are against it never eexperienced the suffering of a loved one with no means to afford health care.Worse yet, with no right to get it if they are victm of some pre-existing condition..Yes, there are people who take advantage of the exiting system for the unsured (emmergecy room only )and they should contribute even with volunteer work.I have known people who have plenty money for party, travel etc., but not to pay for health care.We need reform, we need choces. Also,we need to make people undestand that we live in a democratic country, and the beauty of democracy is that all the people have rights.The people against refortm have the right to keep what is making they happy and shut up .The people that can't afford or are unhappy with the existing system have the right to seek other alternatives.I have health insurance, but I can no longer tolerate the explotation of the private sector. I beg the most powerful people on the land (the media) to help keeping the people informed with no bias.
As a Canadian, I feel qualified to explain the issues in Canada and the basic issue in the US.
In Canada, health care is rationed for everyone. At issue is whether people can buy extra care if they can afford it.
I believe that health services in the US may be of higher quality, for those who can afford it at all. My impression is that those who have health care are afraid to lose the level of quality while other people would just like to have any at all. This is the crux of the matter, the battle between the economic classes!
I guess in Canada, we believe that social programs offer a parachute for those who are less fortunate, while in the US, there is a preference to consider those people as undeserving (e.g., don't work hard enough or smart enough).
Particularly in the case of health care, Canadians feel that the need for care is linked very heavily to bad luck, either through unfortunate circumstances and/or because of heridity. It is certainly true that health outcomes also relate to lifestyle choices, but the Canadian system does not limit treatment availability on the the basis of self-induced problems relating to lifestyle, probably because the cause-effect pattern is not clear.
This debate will run on the fundamental beliefs of Americans: Should people who can't afford healthcare obtain basic care at the cost of reducing the beyond-basic care of other Americans? (I recognize that the use of the terms "basic" and "beyond-basic" are from the perspective of a Canadian).
In the end, it comes down to how the pot of health care services are shared. You can try to make the pot bigger, but you will likely never have enough money to satsify everyone fully.
I'd be interested in our responses, especially from the point of view of Americans as to who (among the legal tax-paying citizenry) would be deserving of basic (whatever that is) health care support.
I'm a registered nurse and have been for many years. There is no doubt that health care is rationed. It is rationed by the amount of health care one can afford. Every benefit in a free society is rationed in this manner.
Here's part of the WHO ranking of health care in the world:
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba
Look out Costa Rica...we're right behind you. Eat it Slovenia! We own you!!!
Just like last time this came up...if this is defeated, you can expect a spike in insurance premiums and a reduction in coverage because SOMEONE needs to pay for the $1.5m per DAY opponents are spending.
I find it amazing that people would rather have BIG BUSINESS in charge of their health...because we all know they value human life way more than money, right?
86% of, or approximitely 300,000,000 Americans have health insurance.
Of the 14% of Americans who do not have health insurance, many have affordable health insurance available, but choose not to take it.
I have health insurance. I pay approximitely 1.7% of my gross income for that insurance and obviously my employer pays an additional amount.
While I do not have the exact amount my employer contributes to this, I am pretty confident that the total amount is still a good deal less than the amount that I would be taxed to fund a socialized government health care program to provide health insurance to the perhaps 10% of Americans who want health insurance and can't get it.
I am also 100% confident that a socialized government health care program would not provide as good coverage and control as I currently have. This would mean that I would need to pay further to get additional private insurance to bring my level of coverage up to be on par with what I have now.
Ultimitely, a socialized government run health care program would result in a significant increase in my health care costs, all to fix a problem that is being massively overstated.
A socialized government health care program would peanalize around 90% of Americans for the benefit of 10% of Americans.
What needs to be done is to tighten control over insurance companies, eliminate pre-existing condition exclusions, eliminate dumping and provide a government "risk pool" alternative for the small percentage that fall through the cracks.
The US health care system does not need reform, it needs refinement.
Comparisons to the UK health care system simply are not valid, as both the population size and density are vastly different. Due to the much lower population density in the US, far more medical centers are required per capita than in the UK. This alone greatly increases the total health care costs. The entire area of the UK is less than 1/3 the area of Texas.
If the socialist health care system in the UK is so great, why are their teeth rotting out of their mouths?
I'm tired of all the pompous, self-righteous, mostly Republican arguments that they don't want THEIR tax dollars being used to pay for lazy, illegal immigrants who don't work and just want abortions. Wake up, PLENTY of hard working, tax paying Americans including myself do not have health insurance because in this economy they had to take any job they can get rather than sit and collect unemployment insurance and many smaller companies do not offer health insurance. If you haven't priced out private health insurance recently its over $1,000 a month for minimal coverage for a family of 3 and does not include preexisting conditions such as my 3 year old's torticollis.
If you don't want YOUR tax dollars paying for my health insurance, I don't want MY tax dollars paying for you to go to school since so many of you CANNOT even spell.
They talk about the uninsured, well how about the lower middle class people like me that ARE insured but still can't afford to go to the doctor? I pay $100 per pay check ($200 a month) for coverage for my wife, son, and I but our deductible is $2,500!! Basically I have to pay another $2500 to use what I am paying $5000 a year for! I only make $12 per hour. Well the insurance company says "that's why you have your health savings account you should put money into so that when you need to go to the doctor, you have some money to pay with". That's all well and good except that I can barely afford to put $10 a paycheck into my HSA and even that $10 is a stretch, taking away from groceries or gas.
The only other option my employer provided with a lower deductible cost $200 per paycheck, which I also could not afford.
We don't go to the doctor often luckily. Makes me feel like dropping my health insurance altogether! Then I'd have that extra $200 a month in my pocket and could pay to go to the doctor if I needed it.
By the way, I'm a registered Republican, moderate. I didn't vote for Obama but I support his healthcare reform. I'll let you all try and figure that one out.
Asking Peter Singer for healthcare advice? This man is heartless, unethical psychopath. He'd sooner recommend we euthanize the disabled and elderly, vote for compulsory sterilization, and force everyone to become vegans before offering any sane solutions. He's at least clever enough to know most Americans won't bother to look into the guy's record of utterly insane beliefs as he tries to snake his way into influencing policy.
Remember, this is a man who once said this:
"With the death of a disabled infant will lead to the birth of another infant with better prospects of a happy life, the total amount of happiness will be greater if the disabled infant is killed. The loss of happy life for the first infant is out weighed by the gain of a happier life for the second. Therefore, if killing the haemophiliac infant has no adverse effect on others, it would, according to the total view, be right to kill him."
Obama administration, you'd do a lot better if you'd leave the crazies out of the debate, thanks.
Responding to Norm Chadwick, it is true that we know which side of the health care issue people are by the number of uninsured being 45M. Where did he get his 26M from someone on the other side of the issue? What makes his number more real when he does not disclose the source?
I agree with Mr Singer's comment about the drug prices. I moved here from Canada in 1997 and immediately experienced an increase in the cost of my allergy medications by 40 to 50%. Although I agree with the free market often yielding good pricing results, why are we protecting the pricing of these companies by restricting access to drugs from Canada or other reliable sources. Would it not be even the real free market to loosen up the rules?
Finally, I lived in a national care system a good part of my life and I do not ever remember someone else than myself and my doctor making the choices. Although I believe there are reasons to prefer my current insurance, the alternative would not be nearly as bad as most people are made to believe it would be, by people on you know what side of the issue. I also remember before Canada had medicare where as a 17 year old young man, I walked with a fractured knee for 2 days until my leg refused to support me because I could not afford medical care.
We have to weigh all sides of the issue and not forget where we came from (I mean our more modest days).
I personally haven't had a check-up in three years, and I have something that resembles insurance. The last time I went to the doctor for a biopsy he used a room in the back hallway of his office, apparently it was considered a hospital room, and I was charged by both my doctor and the hospital for one service. I received no notice and had no way of knowing his back hallway was split between his office and the hospital! There is no access to those rooms other than through his doors! Of course both bills (over $600) were my responsibility because they were applied to my deductible. The hospital wouldn't take payment arrangements and I was sent to collection. Now how is that fair? The US Government is not any more scary than the billing practices of the hospitals and the insurance companies!
It will cheaper for my family for me to die of cancer and be cremated. At least the life insurance company will pay out!
John,
You are one biased, left-leaning reporter and one need only read your questions to see that. I'd be amazed if this comment even makes it onto the board. Also wonder who was interviewed to discuss the other side of the argument. My guess...nobody.
all you people who oppose health care overhaul, you better hope this is how your life turns out!
1. hope your job always offers insurance
2. hope that your deductiable isn't a months salary
3. hope your WONDERFUL insurance company doesn't deny your claims
4. hope you never get a serious illness
5. hope you make 6 figures a year to cover your expenses for sickness
you people are sick, sick sick, Obamas trying to save peoples lives and you want to profit off it, you upper middle class Snobs who have had everything handed to you on sivler platters. I have worked half my life and paid taxes and have had health insurance. But if my job didn't offer it, i wouldn't qualify cause i was born with asthma. I guess people ask to get sick. And people should be bankrupted to pay for their medical needs. So you sick bastards can have 2 houses and a fleet of cars. Count your profits in hell when your bored.
I can only bring myself to address one point... that point being the number of uninsured Americans. Color me stupid but when I see someone debate the number being either 45 million or 26 million... I fail to see a difference. MILLIONS of Americans go without the basic health services that other countries seem able to provide and it sickens me. What the HELL is the difference between 26 million Americans not having what is a simple necessity in life vs 45 million still means MILLIONS. As a veteran that has put my own life at risk as well as watched other comrades do so, I say ONE American without health care is too many and to leave such a situation in place does NOT speak of the America I wore a uniform to protect.
For those of you who think Government has the answer on Health Care, please, do not cry too loudly when they refuse to change your diaper.
On today's "American Morning," the guest commentator, Bill Bennett, referred to a recent Gallup poll indicating: (1) 26% of polled U.S. adults believe healthcare reform would improve their own healthcare; (2) 29% don't think it would change anything, (3) while 34% think it would worsen it.
One thing the poll did not capture, however - and which Mr. Bennett (predictably) neglected to address - is the DEGREE to which healthcare reform would likely improve healthcare for those who either lack it altogether, appr. 46 million, or are undersinsured, appr. 25 million.
18,000 to 20,000 Americans die every year because they lack health insurance, and countless others lead tortured lives due to untreated chronic ailments.
Needless to say, you don't see any mention of THOSE stories by conservative commentators or on conservative-run commercials currently airing.
So if there is any doubt the situation does in fact represent a "crisis" - since middle- and upper-class people with conservative or traditionalists mindsets tend to have the luxury of sticking their heads in the sand if they're not personally involved - just look at the following figures.
The U.S. seriously LAGS behind other industrialized countries in providing effective healthcare:
Were the U.S. to perform as well as any of the top 3 industrialized countries, 101,000 fewer deaths per year would result ["Health Affairs" – Jan./Feb. 2008]. This is despite the fact the U.S. spends far more than any other country on healthcare: appr. $6,697 per capita (16% of GDP). Most other industrialized countries spent less than half of that ($3,128 in Australia or 9.5%; $3,326 in Canada or 9.8%...).
So:
(1) 42% of U.S. adults get no or little healthcare; but
(2) the U.S. spends twice what other industrialized countries spend;
(3) and yet the U.S. places last of 19 in preventing considerable numbers of deaths.
Reform no longer applies to this any longer: without insurance reform and tort reform, it is merely extending access to healthcare to wider population. It really should be called "Univeral Healthcare".
Peter Singer is one of the scariest people pitching this health care plan. I looked him up on Wikipedia and found the following:
Similar to his argument for abortion, Singer argues that newborns similarly lack the essential characteristics of personhood — "rationality, autonomy, and self-consciousness"[28] — and therefore "killing a newborn baby is never equivalent to killing a person, that is, a being who wants to go on living."[
How do you think he would "ration" healthcare based on this view?
Here is my solution: Never befriend anyone who is against the public option. Anyone who is against it is simply a selfish, evil person. They do not deserve my time. I will not work for nor will I purchase anything from anyone so cold and careless as to revel in the fact that they have insurance while some poor soul, who the libertarians believe deserves his fate, suffers and dies without. That is what this argument is about. The war has just begun.