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August 19th, 2009
10:29 AM ET

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.


Filed under: Commentary • Health • Politics
soundoff (332 Responses)
  1. Tom

    There is nothing wrong with rationing and it's a reality. A reality for us now and an increasingly needed reality for the future. In fact, rationing care is probably the moral high ground when it comes to trying the most good for the most number of people.
    But be ready for the consequences–sorry to Grandma, we're not going to try and keep your heart failure under medical control so you can live to be 90...sorry to the smokers who "choose" to continue smoking despite the evidence of a million medical problems....sorry to baby who needs a drastic life saving operation...sorry to the Neurosurgeon used to making 1.5 milliion dollars a year by implanting 500,000 dollar hardware from the biotech industry and charging 400,000 dollars for spine surgery, sorry to teary eyed breast cancer patient trying that one last unproven palliative chemo regimen to try and live for a few months longer–say hello to hospice. Oh, and sorry to uninsured democrat voter who sees this reform as a windfall of "about time" opportunity–welcome to the lowest common denominator.
    Be ready for these "no's" are coming to your life.
    Me personally, I can't see why I am getting taxed more and more to take away more and more of my healthcare. One or the other still is painful...but both? Does this seem fair or right? When Sen Kennedy waits in line for his care or Barack Obama spends the night waiting in the ER for his care so will I.

    August 19, 2009 at 12:20 pm |
  2. david

    Which is more selfish? Me wanting to keep my health care, or you wanting to take it away from me so that you can have it? Government-mandated redistribution of health care is in fact institutionalized selfishness.

    August 19, 2009 at 12:20 pm |
  3. Peter

    Cost containment, whether it be through rationing, tort reform, or fee schedules to hospitals and physicians that limit reimbursement rates, should all be elements that comprise a prospective solution to this mess. The fact that insurance companies are more concerned with profit margins and dividends paid out to shareholders is what troubles me the most. Good health care should be a right and not a privilege. It's interesting to note that the countries that do provide national health care have a higher wellness rate, lower infant mortality, and fewer days missed from work, on average, than the citizens of our fair country. Talk about being penny wise and pound foolish.

    August 19, 2009 at 12:18 pm |
  4. Kathy Speas

    All insurance providers and HMOs put limits on care - one mammogram every two years, X number of physical therapy appointments after a stroke, skilled nursing but not custodial care, X number of days in the hospital following surgery, 3 mental health visits, we don't cover MS or Lou Gehrig's disease, and so forth. How is this not rationing? How can people who want the government to regulate the choices of pregnant women say they don't want the government involved in health care? And if you do not specify end-of life Advance Directives, decide against surgery, and choose not to continue aggressive medication with debilitating side effects, you will be kept breathing on a respirator with tubes pouring Ensure down your throat while you lie there unconscious for God only knows how long at an astronomical cost. The alternative is hospice care - trained medical professionals keeping you comfortable at home, with your family and friends (who also receive emotional support along with your home-based medical support), maximizing the quality of life you have if you live with a terminal illness, and breathing your last in peace. Hospice care is not a "death squad."

    August 19, 2009 at 12:18 pm |
  5. jj

    On pricing....

    I am guessing they don't have every other commerical in the UK recommending that they ask their doctor about.... My four year old son now makes this a part of his goodbye "Bye, don't forget to ask your doctor about...." I bet the endless commericals couldn't possibly be raising the cost of medications, could it Ian?

    Also of note... if a drug company has a contract with the US (Armed services etc...) they can not charge anyone else less than what the US pays. If that doesn't sound like an incentive to charge as much as you can, I don't know what does.

    August 19, 2009 at 12:17 pm |
  6. BH

    Steve...if you dont have health care why are you posting on CNN...maybe you should get a job (or another job if one is not enough) and pay for your own health care!

    August 19, 2009 at 12:17 pm |
  7. John Wendt

    Good gracious, fellow Americans! Is it so hard to admit that the rest of the developed world has it right about health care and we have it wrong? They pay less. Everyone is covered. The quality, by all independent determinations, is better (and ours, even though we pay 10 times more, roughly on par with that of CUBA!). If, like me, you have experienced health care from a publicly supported system, you would sure appreciate it. Even the nurses seem nice, and you get treated like a human in the hospital. Hell, I had a nurse in Louisiana wake me up in the middle of the night while totally knocked out on pain killers (me, not her) to sign a form I couldn't even read! Are my fellow citizens so deluded that they think that there's nothing better out there???

    If you got the money to pay for private insurance, the government will not "ration" your health care–though as should be abundantly evident, your health insurance company just well might, as they have been doing.

    Stop your ignorant cries of "socialism"–lately downgraded to "Naziism". It is no more socialist than Medicare, or an interstate highway–ever travelled on one of those?

    Or, just keep it up, as your costs continue to go up faster than your income. What the hell.

    August 19, 2009 at 12:17 pm |
  8. David

    As a physician and pediatrician I am glad to read this article. There have been too many false arguments put forward and very little honesty in the debate. We already ration health care and we always will. It is the uninsured patient who can get little else other than emergency treatment, so may live life with severe pain from arthritis because they can't get the medication they need or the hip replacement that I can afford. It is the test, or admission to the hospital, or medication denied by an insurance company. It is the patient that does not even go to seek care because they are afraid of the cost or seek care when it is too late. The question is not should we ration health care, but how we ration health care. Society may be able to afford all the health care it needs, but cannot afford all the healthcare it wants. False arguments over how many are uninsured or the false notion of death panels is not relavent or the issue.

    August 19, 2009 at 12:17 pm |
  9. Sharon

    FINALLY–somebody is telling the truth about healthcare in this country and the so called "rationing" problem. My bet is that most people will not accept it as it is not what they want to believe. I have worked in the health care industry for over 30 years and am here to tell you all that this gentleman is telling the truth and nothing but. If you are charged a $100 copay for a week's worth of antibiotics and you can not afford to pay that amount, THAT'S RATIONING! Economically rationing is the very same thing as saying NO–if you can't afford it then it is rationed. When you have a policy in which your insurance company pays 70-90 percent of COVERED CHARGES and you pay 10-30 per cent, guess who determines what is "covered charges" and it is not you. Then you pay your 20-30 percent of "covered" charges and 100% of everything the insurance company decides they will not cover. WAKE UP PEOPLE!!!!!!!!!!!!!!!! You are living the healthcare you are complaining will be provided by this bill. You WILL be better off if it passes than you are now unless you really are OK with your insurance company making these decisions for you.

    August 19, 2009 at 12:17 pm |
  10. Z

    The actual number of those individuals that are truly un-insured is between 8.5-13 million. The 47 million consists of non American Citizens and those that can afford to buy insurance but choose not too as well as those individuals who will be unisured for less than 4 months. So we are going to spend a Trillion Dollars on a Health Care Overhaul for only 4.5% of the total population???? Seems like a waste to me.

    August 19, 2009 at 12:17 pm |
  11. Paul McKelvey

    Whatever the number of uninsured, the fact is that they are being rationed out of the health care market. When an insurance company forces insureds to pay more for a drug that is still under patent, it is rationing that drug.
    Finally, when those who are uninsured go to an emergency room to get care, they are using the most expensive health care option. Usually, they just need a doctor or clinic visit, a much cheaper health care option. That forces us to pay higher taxes because hospitals have to recoup the expense that these folks can't pay. It is against our best interest to ration the cheaper health care options for the uninsured.

    August 19, 2009 at 12:17 pm |
  12. JD

    If anyone ever wonders if 0bamacare will ultimately result in Death Panels, they need only look to Mr. Singer's throwing his clout to the idea. Mr. Singer is an rabid supporter of euthanasia across the board, even favoring the euphemistically-named "non-voluntary euthanasia" which entails putting to death those who cannot speak for themselves and have no-one to champion their cause.

    But don't take my word for it, read Singer's own words – http://www.utilitarian.net/singer/by/1993--.htm

    I'll be shocked if CNN approves this one. Way too much truth written here.

    August 19, 2009 at 12:16 pm |
  13. Deregulate_This

    If Republicans are so concerned about Tort Reform.... Why did they not pass this when they were forcing through the the Bush Tax Cuts for Wealthy people?

    They had control of the House and Senate and Presidency, yet they did not pass Tort Reform or Immigration Reform. I'm noticing that Republicans just complain about those things, but don't do anything about it.

    August 19, 2009 at 12:16 pm |
  14. JOHN

    KATIE, NOT EVERYONE is going thru that, I really wonder how long you been taking this MEDS or getting services ? ...are u getting massages from a past accident and just continued it till INS says ....NOT any more !! ..I would like to know what services denied ..and don't you lie about what it is .

    August 19, 2009 at 12:15 pm |
  15. Lisa in Shelton

    I may be mistaken but I think the primary issue in "tort reform" would be to secure maximum payouts for malpractice claims – since much of MD earnings go to cover the costs of exorbitant malpractice coverage and some folks love to sue despite signing informed consent paperwork or outcomes that are no fault of the MD or Nurse; so, there is an argument that legal costs are driving up the costs of healthcare even more than the rising costs of the overpriced drugs and new equipment and procedures.

    August 19, 2009 at 12:15 pm |
  16. Bob

    I get so angry when Americans hammer the Canadian health care system. Unless you've lived it, how can you have an opinion? I've lived it..here's what I know. I was born with a cleft palate, by two years of age I had had 4 major operations, if I lived in the US, would I have had those operations? How much would it have cost my parents? Would they still be paying off the debt? These are worries that Canadians don't have, and you can NOT put a price tag on that.

    August 19, 2009 at 12:14 pm |
  17. Mark

    Rationing is here now as insurance denies brand names, high co-pay for new and expensive drugs to discourage consumers and those with no insurance have no care. Best coverage is by Medicare, pays well and doctors run any procedure they want on Medicare patients. It is very lucrative.
    "Death panel" is here too. Uninsured (25 or 45 millions whichever one likes) are on slow euthanasia because can't buy blood pressure medications, statins for cholesterol and diabetes can't be controlled. When they crash, their primary care provider (emergency room) will see them and if the heart is still beating they go home. Tax payers are paying for ER and hospital cost for them without any complains. What is the “big deal” when someone says insure all and stop slow euthanasia for millions of uninsured, still same taxpayers will pay the bill but for much better purpose.
    Tort reform is a good idea, why administration is so shy about it?????????????

    August 19, 2009 at 12:14 pm |
  18. JCM

    Something you all should consider when noting that the prices are worse here than in other countries: a vast majority of the drugs are made here. So not only are they cheaper overall in other countries, but the people there are paying for import tarrifs, transportation and other duties that we are not paying, so their drugs are less the cost of our drugs by a retail difference that is greater than the cost of shipment and export combined. We are truly getting hosed by our own american companies. Sure, they're not all American, Merck is not. But Pfiser, Glaxo, Abbot, those are all here. Drive through Connecticut and you'll see all the fancy houses of Pharmaceutical Executives. I have a friend who works for big pharmaceuticals, she makes three times in that industry as a quality engineer as she would in a different manufacturing industry. Even she says they can afford to lower prices, and she has long worked for the generics not the name brand.

    August 19, 2009 at 12:14 pm |
  19. Little Hawk

    Ian, your comment inferring that the drug companies sell drugs cheaper in Canada because they make up their losses in the US is wrong. No company is going to sell a drug for less than the market can bear. They are making money in both Canada and the US; the only difference is that in the US their profit margin is greater.

    August 19, 2009 at 12:14 pm |
  20. ESinIllinois

    Craig – "Summary: How about actually reporting NEWS, rather than OPINION? There is no journalism anymore… Everything on this website (even news stories) finds some way to inject a political statement. Enough."

    I don't necessarily agree with your assessment of Prof Singer. However, I whole-heartedly agree with your summary statement. Whatever happened to reporting the facts and letting people make up their own minds?

    August 19, 2009 at 12:13 pm |
  21. Erik

    No, Ian... Your response is the dumbest comment in the healthcare debate.

    If they sell them high here in order to cover the cost of selling low across the border then that would mean that they are selling the drugs at a loss across the border. There is no reason, or way, that these massive corporations would do that.. That would also imply that we, in the US, are subsidizing the pharma costs of the rest of the developed world.

    They simply make more money off of us.. Happens all the time in all industries. You go to buy a car but don't ask for a better price, then guess what... You pay full sticker. It's even worse, with the pharma problem here, because the lobbiests have the politicians bought and paid for so we are not even allowed to ask for a better price..

    August 19, 2009 at 12:13 pm |
  22. Leigh

    "Tort reform" is a straw man put up by the insurance and health care industries. The theory behind tort reform is that what is really driving the increase in health care costs is the high cost of jury awards to malpractice plaintiffs, and the rising cost of malpractice insurance as a result. This argument lets the insurance and health care industries blame the big nasty bad patients (and their even bigger, badder, nastier lawyers, whom everybody loves to hate and thus make a marvelous distraction). Trouble is, jurisidictions which have enacted tort reform have seen no measurable difference in the cost of health care as a result. It's just a nice red cape to wave in front of the bull (although in this case, it does seem as if it's the bull, or one of its products, waving the cape) - distract the public with nice easy targets for anger, while making sure that people don't blame the real culprits.

    August 19, 2009 at 12:13 pm |
  23. allan

    What many people seem to wish to ignore is that the U.S. is probably headed for a catastrophic bankruptcy that will impair even the social services that we now provide. David Walker, former Republican Comptroller of the Currency, resigned when he accused Bush of allowing the deficit to grow unchecked. Now that deficit is growing at three time the rate of the Bush administration. Many people seem to be desensitized to the ever increasing deficit. We already know that Social Security and Medicare may go bankrupt and now we’re thinking of adding a new program. California is a perfect example of what happens when debt actually causes a reduction in social services. It does not matter how noble the cause, you cannot spend your way to prosperity and nobody rings a bell to tell you the moment financial collapse is arriving.

    August 19, 2009 at 12:12 pm |
  24. Matt P.

    To the person who demanded tort reform: We've had tort reform in the state of Georgia for four years, and it's made no difference at all. The bill passed was a very strong one, and is almost exactly what the insurance lobby asked for, yet costs here have continued to go up at the same rate as the rest of the country.

    Other states have enacted tort reform as well, to the same (non)effect.

    August 19, 2009 at 12:12 pm |
  25. Richard Dover

    Sounds like we have a case of whining isms
    Please take 2 aspirins and call me in the morning....
    Marcus Welby

    August 19, 2009 at 12:12 pm |
  26. JOHN

    steve, ....get rid of your CELL PHONE...use that $100 a month to pay for your MED BILL ......GAWD !! .....set your PRIORITIES STRAIGHT !!!

    August 19, 2009 at 12:10 pm |
  27. JC

    Hey Ian, you should be careful about who you call an idiot, as your comments put you in a big glass house.
    Wouldn't it be better for us if the drug industry sold their drugs for MORE money across the border so they could sell them for LESS money here?
    They sell drugs for less money in Canada, for example, because the Canadian government isn't prohibited from demanding a lower price for their volume discounts. The pharmaceutical industry in the US spends tens of millions of dollars in campaign contributions to ensure that that doesn't happen, and owns BOTH parties, including Obama. Haven't you noticed there is no call for lower drug prices in his health care reforms? PhARMA is poised to reap billions in profits from healthcare reform.
    The people who say we should run government like a business are the same people who block Medicaid/Medicare's ability to negotiate lower prices with volume discounts. How long would Wal-Mart last if they weren't able to demand volume discounts?

    August 19, 2009 at 12:10 pm |
  28. Gina

    Insurance companies and drug companies are dictating our health care options and our very lives for their own profit and the greedy profiteers do not want to relinquish their riches. The recent beligerent GOP propaganda tactics in opposition to health care reform at townhall meetings are reminiscent of Stalin's measures in the Communist takeover in Eastern Europe after WWII. We need a strong public option for health insurance to break the back of the monopoly currently held by the insurance companies and big pharma.

    August 19, 2009 at 12:10 pm |
  29. Nick

    So what all these Liberals are saying boils down to this:
    Some people already have their healthcare rationed therefore let us create a system where care is rationed for even more people, the government does the rationing, and everyone will pay more taxes. Awesome.

    August 19, 2009 at 12:10 pm |
  30. Gene

    Ian says: "No, you IDIOT!! The only reason they can sell them for less money across the border is because they sell them for MORE money here!"

    That may be the case, but are you advocating that we should subsidize the drugs used by other countries? If we force prices lower here, drug companies will be forced to raise prices elsewhere – seems only right that all parties should shoulder the cost (and reap the benefits) equally.

    August 19, 2009 at 12:10 pm |
  31. Chris

    If we truly want healthcare reform, then let's institute the following:
    1) Pass torte reform. This will lower the cost of Physician Insurance and reduce needless additional tests run.
    2) Remove all Pre-existing clauses from insurance contracts. This would allow all to get coverage regardless of their situation.
    3) Remove the state governments ability to levie taxes on the health insurance premiums we pay.
    4) Allow insurance companies to sell policies without all of the additional state mandated benefits which increase cost of the insurance policies we buy. If a person wants the additional coverage...let them buy it.
    5) Require hospitals, outpatient surgical centers and the like to publish costs for services rendered. Competition will work wonders on those who are not competitive.
    6) Institute a national reinsurance program that will protect all of us against catastrophic medical situations.
    7) Provide tax incentives for all looking to buy insurance.

    I am not sure about you, but I would rather try these simple steps instead to handing my healthcare over to the Government.

    August 19, 2009 at 12:09 pm |
  32. Steve

    Finally someone with a brain. Of course health care is rationed!! It's called a summary plan description and these ignorant people that don't think health care is rationed should read the summary plan description for their own health plans.

    That document might tell you that you can't have certain medications or maybe that certain procedures aren't covered. I had a plan that limited you to two months of physical therapy.

    It's time for an intellingent debate about health care, not an ignorant debate!!

    August 19, 2009 at 12:09 pm |
  33. A

    Using the "number they use" in a quote as a gauge to determine what side of the debate someone on is asinine. So what if someone says 45 million or 26 million–aren't we all talking MILLIONS here? This is America and it is not okay to have this many people left out of HEALTH care. Even if the number was 1 million or 10,000–its too many. The real question is: How many of us are satisfied with the "health care" insurance companies are willing to offer us at top dollar today?

    August 19, 2009 at 12:09 pm |
  34. ESinIllinois

    Ian said – "No, you IDIOT!! The only reason they can sell them for less money across the border is because they sell them for MORE money here!"

    You seam to be suggesting it's ok to subsidize cheaper meds across the border. Maybe they need to raise the cost of meds for Canada and others.

    August 19, 2009 at 12:08 pm |
  35. mark in houston

    i know doctors that load their waiting rooms. and see 60-90 patients a day. my old doc wouldn't even look me in the eye, but ask me about 5 questions then write me a prescription and pat me on the back. this took about 5 minutes.

    this is not health care. this is explioting patients and their health insurance.

    my old dentist would take needless x-rays.

    this really upsets me the most. big medicine and big insurance colluding and making money off ordinary people.

    we need health care reform. NOW!

    August 19, 2009 at 12:08 pm |
  36. Marv

    The best way to beat the Republican Lie Machine is to provide FACTS to people and educate them. I'm so disgusted with the GOP and conservatives and their never ending stream of misinformation and delusional statements: Death Camps, Birthers, Nazis, etc... The plain and simple fact is that America has some of the best health care in the world, but it's in the hands of the worst HMOs, Insurance Companies, Lobbyists, Corporate Greedys, and Republican Politicians. Every other civilized country has a successful nationalized health care system, most with a public option, that reduces government waste and keeps their citizens healthy. It's a no-brainer, but these conservatives are only proving that they have no brains by trying to stop this.

    August 19, 2009 at 12:07 pm |
  37. Lisa in Shelton

    since no one plan will make everyone happy, and most agree there is a genuine need to fix our broken system – can't we stop the yelling and create a muti-faceted approach to assess cost benefit analysis of each the various plans IN ACTION not just theory? Try all of it SOON – gov't run, for-profit, and non-profit co-ops simultaneously and steer more business to better and more cost effective coverage as time goes on?

    August 19, 2009 at 12:07 pm |
  38. Ric

    When was the last time a major government program has worked...and don't say "Cash for Clunkers". Social Security will be bankrupt by the time I need it (I'm 34), and the whole country will be by the time Obama leaves office!

    We have the best health care system in the world people, why let a bunch of politicians decide for us....This country was built on hard work and dedication....not hand outs!!! Take advantage of the opportunity, rather than expect a "Bailout!"

    Those without healthcare aren't turned away...Let's remove some of the obstacles (malpractice suits) Doctor's and providers have to work with, increase e-records adoption, and we can reduce costs...without more taxes!

    I've still yet to hear how were going to pass a $1Trillion healthcare reform without taxing the middle class...Does anyone care about paying taxes anymore? I know our forefathers did.

    August 19, 2009 at 12:07 pm |
  39. H

    Everybody, whether insured or not, must support health care reform and a public option like Medicare must be included. The word "rationing" is just another scare tactic by the opponents. Wake up and smell the coffee! Would you rather have your health care decisions be made by profit-sucking insurance companies? Having a public option will keep those guys honest.

    August 19, 2009 at 12:06 pm |
  40. JS007

    CNN, I can sincerely commend you for this article! Finally the media is taking a leading role in debunking some of the stupid arguments against national health care. 18,000 people die in America EACH YEAR due to not being able to afford, or being denied care by their insurance company. How is that not rationing? The question is do you want a government bureaucrat motivated by re-election rationing your care, or an insurance company motivated by greed and profit? I'll go with the government bureaucrat.

    Countries like Britain, France and Canada have much better health outcomes at half the price. Americans have been brainwashed that "socialized" anything is a bad thing. What about the military? The military is fully owned and operated by the government, and it is the best military in the world. The private market only works for products where consumers have a lot of power – like TVs or cars. Moral or indispensable goods, such as health care, that HAVE to be purchased, cannot be left up to profiteers. People can't say "I'll put off my life-saving surgery until the prices come down".

    August 19, 2009 at 12:06 pm |
  41. Larry

    I wish that everyone arguing about what this Bill will and will not do would take the time to read the actual Bill, and see for themselves, as opposed to arguing about it using facts from someone else, who hasn't read it either, or is just fanning the flames. If we all do this, then maybe we can finally have educated discussions about the good and bad in the bill.

    August 19, 2009 at 12:06 pm |
  42. une

    As a healthcare professional; I must disagree with the above statements. Right now I work in NYC. The hospital I work at see all the undocumented uninsured and everything including their mother. The only reason why they are able to do is because when someone like me with insurance has its appendix take out my insurance will pay for me and double the cost to cover the other guys. So the government will try to kill the goose that lays the golden egg. Than the number of uninsured are way blown up by the media.
    Also what ticks me off is the fact than when I went to Mexico the first thing out of their mouth was “insurance or cash”. Don’t mean to sound small hearted but the reality is such.

    As far as people that don’t have insurance they should enroll in Medicaid. There is a government option if you are without money. If you have enough income that you don’t qualify that you should pay for it just like the rest of us. Nothing is for free in this world someone must pay for it.

    TORT REFORM

    August 19, 2009 at 12:06 pm |
  43. Mark

    Norm,

    I'm not sure where you get your numbers from, but the 46 million that is used is based on U.S. Census numbers. Many other organizations actually estimate the number to be higher. And that number, regardless of what it is, doesn't include the "underinsured", who also need better access to health care. As far as tort reform is concerned, where it has been implemented, there has been a neglible effect on health care costs. The savings, whatever they are, are NOT being passed to the consumer. So, although I agree that tort reform is needed, there's no evidence to support the idea that it will decrease health care costs.

    August 19, 2009 at 12:06 pm |
  44. Nonsense

    North Chadwick, why is either # acceptable? 1M is too many. but i do agree with Ian.

    Re: rationing – if i can't see any doc I want, that's rationing. if i have to get approval to get a test or have a surgery, that's rationing. if a drug isn't approved, that's rationing. that's our entire system NOW.

    August 19, 2009 at 12:06 pm |
  45. Josh

    I'm disappointed that no one seems to care that this whole thing is completely unconstitutional.

    August 19, 2009 at 12:05 pm |
  46. VS

    Some insurance companies restrict 'physio' to 12 sessions. So the patients with fixed contracture (post surgery/fracture....) will have to come to the operating room to have the joint straigtened under anesthesia. This is the sort of waste we should prevent .

    August 19, 2009 at 12:03 pm |
  47. Kevin Schuder

    To Ian:
    His reasoning that drugs can be sold for cheaper here makes sense if those in England and Canada pay a little more to offset our lower prices. Or, maybe the drug companies could get squeezed a little... the top 10 manufacturers made $40 billion in 2006.
    Still think we can't negotiate for lower costs?

    August 19, 2009 at 12:03 pm |
  48. Robert

    "No, you IDIOT!! The only reason they can sell them for less money across the border is because they sell them for MORE money here!"

    And you're OK with subsidizing the costs of drugs in other countries? You don't mind being ripped off here in America so that drug companies can sell their products in other countries at lower prices? I do mind, and so do many Americans. This is one of the practices that health care reform would address, by bringing costs down for AMERICANS.

    August 19, 2009 at 12:02 pm |
  49. Jason

    Ian, It is better to be quite and be thought an idiot, than to open your mouth and prove it...

    perhaps you should try keeping your mouth shut.

    August 19, 2009 at 12:02 pm |
  50. Kevin

    We don't need health care reform. Tort reform, yes, insurance reform, yes, govenment interference reform, yes.

    August 19, 2009 at 12:02 pm |
  51. Mykel

    Ian said: "These people are incredibly dumb. This is, perhaps, the single STUPIDEST comment I’ve ever read in the healthcare debate … and that’s saying something!"

    Actually, Ian. That statement is patently true. Perhaps you are incredibly dumb, but I doubt it. I won't stoop to your level of degrading others. Your statement, by the way, is also true. They are both right.

    What Singer and you are both saying is that the result of higher prices in the U.S.–related to our lack of a national healthcare provisioning service negotiating better prices–there is a disparity in price. That disparity is evidenced by the fact that the drug companies can negotiate lower prices in other countries because the U.S., in essence, supplements the rest of the world. The profit margin gained in the U.S. allows for lower profit margins in other countries. Hence: If drug companies can afford to sell drugs for less across the border, that is evidence that the prices we pay in the U.S. are relatively. Following that logic, it is evidence that we could be paying less. Only when we are all paying the same price per unit, is there evidence of parity. Given America's heavy reliance on pharmaceuticals, the volume discount we should be getting–because of our untapped buying power–should mean lower prices in the U.S.

    August 19, 2009 at 12:02 pm |
  52. Chelle

    Oh my goodness Ian. The reason drugs are so expensive in the US isn't because you are subsidizing the rest of the world – it's because the drug companies are raking in record profits!!! Only a small fraction of their profits go into Research & Development – the rest go to line the pockets of the CEO's and their lackeys.

    August 19, 2009 at 12:02 pm |
  53. Ken

    The interviewer is just teeing-up speaking points for a professor's personal opinion rather than challenging any of his points, so it's difficult to take anything in this article at face value.

    Personally, I've never had an issue with private insurers as to what can or can't be covered; but admittedly, I've never needed anything beside a normal checkup and the occasional antibiotic. However, I think there's a fair point to make that people need to take more accountability and ownership for their own costs.

    A large driver the average person's health care costs over a lifetime are people's poor health habits, and that will not only drive premiums, but also force companies to recover costs in other areas (such as rejecting other costly procedures).

    If people ate healthier, exercised, didn't smoke, etc, then heart disease and other costly, long-term conditions would be fewer and costs could be contained. But that's not the discussion people want to have, and instead think a public option will be better because more healthy people will pay to offset their expensive procedures.

    August 19, 2009 at 12:01 pm |
  54. ZAK

    These guys who oppose healthcare reform donot understand the plea of the not insured who although working hard cannot afford high premiums and high deductibles and the companied they work for donot provide health insurance as their owners (mostly republican who get tax deductions under republican goverment were rewarded for that i am a witness as i work for one)don ot want to pay their part so a public health care reform would go a long way than to have a collapse of the hospitals for non payments by people who cannot afford their bills.

    August 19, 2009 at 12:01 pm |
  55. Leo

    What difference do the Republicans make. The Democrats have adequate numbers to do whatever they want and claim to be all powerful. Why don't the Democrats just unilaterally "take care of business" if they are so sure that what they are doing is good for the country (or is it just good for their pocketbooks?)

    August 19, 2009 at 12:01 pm |
  56. KCMO

    the 45 million uninsured is an incorrect number for two reasons......1) that number includes illegals and 2) that number is from 2007 and lots of people have lost jobs(and insurance or the ability to pay for it) in the last two years.

    As for Ian saying the only reason other countries pay so little is because we pay so much is not true, simply not ture....your the idiot Ian. In america we don't have nationwide systems like other countries and that causes our hospitals to lose bargaining power because every hospital or healthcare organization is responsible for buying and negotiating drug prices instead of a system the encompasses an entire county. Also, almost every major high-priced, high-profile named drug has a generic brand, which is the same, that is already sold at a fraction of the cost, but doesn't get the advertising.

    August 19, 2009 at 12:01 pm |
  57. HyacinthDC

    IMHO we need to rein in the insurance companies. Force the ins co to keep people on the rolls, add people to the rolls, and limit their exorbitant profits. Ins co's cry all the way to the bank.

    August 19, 2009 at 12:00 pm |
  58. Xysea

    So Norm, 26M people uninsured is okay, is that your argument? lol

    Wow. The lack of empathy for others is pretty amazing.

    And Tort Reform has already occurred. You must have missed the memo.

    August 19, 2009 at 12:00 pm |
  59. Keith

    45 million, 26 million, who cares? EIther number is a frickin joke for a country supposedly as great as ours. If you cannot agree that either number points to a major breakdown requiring an overhaul than you are disengenuous. Republican hard liners will always try the old end around by using numbers like this to avoid the real isssues. Typical scare tactics for the short attention span constituents.

    Wake up America. We're wasting a ton more money in the far east and getting ZERO out of it yet you don't complain about that. No, you fly your flags in support of it while attacking an attempt to actually make our lives better. Sad, very sad.

    August 19, 2009 at 12:00 pm |
  60. Katie

    Finally! An article boldly stating that rationing of health care is here. I've had services denied and have had to make the decision to pay out of pocket or go without. I'll wager nearly every insured person has faced that choice. For some, the consequences are dire. Talk about Death Panels! When some bureaucrat says no you can't have that – and you die – that is a Death Panel decision. It's already happening! And furthermore, whether it's 25 million uninsured or 45 million uninsured (such a silly point to debate – either way we're talking several big cities' worth of people!) there are A LOT people who have no health insurance and can't afford to see a medical professional. Way more than those who died on 9/11, way more than all the veterans of all the wars, way more than the displaced people of New Orleans when Katrina happened. Think about it! Still willing to believe all the Neo-Con nonsense about health care reform?

    August 19, 2009 at 11:59 am |
  61. mya

    "No, you IDIOT!! The only reason they can sell them for less money across the border is because they sell them for MORE money here"

    So Americans have to pay through the nose–and to the detriment of those lower-income/fixed-income individuals–so other countries can get it cheaper.

    Whose the idiot?

    We are for allowing that situation to exist.

    August 19, 2009 at 11:58 am |
  62. william k. fitzwater

    When people start talking about rationing of care they are misrepresenting the facts. Health care is already being rationed by virtue of its cost. If I cant afford a procedure and it is not life threatening many people will forgo it . Even when I have health insurance . This is in effect rationing.
    The more truthful part is when heath care reform is passed it is a code word for saying I don't want my health care being taken away from me to be given to some one else. Institutionalized selfishness part of the conservative mantra.
    There are two argument here :
    1. fundamental limits of resources. there is only so much to go around and you must hoard your resources and fight any one who takes away resources.. approach of fear of change
    2. unlimited resources and for thereto be truly justice to be done here resources should be shared for the common good. More will be created. Acceptance of change knowing the risks involved.

    this is the real argument over reform. Fear vs Hope. I hope hope wins in the end. It is also testing the heart & spirit of the American people. I have seen more selfish mean spirited people in this debate. Greed as well. "for the love of money is the root of all evil". I would wish for more of the Alterism like Kennedy "ask not what your country can do for you".
    I don't know about the true character of the American people any more and in some ways some of the people I am truly ashamed of.

    August 19, 2009 at 11:58 am |
  63. Ron

    What are people talking about when they say that it takes much longer to see a doctor in Canada or England or wherever, than here?
    That is just incorrect. If I call my doctor for an appointment, I usually have to wait for weeks to get in to see him. They are so booked up that I can't just run over there today. This is sometimes a big problem when one is suddenly quite ill, so usually there are plans, through most insurances, to go to an "urgent care" center for help. But don't make it sound like other countries have to wait much longer than us. That is simply not true. I think if one does not live in one of these other countries, we should not just take for granted what the biased talk show "hosts" are spouting off about. There are sure more than enough lies going around on this whole issue.

    August 19, 2009 at 11:57 am |
  64. Thomas From Kentucky

    Every Dem Pol and healthcare advocate (now Singer) has repeated the "45 or 47 million uninsured Americans" number. However, that number includes between 10 to 13 million illegal aliens. If Dems want to make it clear that illegals will not be covered under the healthcare reform bill, stop repeating the 45 million number, it would go a long way. Also, is prof Singer's suggesting that anyone wants "unhelpful, good-for-nothing, expensive" treatment? I wouldn't pay for that, and hope the govt wouldn't either. If this is his only argument for rationing being good and everyday, what the heck is he talking about. Corporations do it all the time? We ration in our personal lives? This article is clearly a pro rationing argument, why have it, there is not going to be any rationing right? CNN should stop trying to convince the public that rationing is not so "Scary" if the president and his admin say no rationing is going to take place.

    August 19, 2009 at 11:57 am |
  65. Benjamin

    Why Medicare savings shoud be paying for the uninsured? This is nore fair. Any Medicare savings should be placed back into Medicare to cover Meciare recepients only. The Medicatre recepients paid their Medicare taxes and their numbers are going to increase with babyboomers hiiting 65. Medicare need more funding and not less.
    How can anyone even suggest to cut the Medicare spending and pay with the savings for non-medicare programs?
    The entire concept looks like robbing the eldery.

    August 19, 2009 at 11:56 am |
  66. Paul

    They always bring up tort reform, because the Doctors are always being sued. Sorry people, that is not possible unless the Doctors re-educate themselves. Most Doctors finished their education in the lower half of their class, and expect to go out to make money on what they know and take chances of success. If they fail, then they get sued and make it more difficult for other Doctors to provide the service at a risk of being sued. The insurance companies sell premiums higher to cover the Drs. mistakes. So, its time to put a cap on Drs., Lawyers, and Insurance Co. charges for these expenditures. Healthcare reform, Insurance reform, and Tort reform, all go together. You can also put Prescription drugs on the list.

    August 19, 2009 at 11:55 am |
  67. DFinFL

    I keep hearing talk about "tort reform" (screaming actually), but none of those who demand tort reform seem to be able to define exactly what they want to change.

    Does tort reform mean that doctors and insurance companies will be above the law and able to do, or not do, anything they want? Will some law suits be illegal and others legal? If so, which law suits are allowed and which are not allowed?

    Can anyone, from any side of the fence, provide a clear explanation of what "reforms" they are demanding?

    ..

    August 19, 2009 at 11:55 am |
  68. Nancy

    The problem with private health care is that health is not a market. It doesn't respond to market forces. Hospitals and doctors sell sick care, not health care, and they are motivated to fill their hospital beds and do as many procedures as possible, needed or not, and to charge as much as they can. this means rising costs. Insurance companies add more layers of costs with advertising, lobbying, paying staff (and doctors!) to refuse people, etc. Basically, there is no pressure to keep costs low and to assess the overall system to make sure it maximizes health (not maximizes sick care).

    This is why ALL other western countries have moved to a public system. The taxpayer, governor, and auditor keep pressure on the system to keep taxes low, while the same taxpayer, governor, and auditor use the same medical system, so are motivated to keep standards high.

    A profit motive can't do this.

    August 19, 2009 at 11:55 am |
  69. Hadley V. Baxendale

    In 2002 I was found unconscious on the sidewalk in Wilmington, DE and taken to the hospital. The very next day Blue Cross called the hospital asking that I be discharged. Luckily for me, the hospital resist ed.

    August 19, 2009 at 11:55 am |
  70. Leigh

    While the basic argument presented here is sound - we already have "rationing", and the only question actually being debated is whether the rationing should be handled by those out to profit from it or those who don't have a profit stake in the matter - calling Peter Singer an "expert" on bioethics is rather like calling Gov. John Sanford an expert on marital fidelity. Professor Singer advocates euthanasia of handicapped newborns. The argument he advances here needs to be heard, but the fact that he's the one being given the public platform to make it is going to destroy its credibility.

    August 19, 2009 at 11:55 am |
  71. Pal Martin Hurst Texas

    OBFUSCATE!

    Most people agree
    "RATIONING" is when an entity (gov't, army, parents)
    determines "who" & "how much" of a limitied resource
    (food, water, etc..) that someone will get.

    HealthCare is NOT rationed.
    It is PURCHASED by those who want and are capable of PAYING
    for those services.

    August 19, 2009 at 11:54 am |
  72. Dave

    Perhaps Ian doesn't undestand capitalism. Does anybody really think for-profit drug companies and for-profit insurers take less than they could get across the border, just because they gave enough here, ie "enough" profits already? Their focus is to maximize quarterly profits, ie sell for as much as possible. That's how the executives maximize their bonuses/stock options. Which inherently puts the interests of those with power against those without, when insurers minimize, ie deny/don't pay, claims they maximize profits and compensation for their executives.

    August 19, 2009 at 11:54 am |
  73. Aline

    The biggest need in reform is tort reform, stop the outrageous legal suits and awards that have doctors paying such high premiums for their own protection, and cause them to send patients for all sorts of tests etc. just to protect their own liability.. Can't talk to a doctor past their liability concerns. Only doctor available here to me recommends all sorts of test not appropriate, and prescribing meds to which I am allergic or intolerant, just so he wouldn't be accused of being negligent (his own words).

    August 19, 2009 at 11:54 am |
  74. Cole

    The fundamental issue is why should an uninsured person get comporable healthcare to someone that does have insurance. Those that do are paying in some fashion or another and have made professional or life choices to ensure they have healthcare. In no way should I (who am already paying) also pay for you to receive. It is not a right. Nothing that is a right should require taxpayer funding.

    August 19, 2009 at 11:54 am |
  75. Stan Chraminski

    We're not getting anywhere on health carecost containment until we set a goal to be the fittest nation versus the fattest. We have to take responsibility for our own lifestyles and health and not rely and the doc to "fix" what we neglect. One of the reasons other countries can have decent public plans is that their people are not as sedentary nor do they gorge on Big Macs. Of course, we are trying to change that end and pull the world down to our level. Prevention should not only be drugs and tests, but lifestyle counselling. Most are happy not to be sick but the goal should be how healthy can I actually be, not how much can I abuse my body and not be sick. Many, many diseases can be eliminated by lifestyle changes.

    August 19, 2009 at 11:53 am |
  76. Nichole

    Norm – are you serious? We're talking millions of people without health insurance and you think it's ok as long as the number is only 26 million? Get over yourself. The perception is that this is a greater need because those of us who do have health insurance can barely afford it and the cost just keeps going up!

    August 19, 2009 at 11:52 am |
  77. Guillaume

    tan, pharmaceuticals are one of the (if not the) biggest profit making industry out there. They make that incredibly profit by selling high. They could sell lower and still make a buck. There is a lack of competition and free market in that sector, and the problem is multiplied by human nature that always wishes life had no price.

    Let me assure you, to your insurance, the price of your life is known and detailed. Stop playing into pharmaceuticals' game.

    August 19, 2009 at 11:51 am |
  78. Michael

    The Republicans are doing what they do best "fear mongering". And the funny thing this is that they really do not care about the healthcare issue at all. The Republicans are more concerned about tearing down the Obama administration, with hate, fear, division and racism. This is what the GOP is all about.

    August 19, 2009 at 11:51 am |
  79. David Henneberry

    The very last statement in the article was misleading. He said "If they can sell them for less money in other countries they can sell them for less money here". The research costs for developing new drugs are very high and I don't think that research and development costs incurred within the United States can be deducted against profits from sales made by foreign subsidiaries. That could be changed of course, but it could be a very significant factor in the pricing decision if they have to recoup all of the r and d costs out of domestic sales. The problem with the health care debate is that many very detailed situations like this occur and how in the world will they ever craft a new bill to deal with all of them appropriately?

    August 19, 2009 at 11:51 am |
  80. Yerch

    I hate that people try to bring tort reform into the healthcare debate (see Norm Chadwick's comment). Tort claims have risen at the exact same rate as growth in the healthcare industry. They account for the same percentage of overall cost as they did fifty years ago. This is a red herring floated by insurance companies to cheat people out of money. If you cap tort damages all you do is take away money from people who have been seriously harmed and ensure that ONLY frivolous suits will be brought. Frivolous suits are always small dollar claims that it is cheaper to pay than to litigate. The cap doesn't affect them. But, hey, why not just spew some right wing talking point without thinking about it? That's certain to add something positive to any discussion of healthcare reform.

    August 19, 2009 at 11:50 am |
  81. John Dolan

    Tort reform is a red herring as malpractice costs constitute about 2% of total healthcare expenditures. Insurance companies profits increase as they point their fingers at the trial lawyers (which is convenient as nobody loves lawyers). Do some research to see how little tort contributes in any meaningful extent to health care expenditures. The insurance lobby strives to deflect attention from the true reasons for annual, double digit premium increases which are not driven by their loss experience.

    August 19, 2009 at 11:50 am |
  82. LB

    Good dialog. For the opposition to the public option in health care reform, I suppose they see "rationing" health care as the government telling the people what treatments or other health benefits their health insurance plans will cover and what they won't. But as the interview illustrates, that level or "rationing" health care already exists only instead of it taking place at the government level, it happens between your doctor/hospital and your insurance company. The way I see it, the Health Choices Advisory Committee would establish a more level playing field for allowable health benefits and coverage options throughout the health insurance industry. I see nothing wrong with standardizing an unbalanced and sometimes unfair health care system in this regard.

    August 19, 2009 at 11:49 am |
  83. Jackie in Dallas

    Thank you, Prof. Roberts, for telling the truth. Rationing already is a fact of life in the U.S. You are always limited - by what you can afford, by what the insurance companies will pay for (and that is usually set by a businessman, not a doctor), or by what is available in your area.

    I live with this issue. I'm one of the 45 million (actually, probably a lot more) Americans without health insurance. I've worked and paid taxes all of my adult life, and I'm 59. One insurance company dropped me when I was diagnosed with Crohn's; others would cover me except for any preexisting conditions like Crohn's, but at premiums I couldn't possibly afford. There's no public assistance for people like me - I make too much money to qualify for what is available, but not enough to pay private insurer premiums.

    In reality, most Americans are underinsured even if they have insurance - their deductables are so high or their premiums are so high that they go for the cheaper policies with less coverage. Prescriptions - even for generics - cost me in excess of $100 a month, and that is with a cost reduction plan through my pharmacy. Those same drugs, the identical manufacturers, dosages, and names, cost 1/3 that in Canada or England. Why? Because the pharmaceutical lobbyists in Washington have blocked any attempts to regulate their price fixing. We are told that those name brands are more expensive to cover research. Bull doo-doo! They are up to pay for advertising on every TV channel that accepts advertising, free vacations for their executives and top sales personnel, and all the other perks. Like Prof. Roberts says, those same drugs just across the border are a fraction the cost!

    I don't begrudge doctors, pharmaceutical companies, hospitals, etc. the opportunity to make a living or at least pay their expenses, but when the cost of a 5-minute meeting with a doctor (after waiting nearly an hour) costs me $50, but only costs an insurance company $20 or less, there is something wrong.

    August 19, 2009 at 11:49 am |
  84. ja

    and the insurers are stacking cash with copay and patien pay portions, the protesters, are futile with who they are screaming at

    August 19, 2009 at 11:47 am |
  85. Ben

    I prefer to use the term "coordinating," instead of "rationing." A denial of service from the payer is true rationing – a coordinated approach developed with a general practitioner does not eliminate access, but directs it to those procedures and services that are most likely to bring true benefit.

    The problem is that consumption and cost aren't aligned – I have fantastic benefits, so I can jump around to specialists, demand whatever drug was marketed to me on late night television, and never worry about the consequences. I would MUCH rather that my care plan be developed with my family practice physician, and have him help me navigate my way through the process, rather than just take random shots in the dark, or be manipulated into services I don't really need. This is the smart part of the NHS in the UK – the down-side is if there is a dominating health plan that sets reimbursement rates too low, there won't be enough supply . That leads to rationing, not rationalizing. Whether we have a public health option or cooperatives, this negotiating power needs to be wielded cautiously. I would hope that healthcare providers would have adequate opportunity to provide input on the true cost to provide service in these negotiations.

    August 19, 2009 at 11:47 am |
  86. Craig

    Oh, for the love of God. More opinion articles. How about an article that actually outlines key sections of the bill without trying to spin it politically? The democrats are screaming about Republicans and lobbyists trying to muddy the debate with misinformation, the Republicans are screaming about the Democrats trying to control everything. How about cutting to the chase and actually REPORTING on what's true and what's not, rather than wasting your time going to professors who likely haven't even read the bill? All he's doing is trying to redefine "Rationing" in a way that suits him politically. Is this really news? Do you really pay people to look for people to talk to just to ask them their opinion? Go find random people on the street, I find their opinions more fascinating and worthwhile than a bunch of college professors,

    Summary: How about actually reporting NEWS, rather than OPINION? There is no journalism anymore... Everything on this website (even news stories) finds some way to inject a political statement. Enough.

    August 19, 2009 at 11:46 am |
  87. J. Huck, NJ

    Ian wrote:

    “If the drug companies can sell them for less money across the border, they can sell them for less money here.”

    No, you IDIOT!! The only reason they can sell them for less money across the border is because they sell them for MORE money here!

    –> and you got that right! we are subsidizing people buying medicine outside of the US. If they can sell those drugs $0.50 outside and $1 here in the US, why can't they sell those $0.75 across the board.

    You know why? because THEY CAN sell it here in the US and in Canada THEY CAN'T... their government gave them those price protection and we don't. We can just say, we're all suckers here!

    August 19, 2009 at 11:46 am |
  88. George E Coles

    This is just another uneducated guess at what will happen with Healthcare under the government option. Having lived through the reality in Canada before moving here with my job, I could not disagree more. You media people have done nothing to explore the Canadian outcome and when you have to deal with healthcare administered by the government, you will not be pleased.
    You can do something intelligent. You can go and dig into healthcare coverage in Canada and other places like Great Britain and Germany and Holland and France and see how misguided your support of government admistered health care really is.

    August 19, 2009 at 11:46 am |
  89. bill bruening

    Good for Professor Singer. Of course private health insurance has rationing. It has happened to me and others on many ocassions. Tests were denied and prescription drugs were denied. It is just silly to think that a public program or a co-op will introduce for the first time rationing.

    Pewrhaps the notion of a philosopher-king is not that outrageous or outdated!!!

    August 19, 2009 at 11:45 am |
  90. Terrible swift sword

    Evolution vs. creationism is "hotly debated" too. The 2+2=5 arguments against evolution are no more valid just because they are vociferously stated.
    The US Census reported 46 million uninsured in 2007; if you believe the Census bureau has overstated this number by 77%, it says a great deal about you and your (FoxnNws & Rush?) sources.

    August 19, 2009 at 11:45 am |
  91. willie

    Republicans still scaring the elderly with lies. Government programs like social security, medicare and medicaid have made the difference between life or death for many senior citizens over the years. I will tell you what is scary. Imagine if the Republicans could vote on abolishing those socialistic programs. What would happen to the elderly and poor if they voted from their raw ideology ? The true death panel rests in the pit of the conservative mind.

    August 19, 2009 at 11:44 am |
  92. Outraged Taxpayer

    First outrage:
    Misplaced perspective – 45 milion uninsured means that 85% EIGHTY FIVE PERCENT!) of America is insured. Why not put it that way?

    Second outrage:
    J: ” Is it the care they need, Peter, or is it the care they want? "

    P: "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?"

    Where do you get the nerve to be the deicision maker over what I "need" or what I "want" when it's my doctor, my health and my earned income that provides the healthcare? That dovetails into the third outrage which is the use of the phrase "the money we have." "WE?" Are you kidding?

    Final outrage is the myopic economic anaylsis about the cost of drugs and the R&D. Yes, everyone in the U.S., U.K. and Canada benefits from the R&D but Singer's response misses the point. Yes, the companies could sell for less in the U.S. but without the income generated by the U.S. sales, the R&D would DRY UP for eveyone! Would you prefer to have the pharmaceutical miracles we have today or would you like to have remained in the 1930's?

    August 19, 2009 at 11:42 am |
  93. wbn

    You would think the UK and Canada would not be held up as examples, when it is common knowledge these systems are far inferior to USA care. Just yesterday (evidently not reported by CNN) Dr. Anne Doig, the incoming president of the Canadian Medical Association, said her country’s health care system is “sick” and “imploding,” the Canadian Press reported. She said it was providing inadequate care (they come here for serious care) and was going broke! If the government wants to help, they should develop a plan to supplement individuals and families trying to buy private insurance. No socialistic approach will work!

    August 19, 2009 at 11:39 am |
  94. Alex

    I've seen the results of British National Health Service "care" provided to one of my patients. He would have been better served not having them treat him. We had to re-do the work, and it was much more time consuming and expensive as a result. It's not what we want here in this country; not the right solution.

    August 19, 2009 at 11:38 am |
  95. Steve

    Thank you, Prof. Singer. The truth WILL set us free. But not until the right-wing gets over itself on health care reform.

    August 19, 2009 at 11:38 am |
  96. Andy

    I have been reading a lot about the healthcare reform. I just don't a simple concept here that a patient has to see a doctor for medical assistance and rest of the world is chasing every opportunity to get part of the fee being paid by the patient to doctor. The Doctor's are going out of business and are ordering un necessary tests to cover themselves from legal liability concerns. I think the government needs to take bold step to fix the environment, if they can rather than skew the doctors or the patients

    August 19, 2009 at 11:35 am |
  97. Khaleelah Muhammad

    I'm glad to see someone is finally "reminding" people that currently health insurance companies are making decisions for us as to which procedures we can and can't have because of what will be covered. Why should a Public option be any different? Whether or not you call it rationing, it comes down to the same thing...someone other than you deciding what procedures you can have or more accurately put, what the insurer is willing to pay for. You can still have the procedure IF you're willing to pay yourself. It is amazing to me that some of the same people who can't understand why so many people of color believe they don't get a fair shake in this society are the ones who are now making claims that the government will have death panels to knock off grandma. Give me a break already!! This is the biggest piece of bull hockey I've heard in a long time. I'll bet the Republicans had an opposing plan ready for either side of the plan President Obama took. I don't think the President's rating is slipping as much as it is only because people are losing hope in his plan but because he if focusing too much on a dream...getting the Republicans to be bi-partisan.

    August 19, 2009 at 11:35 am |
  98. Ian

    These people are incredibly dumb. This is, perhaps, the single STUPIDEST comment I've ever read in the healthcare debate ... and that's saying something!

    "If the drug companies can sell them for less money across the border, they can sell them for less money here."

    No, you IDIOT!! The only reason they can sell them for less money across the border is because they sell them for MORE money here!

    August 19, 2009 at 11:35 am |
  99. steve

    wish all those people with health insurance would shut up what about us that don't have insurance and cant go to the doctor ,we need the government to help.and put a stop to big insurance company and the medical profession.the rates are out of control and its time for government intervention

    August 19, 2009 at 11:34 am |
  100. Norm Chadwick

    Mr. Singer claims there are 45 million uninsured Americans. This number is hotly debated. You can tell what side of the fence a person stand on the health care debate by what number they use. I have heard 26 million is a much more realistic number, but if Obama uses the 45 million number the perception is that this is a greater need. When the politicans and bleeding hearts are willing to put Tort reform as part of the plan I will be willing to take Health Care reform more serious. Without Tort Reform it is not Health Care Reform.

    August 19, 2009 at 11:33 am |
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