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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. K. McAlllister

    We need a Single Payer system but our rationing has left of with the Public Option. The Public Option is our best bet to lower costs throughout the system because it will create a national standard for competition and break up the monopolistic or oligarchal systems that insurance companies maintain in each state. Breaking the ties between employer provided health insurance and employment will enhance Americans ability to change jobs, start their own companies, and persue their happiness. Employers will also enjoy the savings brought on by the competition and will likely be able to hire a few more folks.

    August 19, 2009 at 12:56 pm |
  2. Mary Ann

    One huge expense for drug companies that could be eliminated would be the ADVERTISING. They spend way more total money on advertising than they do on ALL R&D! Eliminate the TV, radio, newspaper and magazine ads and drug prices should plummet. Make prescription drug advertising illegal – let them inform the doctors because the patients now just think one of the new, highly advertised, drugs is just the thing they need and go to their doctor and demand it. Most patients do not have medical training.

    August 19, 2009 at 12:56 pm |
  3. je

    Hey, MYA, at 11:58 . . . you asked "WHOSE the idiot?" . . . . . . gee, I don't know . . . . My question to YOU, "WHO"S the idiot?" Moral of the post . . . don't call someone else names if you're no smarter than a 4th grader.

    August 19, 2009 at 12:55 pm |
  4. John

    All this talk about tort reform is a pipe dream. Right now, the courts are the only way of keeping providers honest. I remember during the Reagan deregulation days that Republicans were saying that government had no business regulating business, that the real place to address these problems were the courts. Now, they want tort reform. If you limit damages, those funds will simply be put in the insurance company's pockets, rather than being passed on to the consumer. And incompetent doctors will have less reason to be careful.

    August 19, 2009 at 12:55 pm |
  5. Philip

    "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!"

    Excuse me, but how does that work? Are you saying they're only making a profit on American sales, and taking a loss on every foreign sale? Why would they do that? There's no reason to bother selling the drugs if they're taking a loss, so we must assume they're making a profit. And if they're making a profit THERE, then they can make the same profit HERE!

    Idiot.

    August 19, 2009 at 12:54 pm |
  6. indyreader

    Here's an irony for ya: The reactionary right (aka free-market fundamentalists, disproportionately the same ones who cling to their religion and other ephemera) are in fact trying to enforce a Darwinian-style evolution among the citizens of the US. The selective pressure is the maladaptive inaccessibility of health care, and the characteristic being selected against by this pressure is the condition of being poor – the lack of ability to pay for health care. Do they think that the poor will eventually disappear through not-quite-natural selection? They won't. Which should be obvious. But the free-market fundamentalists aren't trying to make things better.

    The progressives are, on the other hand, aiming towards making things better for the worst-off among us (even if the exact best way to do this isn't known yet, and even accepting that it will never be perfect), and of course we're therefore communists or something. There's got to be a pragmatically *better* medium in here somewhere, and if rolling my eyes every time someone calls us 'socialists' is the worst to be endured in finding it, that's fine with me.

    August 19, 2009 at 12:53 pm |
  7. sick of fake outrage

    Outraged Taxpayer says:

    "Where do you get the nerve to be the deicision (sic) 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?"

    Who are YOU kidding??? Who do you THINK makes the decision over what you "need" or "want" NOW? You and your doctor? PLEASE!!! The options given to you by your doctor are COMPLETELY CONTROLLED by what the insurance companies will allow.

    I am SICK TO DEATH of people like you pretending that what we have now is just fine. But it's very typical of your ilk, which can be summed up as "I got mine, screw everyone else." Yeah. YOUR EARNED INCOME. I guess everyone who isn't covered or can't get coverage is just earning Monopoly money as far as you are concerned!

    Someone please explain to me exactly HOW the free market system is going to EVER work for healthcare? What POSSIBLE incentive would any insurer EVER have to continue insurance for people with serious (expensive) health issues? Yeah. Let's not trust the government, because the insurance companies are going to "do the right thing" ROTFLMAO. At least with the government, we have some power to hold people accountable–we can vote them out of power. We have zip in terms of holding insurance companies accountable. But by all means, let's take what limited accountibility we do have with the government being involved, and scrap it, because everyone knows anything with the word "government" in it MUST BE BAD.

    Two words: GROW UP

    I hope all of you one day come face to face with the system you advocate: where you end up with something life threatening, and your precious free market, no government intervention health care solution DUMPS YOU LIKE TRASH because there is no market incentive NOT to.

    August 19, 2009 at 12:53 pm |
  8. Alyssa

    I wonder how many of these protesters have actually read the bill that they are screaming about. There are no "death panels" – that provision of the bill is to provide payments to doctors for end of life consultation. In other words, living wills, hospice care, available treatments, etc. They currently are not reimbursed for this service and should be because those that do have end of life counseling fair better than those that do not. Think about it – suicide is illegal, right? So why would there be a "death panel" provision?

    Rationing? Nope – MedPak was established by Republicans in 1997 to monitor Medicare costs. There is nothing in that provision about rationing of healthcare.

    The hypocrisy of the right is astounding.

    August 19, 2009 at 12:52 pm |
  9. Jim

    I am a doctor in private practice and few of my fellow heatlh care providers will state this: Until Americans realize the "insurance" companies are the biggest parasite on American humanity, any reform will have limited impact. Insurance companies siphon off nearly 40% of all healthcare dollars in this country. You have had insurance executives making fortunes for 150 years off the ignorance of Americans.

    When American finally realizes the insurance is the largest tick on our backside then perhaps we can move to eliminate a system that provides no benefit and exists as a truely parasitic institution.

    August 19, 2009 at 12:52 pm |
  10. Pete

    The simple fact is that those who are pushing for socialized healthcare distort the facts by mixing raw numbers and percentages.

    The facts:

    86% of Americans have health insurance

    14% of Americans do not have health insurance

    Of the 14% that do not have health insurance, a significant but difficult to quantify percentage choose not to have health insurance.

    Summary:

    86% Insured, 14% Not insured

    Approx. 300,000,000 Insured, 45,000,000 Not insured.

    The US healthcare system needs refinement, not reform.

    August 19, 2009 at 12:52 pm |
  11. mary-miami

    There are thousands of people working full time jobs at minimum wages who don't have the "benefit" of health insurance. There are others who cannot afford to have deductions for insurance taken from their paychecks, so they go without doctor's checkup. There are even more people who are unemployed through no fault of their own, and don't have the money to see a doctor if they have a need. There are others who have gone for years...without seeing a doctor, dentist, optometrist. We need free healthcare for all people not just a select few. For those lucky enough to have HMO, you are already selecting from a list anyway. For those with PPO, you are wealthy, because that insurance makes you pay first and then be re-embursed, so you have the money to pay it. The United States is the only industrialized country in the world to not offer it's citizens free healthcare, and it is a human right. As far as the argument of having to wait for treatment...better to know you will get help than never getting it.

    August 19, 2009 at 12:51 pm |
  12. Sgt.Serge

    SAD, SAD, SAD. Keep bashing Canadian Health Care without looking at facts. The world is wantching and laughing as you guys fight for scraps and toss mud at every other system.

    Take what is good from other systems and get rid of what does not, it is not black or white.......

    Please wake up people,

    August 19, 2009 at 12:51 pm |
  13. Allison

    If you all want news without spin, try PBS. They actually will discuss facts without yelling at each other like all the other news outlets, including this one.

    August 19, 2009 at 12:51 pm |
  14. Maurice

    A government option in our healthcare system can do for our country what regulating the industry has failed to do, create competition. In a capitalistic society where market forces are allowed to work, citizens in the United States will not pay more for medicines than Canadian and British citizens.

    If the profit margins aren't high enough, then let the global markets decide.

    August 19, 2009 at 12:50 pm |
  15. Tim

    What evidence is there that a public option would work and be solvent? Medicare, Medicade, Social Security? The U.S. Postal Service? All broke/insolvent; waiting to die.

    34% of all health-care related expenditures are already spent by the central gov't via Medicare. In doing so, they shortchange doctors and hospitals by 20-30% of what private insurers pay. In order to make up the shortfall and stay in business, doctors and hospitals charge higher rates for the privately insured. The central government's current involvement in the so-called health care system IS largely the problem.

    The federal gov't could NEVER be a legitimate "competitor". At the first sign of them "losing" they would raise the payroll tax, print or borrow more $$, or ration care–not exactly a fair competition and there's NEVER an incentive for the gov't to be efficient. Further, how does a so-called competitor also serve as referee? Imagine a boxer also filling the role of referee during his own fight. How STUPID is that?!

    Tort reform and allowing interstate competition are two EASY things we could do right now that would lower costs over time.

    Good article here:

    http://www.bloomberg.com/apps/news?pid=20601039&sid=aJ01reSCujDQ

    August 19, 2009 at 12:50 pm |
  16. Juanita-Ky

    If our health care system is better than UK and Canada, why do we have a higher infant mortality rate?

    August 19, 2009 at 12:49 pm |
  17. andrew

    Missouri has tort reform passed and on the books. Has there been any reduction in health care premiums there? I would guess that if there was real connection between tort reform and costs this would be reflected. Please point to data that shows this to be true or false. I'm just asking.

    August 19, 2009 at 12:49 pm |
  18. stan turecki

    Whats wrong with rationing healthcare?

    Is it really wrong to say we aren't going to throw money in a bottomless pit to extend the life by a few years of a 70 year old 3 pack a day smoker when that money could be used to provide preventative healthcare for a 1000 people and produce a much higher increase int he quality of life for many people? Or maybe use the funds to provide college educations for 50 students that cant afford university and as a result there is a much higher chance they will get good paying jobs and not need a public option?

    Rationing is about getting good value for your resources. Most people would call that being responsible.

    When you consider the 'what if it was you or your mother who was being denied treatment' then you are basing policy on a PERSONAL response. There is little room for such personal sentiments in public policy.

    August 19, 2009 at 12:49 pm |
  19. Deborah

    If you don't think health care is already rationed, then you probably haven't had to use your insurance for anything beyond routine matters. As someone who has had to fight for adequate treatment of a chronic condition, I'd much prefer that those decisions be make by doctors than insurance companies.

    August 19, 2009 at 12:49 pm |
  20. Jonesey

    I would wager that those who are the most outraged at the concept of a government option are those who already have health insurance. Even the pathetic Canadian who wrote earlier in this post (I am also a Canadian living in the U.S. with a healthy health insurance plan) who apparently doesn't understand the simply concept that ANY degree of health care is more humane than none. Shame on you for stomping on those less fortunate than yourself. In fact, I actually question that you are Canadian... as opposed to some right-wing nut planting propaganda... because Canadians are raised to be socially conscious. You are not.

    August 19, 2009 at 12:48 pm |
  21. Darrin

    As a trial attorney with international clientele, I can tell you that with international clients who have single-payer government health care, I cannot get the medical bills, and this greatly reduces the damages I can seek at trial. If there is no client liability for the medicals, and no subrogation claim by an insurer (like in the US), then there are no "recoverable" damages.
    If you like large jury awards in personal injury cases, then by all means, vote AGAINST health care reform. However, if you would like to see those awards reduced because there is only one payor for the medical claims, then we need to reform.

    August 19, 2009 at 12:48 pm |
  22. Don

    I am going blind. A new procedure could save my sight. It also might not work. Any possibility of success has a high value to me. The possibility of failure makes the value questionable to my insurance company and the government. Who should determine the value of my sight, and my quality of life?

    August 19, 2009 at 12:48 pm |
  23. HHH

    It is good to hear that there is a true prospective of the fight over private or public health care. There is this continuing arguement over how many uninsured there is in American 45 Million, 26 million or 15 million but it really dont and will not matter if there is a out break of some sort and I think everyone will wonder what our Government is doing and want them to do something. I think it is good that we finially have some officials who are finally be proactive and not reactive about every American citizen and not just those who are only willing to see there own point of veiw.

    August 19, 2009 at 12:47 pm |
  24. Mary, New York

    I wonder if all the government employes, Senators, and Congressmen are subject to "rationing" under their health care plans paid for by the American taxpayers. Every taxpayer already pays Medicare tax, but only seniors over 65 get to use it, and those seniors still have to pay a substantial amount out of pocket. Why can't all American taxpayers just be put into the existing government employees plan and instead of private insurance companies collecting the insurance premiums (and make a profit), the government plan collects lower "premiums" (without making a profit).

    August 19, 2009 at 12:47 pm |
  25. J.A.K.e

    For all those afraid of socialism o nthis issue... wake up, and get over yourselves!

    Inusrance itself is practically the DEFINITION OF SOCIALISM!!!

    it's the only way it CAN work. lots of people pay a similar amount so that if one person can't pay for an otherwise unaffordable treatment, or a car wreck, or whatever, they get the money from the collective masses. the gov't wants to tweak the system, but it's socialism either way, so stop acting like it's an evil word.

    August 19, 2009 at 12:46 pm |
  26. Joe

    Yes Medicare and Medicaid have helped many, but these are socialistic programs that monetarily have failed. They are broke, they are in the negative, they have a deficit. Social Security same scenario, post office same scenario, Amtrak same scenario. I don't care if it helps people in the short term, how do you pay for these things long term, no one can seem to answer that question. Right now you could take all the paychecks of every individual in the US and not begin to touch the debt. This is not sustainable. Read your histroy, Russai, the Romans, these policies will fail in the long term. You can argue all the good these programs will do, but if you can't pay for it how will it last. Print more money out of thin air, which in turn inflates the dollar and makes everything more expensive. People wake up, stop fighting amongst Republicans and Democrats, it is the same snake with two heads!

    August 19, 2009 at 12:45 pm |
  27. Peter

    I'm a recent college grad, so guess what, I dont' have health insurance. I have a job, but I'm not eligible for 6 months. Health Reform is the only way the next generation of leaders will be secure in their futures. Just because you have health insurance doesn't mean those who don't are "lazy, unemployed, no direction".-Total B.S. At least we finally have a president who can see the real issues and not just his fabrication of reality-(see Bush 1&2).

    August 19, 2009 at 12:44 pm |
  28. Cevin, WI

    The difference I see in how a government would ration care versus a private insurance company rationing care is how they decide how much money is in the kitty. A private insurance company balances this against profits. I would expect a government agency would balance this as part of the total budget. Social Security was supposed to be a stand-alone system, but Congress has been borrowing money to pay for other priorities for decades. Would my treatment be denied because Congress made the HHS cut money out of their budget to pay for another war? For fixing the Social Security program they borrowed from? For more subsidies for unproven/unprofitable technologies? For more bribes to N. Korea to settle down? For more Air Force jet's for congressmen to fly around on?

    Having to make triage decisions based on investor profits is bad enough. I'm not sure I trust what happens when Congress gets ahold of the money.

    You can call me paranoid or a fear-monger all you want. They borrowed from Social Security, and it was "protected". Now they keep telling us it's going broke and they may have to cut back on benefits or delay retirement age. What guarantees do I have that this won't be "protected" in the same way?

    August 19, 2009 at 12:44 pm |
  29. Jeff

    What pharmaceutical miracles? Drugs for erectile dysfunction? For restless leg syndrome? For the myriad of behavioral problems we have?For controlling your bladder? When was the last time you heard about a drug that actually CURED something instead of just treating a symptom? Because treating the symptom make you money for a long time...curing makes money ONCE. There will never be a cure for cancer unless it is developed in a university because there is not as much profit in the cure as in the treatment. Don't you people understand that the insurance companies are in business to MAKE MONEY not through an altruistic motive. Everything they do is by cost/benefit analysis and if that means denying a treatment form something that has proven effective but is expensive, they will. Insurance companies employ individuals whose only function is to look for reasons to DENY you coverage which makes good business sense. I'm not saying government run health care is great or even good, but we need to have a REAL dialogue about it without all the hysteria being bought and paid for by the insurance, pharma, and health care corporations.

    August 19, 2009 at 12:43 pm |
  30. Jessica

    Outraged Taxpayer "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?"

    So you, have no clue that currently its your INSURER who's deciding what's covered and whats not? do you really not realize that?

    "That dovetails into the third outrage which is the use of the phrase “the money we have.” “WE?” Are you kidding?"

    yes, COLLECTIVE WE – because when you pay an insurance premium, those dollars arent for YOU – they are for EVERYONE.
    So, step off your pedestal buddy and realize that YOU are not taking care of your OWN needs – otherwise YOU wouldnt NEED healthcare insurance...WE are all sharing the burden of the cost ALL OF US.

    August 19, 2009 at 12:43 pm |
  31. Personal Responsibility

    The real question is why 10% of American's have to pay 90% of the taxes, which will inevitably pay for all these uninsured. As one of those 10% I am tired of the constant urging of the 90% to put more burden on my back. One issue that many keep ignoring is that many who do not have health insurance could in fact afford to do so, but instead they have chose to make other financial decisions such as buy a better car or have more free money for their own discretionary spending. How many times have you seen an older but reliable Honda civic or some other inexpensive car with 20" rims on it (those rims probably cost $1,000 or more and thus could have paid for a significant amount of health insurance). People in this country make many irresponsible financial decisions in order to keep up with the Jones. These people made an irresponsible "rationing" decision. This type of fiscal irresponsibiltiy signficantly contributed to the current financial situation as well (for example, those who bought more house than they could afford because they assumed the value would just keep going up). It is time that people start taking some responsibility for their own actions in this country instead of constantly pointing to the government to solve their problems through higher taxes on the 10% that are pulling their weight.

    August 19, 2009 at 12:43 pm |
  32. diane butler

    The republicans are out to destroy the country. Most people in this
    country know that health car needs to be more accessible and affordable.The republican 's keep putting out false information about
    rationing, end of life "death squads" and long waiting periods to see
    doctors. I have watched almost all the town hall meetings shown on
    cnn. and it is obvious that some people are not thinking rationally
    because if they were some of the town hall meetings would not have
    been so emotional. Also why do people have to carry weapons to
    town hall meetings.?

    August 19, 2009 at 12:43 pm |
  33. Jon

    Tort reform should happen. There's no reason to have the lawsuits we have in this country. Although I think advocates should bear in mind that in states like Texas and California, where tort reform has taken place, it did not blunt the increases in medical costs, and insurance premiums remain high. Tort reform is essential to maintain a sane society, but the jury is out as to whether or not it will reduce health care costs.

    August 19, 2009 at 12:42 pm |
  34. Niki Mazur

    I understand that people are passionate about this issue, but I don't understand why people who claim to feel so passionately about health care reform don't take time out of their day to learn more about it. All of the politicians keep spouting off about how wonderful it is that the topic is being debated in the streets. It would be wonderful if the facts were debated, but so far, the lies have had center stage.
    As long as I am on my soapbox, I am also sick of hearing about tort reform. Medical malpractice suits are so expensive that 99.5% of lawyers won't touch a case unless someone died or was permanently injured due to a doctor's carelessness, and even then, it has to be proven that the care that the doctor gave the patient was way below the standard of care that an average doctor in the area would have given. If anyone else screws up royally and kills someone, we have no problem if that person is punished. I don't see why doctors should have it any differently.

    August 19, 2009 at 12:42 pm |
  35. Kevin Meyer

    "Paul August 19th, 2009 11:55 am ET

    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."

    Sounds like you should be a doctor since you know so much. "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 ", Well if you graduate with 30 in a class, that means there will be at least 15 in the 'lower half'. And I know that in my graudating class of 13, only one had a GPA lower than 3.2 and I do expect all of us to go out and make money because we do know alot more than the public does about their own health.

    Problem is, we have people that only want to see a doctor when they are sick. That's when costs go up up and up. People don't want to be pro-active in their own health. Drink a Big Gulp on the way to work, eat lunch at McDonald's, drink too much beer, etc. It's our own countries bad health that makes our healthcare so expensive. We spend the more money than any other country in healthcare, yet when we look at it we are the 43rd ranked country in actual health. 43rd in the world, yet we spend the most money. Where is the disconnect there? People don't want to do other things in their lives that promotes healthy living, see a chiropractor, see a nutritionist, see a massage therapist, acupuncturist, exercise trainer, etc. They don't do this because people don't understand healthy living. I understand there are certain genetic predispositions and I don't want you to think that I overlooked that in regards to my above statement.

    I could really care less about this health care reform, because people in this country will never take the initiative of living a healthy lifestyle anyways whether this is passed or not. I would rather have the reform not passed because I don't want to have to pay for some overweight person that has never done anything about their weight and lifestyle and I don't want to pay for their diabetes medications, cholesterol, high blood pressure, and who knows if there are any surgeries associated with that.

    August 19, 2009 at 12:42 pm |
  36. Doug

    A trillion dollars for public healthcare? Heck, we've spent that much on Bush's godforsaken war in Iraq and I haven't seen my taxes go up one penny.

    August 19, 2009 at 12:42 pm |
  37. Capt J

    Rationing as I understand it is the result of too few medical personnel to treat folks. Like adding 20-40 million people to be treated by same resources. What's happened is the system eventually becomes corrupt and care is rationed based on many tangible and intangible criteria (who you know). It not what procedure you may get it's whether you get treatment at all. The rationing your talking about is appropriate if managed fairly. Lastly, what it boils down to is how can we afford to give free healthcare to 20-40 million people and whether as a nation we want to do that. Far left liberals are dieing to do it while those on right can't figure out how to pay for it.

    August 19, 2009 at 12:42 pm |
  38. `Randy

    To outraged Taxpayer....
    where did you learn your math skills? If 85% of the US were without healthcare, the number would be 255,000,000 people. Either you don't know the population of the US or have no math skills, or maybe you are just a Republican...

    August 19, 2009 at 12:42 pm |
  39. a health economist

    Peoples' comments never cease to amaze me on this subject.

    Norm Chadwick, the 45 million figure includes foreign born individuals here LEGALLY as well as anyone without insurance at ANY point during the year (sometime called underinsured).

    Ian, differing prices in different areas for any good happen due to different preferences of individuals as well as any market barries preventing 'migration' of a good across borders. Without that just because something is more expense in one location doesn't mean it will be cheaper elsewhere. Take an economics class and learn something.

    wbn, costs are substantially higher in the US vs. the UK and Canada. Outcomes for many, many conditions (life expectancy, infant mortality rates, etc) are better in the UK and Canada. Approximately 78% of the UK and Canada are happy with their health care. US...58% Oh, and by the way, all forms of insurance are SOCIALISM because they involve transfering wealth from one to another from the premiums they pay. Other forms of socialism in our society are policy/fire departments, road ownership, and the military. None of these function on the Capitalism ownership principal. See my suggestion to Ian.

    August 19, 2009 at 12:41 pm |
  40. Jessica

    Just heard from a friend who works in a hospital, they are laying off 15 nurses (despite being swamped)...and yet, the hospital is losing money (probably because they are treating many uninsured and those who are insured might not be paying their part thats due)...

    but yeah, our current option is doing just fine!

    August 19, 2009 at 12:41 pm |
  41. Your stupidity won't rub off on me.....

    It's funny, conservatives believe in the "right to life" on abortion but believe in the priviledge of money to purchase health insurance. How hypocritical....
    It simply boils down to this and everyone should ask themselves this simple question:
    Should healthcare be a for-profite institution?
    If you answer no you must realize there is a price for this.
    If you answer yes, then you must not, ever, ever, complain about the cost of your health insurance plan, quality of service from your insurance provider, etc.
    The prof. astutely points out one of the great lies regarding this debate, rationing. Gee, I wonder, do I think an underwriter operating under the instructions of a greedy executive is going to approve this expenditure?
    But here's the other. These capitalist fundamentalists suggest that the free market needs to provide for competition and somehow this pertains to the insurance cos. Who cares about the insurance cos, they are not the CARE PROVIDERS. I want the choice to see any doctor I see fit, any specialist I see fit, any hospital I see fit. How many people currently have that choice? If you have an HMO, you sure as heck do not. If you give each citizen the ability to see any CARE PROVIDER they see fit, that introduces a tremendous amount of competition between doctors, hospitals, etc to provide the best care. You see, the truest free market scenario to improve CARE is to allow everyone to choose their CARE PROVIDERS based on whatever criteria they choose, not by who is in network or who the insurance company pressures their PCP into recommending for a specialist.
    Also, Repubs claim to be the party of small business? Oh yeah, right. The Repubs would love to do what has been done in my state by Mitt, mandate private insurance and watch your rates soar. I am not sure why it is that they believe employers should be responsible for health care.
    As for the socialist crap, I don't hear Repubs calling for the disbandment of our socialist military, socialist police force, socialist fire departments, socialist intelligence agencies, etc etc etc. I sure as heck wouldn't leave any of these services to the care of for-profit business (see Blackwater and the govt sponsored paramilitary force in Iraq and how irresponsible they have been...). Enough is enough.

    August 19, 2009 at 12:40 pm |
  42. indyreader

    Yes, rationing already happens. And it's perfectly fine with the fear/uncertainty/doubt-spreaders who are trying to derail healthcare reform, simply because that rationing is done by organizations with a profit motive, who are thus rightly worshiped as supreme free-market entities.

    This has been painfully obvious since the first ill-enunciated bleat of "death panels!" emanated from their ranks. I'm glad someone with the knowledge and background to put it all in perspective is speaking out and being heard.

    August 19, 2009 at 12:39 pm |
  43. John K.

    I work in a Kansas public health office and ALL OF US HERE think this is the most ridiculous debate EVER! We see everyday the need for "universal health care," and NO we don't care if people think it's socialist...it's needed! I've said it before and will say it again, these Nazi fearing, Death Panel believing, Socialism worrying people need to STOP LISTENING TO RUSH LIMBAUGH AND SARAH PALIN!!!! America already has socialized medicine, i.e., Medicare, Medicade, and the VA system. Health care rationing happens everyday in the public and private sector...insurance companies don't make $$$ by allowing every single treatment option out there. America already has some of the longest waits to see a doctor...unless you go to the ED. For example, recent article out stating that it takes approximately 63 DAYS to get into a primary care physician in the Boston area. Also, I don't care if it's 25 million or 45 million (Pres. Bush used 47 million...take that!); is it not right for the federal govt to want take care of America and Americans? If the federal govt doesn't take this on who will? Do you honestly believe Blue Cross or Kaiser or Cigna will volunteer to change their ways? I think Pres. Obama is doing what is right and just for America and for Americans!

    August 19, 2009 at 12:39 pm |
  44. an oncology nurse

    of course care is now rationed! I wonder how many people who say they like their private insurance policy have ever had a serious illness. The oncologists I have known all work long hours, trying to provide the best care for their patients. That includes trying to find funding to pay for new, expensive & beneficial treatments. Many ,many patients don't get optimal care because they cannot pay for it, whether they are insured or not, or whether they have public or private insurance. The cost of new medications is obscene.

    August 19, 2009 at 12:39 pm |
  45. Howard

    CNN, your title to this article certainly twists what he is saying which is basically that somone else "we" will be making those rationing decisions for you, "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."

    Who the heck is WE?? This guy, who compares making healthcare choices to going to the supermarket??

    August 19, 2009 at 12:39 pm |
  46. Matthew

    Ironically, rationing by insurance companies often loses them money. Here is one personal example, but there are many such examples. My daughter was born with a severe spine curvature. The braces she needed to wear were remarkable, but expensive ($5000). Our policy covered the cost of the braces, but not the cost of the VERY inexpensive adjustments (about $100) that the braces required every few months so that they fit properly as my daughter grew. So, we had the choice of spending $4900 in insurance company funds every six months (versus $100) or accepting poorer care / outcomes for our daughter because the rationing board had decided that brace adjustments were not fiscally advantageous (clearly a flawed decision for patients with infantile scoliosis).

    August 19, 2009 at 12:39 pm |
  47. Seth

    If some people are against public health care... because its socialist, then lets take away all the other socialist programs as well.

    No public schools
    No government funded universities (that do a HUGE amount of drug research and don't get squat for it)
    No airports (no airline has EVER made anywhere near a profit if they wouldn't have government funded airports)
    No interstates
    No social security
    No medicaid
    No fanny mae (Kiss 50% of home loans goodbye)
    No freddy mac (Kiss another 25% of home loans goodbye)
    No sally mae student loans (Oh look, there went most of your doctors)

    At that point, not only will our health care be worse than bulgaria, but the rest of our country would be worse than nigeria!

    While we're at it, why don't we get rid of public police, fire departments, road crews, and public utilities in many places of the country!

    Are you people THAT STUPID?

    August 19, 2009 at 12:39 pm |
  48. bob

    Although the good professor and the liberal newsperson site instances in today's' private healthcare system where they believe "rationing" takes place, there is no way any person who has more than a pea for a brain or who is looking for "free" healthcare paid for by real taxpayors, would want someone with a "postoffice","postal" mentality to be deciding any aspect of their healthcare!!!!

    August 19, 2009 at 12:39 pm |
  49. sean doyle

    Alex! I dont believe you are a doctor. I live in America but grew up in England. The doctors there are just as qualified as you. What arrogance!

    August 19, 2009 at 12:38 pm |
  50. paula bucari

    I have been a nurse for 36 years and have seen "bodies" kept alive when there is no hope of recovery. People subjected to the most horrible practice of being kept alive even as their bodies were desperately trying to die. People with skin sloughing off all over their bodies from poor circulation & inability to move,people from nursing homes brought in non responsive, totally contracted from non movement, to have a feeding tube changed because it was clogged -having to call a family member in another state for consent. Ninety+ year old having feeding tubes placed because "he's not eating". Two to 3 weeks is the average life expectancy after this procedure. AND IT IS PAINFUL! A 92 year old having a mammogram-why? And as a patient told me last week when I informed him that he could refuse continuing to have all the tests and procedures he was being subjected to he said "I don't?" Neither patients nor families are counseled on their rights of refusal, nor -in many cases- their actual recovery potential. The hospital doesn't want patients to die there, the surgeon wants you to "live" long enough so it doesn't affect his record. The bottom line is we are born and we die! Why must we be made to suffer at he end instead of going out with some dignity? Even convicted murderers are given an injection & put to sleep, whereas patients are frequently not kept comfortable near the end because we do not want to be seen as "causing" their death Why can't this country accept that death is ALWAYS part of life?

    August 19, 2009 at 12:38 pm |
  51. Chelle

    I am so tired of arrogant people saying "I've worked hard to get insurance, anyone who doesn't have it is just lazy" Newsflash – the only thing standing between you and no insurance is your job. You lose that you lose the ability to pay for insurance. You get sick – you lose your insurance. Stop stereotyping people without insurance into lazy people trying to milk the taxpayers.

    August 19, 2009 at 12:38 pm |
  52. KC

    Few months ago Dr. Gupta interviewed president Clinton and according to President Clinton US is subsidising drugs to Canada and other weathly nations. Why are we debating what Britain and Canada pays for drugs?

    August 19, 2009 at 12:38 pm |
  53. Bruce in VA

    As Obama would say, let me be clear...

    ...Of course there is rationing in private healthcare, but we have something like 1300 insurance companies from which to choose (exagerated in the sense that not all companies operate in all regions, but you get the idea). So if I don't like the way one insurance company "rations" (for example, I don't like their formulary), then I may have the option of another. That is, market forces will prevail. There is the Cadillac plan and the Chevy plan (at least I think we still have those two plans). Now since the public option is a pretext for a single payer system (for example, both Obama and Frank have said this when they inadvertently blurted out the truth), the lefties want to drive the 1300 insurance companies out of business, leaving us with one plan and no competition. Then, when we encounter rationing under that plan, we are SOL.

    August 19, 2009 at 12:38 pm |
  54. bill

    As several people noted below the comment about cheaper drugs is off base or at least needs more explanation – I would think that international drug companies balance their bottom line and that higher US prices would help alleviate lower prices mandated by national health plans i.e. Canada and the UK...so is it the case that Americans are to an extent subsidizing the rest of the world's health care (via paying higher drug prices leading to increased R&D efforts by drug companies to find more new drugs to sell to more Americans at higher prices)?

    August 19, 2009 at 12:38 pm |
  55. Ann

    My best friend just got her Medicare card. I'll get mine in two years. Since I have been helping my mother for the past ten years with her various illnesses – she's a vibrant 89, I believe I know a lot about Medicare. That card is worth more than a wheelbarrow full of gold. I no longer worry about getting old. Medicare doesn't just help the elderly, it provides jobs – and the motivation for people to become educated to fill those jobs. People don't be so afraid. Provide for all. The world will be a better place.

    August 19, 2009 at 12:37 pm |
  56. Jessica

    Ian "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!"

    actually, that's not correct. if you worked in a business where you set your own prices, you'd know this. I work in a sales office – you get to know your customer, and what they'd accept.

    If you know this customer is a stickler, we wont build much margin in...but if we know that customer doesnt question the charges, we make a bigger margin on it. Should they call us on it – we scramble, lower the rate and say "i just found a better supplier that can provide this for less"...even though thats not true, we just reduce our profits.

    They charge us more, because we are willing to pay more. PERIOD.

    See also the gas situation – when we were paying $4/gallon...poor nations were paying $1-2/gallon...why? because they couldnt and WOULDNT pay $4 a gallon...and why did our price fall? because we stopped paying $4 a gallon too.

    Is Exxon going broke now that WE arent paying $4/gallon – NO!

    August 19, 2009 at 12:37 pm |
  57. Ran

    So the answer is for experts working for the Government to make the tough decisions? Only after they add their own ridiculous infrastructure cost to their mediocre work ethic.

    And squeeze the pharma companies to charge less in the US because they charge less in the UK or Canada system? Remember there are many drugs that are cheaper here than over there. The people running pharms are at least as smart as college professors and bureaucrats.

    You can't design this on a napkin and use your weight in Congress to push it through. It doesn't work today because it is complicated, and adding fat to it won't make it better. Geez.

    August 19, 2009 at 12:37 pm |
  58. Wondering

    The whole problem is insurance which is a pyramid scheme. It only works to defer risk by having many pay in a small amount and only a few collecting. This make sense for car accidents and potentially for catastrophic care such as cancer, however, it does not make sense for standard health care. Health care costs even for standard procedures is expensive because there is a huge pool of money to pay for it without any market forces controlling the costs. The model doesn't work because everyone needs basic care. In addition, Americans are stuck on the entitlement bandwagon. They feel they are entitled to the best health care in the world and that there should be miracle cures. However the portion of the population who actually take responsibility for their own health by eating properly, exercising and not drinking or smoking is probably pretty small. True healthcare reform would eliminate insurance for basic care, we would all pay for that just like paying for car maintenance. Insurance would then be available for accidental injury (already is ADD) and catastrophic. These should require some requirement as to the person's risk factors such as smoking/drinking and obsity (similar to number of speeding tickets/accidents sets car insurance premiums). Allow market forces to adjust costs of basic services. Also please note, doctor does not mean GOD. All people eventually die, there is no known cure, so stop looking for it.

    August 19, 2009 at 12:37 pm |
  59. Rick

    I've decided the right path for me is to quit working, wait for the reform to pass and then get my free healthcare. I'm happy to give my job to someone who doesn't have one and still get healthcare. That way I can sit on a beach and relax, go to the doc when I need to and not work. You can pay for mine by working at my job. Afterall, that is what I'll be doing for the un-insured until I quit.

    45 mil minus people who prefer not to have insurance minus illegals minus people who get covered by some other government program leave the people I'm really sympathetic to...which, I believe is a much smaller # than 45 mil.

    August 19, 2009 at 12:36 pm |
  60. Ryan

    I think this is a good point. Give people on public assistance a standard of care, but they don't get the extras unless they pay for it. A perfect example, if you're on Medicare and pregnant – you get all of your appointments for prenatal care, and you go in to deliver the baby and the doctor will deliver the baby and make sure you and the baby are healthy, but you shouldn't get an epidural – that is an extra – it's not a necessity so why should our tax dollars pay for you to be "comfortable".

    August 19, 2009 at 12:34 pm |
  61. Pete

    Our health care is already rationed by private insurers – does the phrase "your insurance doesn't cover that" ring a bell to anyone? I have a great PPO, which lets me choose my doctors – but it doesn't let me choose what procedures they can perform under coverage, or what prescriptions I can have filled that is covered by my plan.

    I have 2 1/2 year old twins who both needed an immunization shot – one got rejected, one didn't, without any medical reason why. When we informed our insurer that we couldn't understand why one got rejected, they got un-rejected – which is good, I guess, but what logic is there for that other than "screw you, pay your bill and we'll reimburse you as little as possible"?

    Who do I trust MORE to look out for my interests – the US government or a private insurance company? Easy – the government. The insurers want profit (and get scads of it), the government just has an agency to run.

    Oh, and Ian, you nitwit – when the dude says "If the drug companies can sell them for less money across the border, they can sell them for less money here.” he isn't arguing against Euclidean math – your smug argument appears to be that if A < B, then A can't equal B.

    His argument is that if you are selling for $2/pill here and $1/pill there you can bet the farm that pill doesn't cost them over $1 to make, package, market and deliver – or they just wouldn't bother to sell those pills over there. So why aren't we getting $1/pill here, in the largest and most competitive pharma market in the world?

    August 19, 2009 at 12:34 pm |
  62. KingG

    I hear everyone wanting "affordable" healthcare? What is an affordable monthly price? As an example, I have requested a quote for a "catastrophic/High Deductible" healthcare plan for my family of 6. Price is quoted at $295/month. Affordable for me? Yes, if I make a minimum of $15/hour. Pennsylvania CHIP will cover my kids at that salary, so I only have to cover myself and wife. This seems affordable and protects me. I am not sure where the crisis is?

    August 19, 2009 at 12:34 pm |
  63. Jessica

    Norm Chadwick – and i can tell what side of the fence YOU are on.

    What's your point?

    What reason do you have to NOT believe that the 26 million figure isnt presented by the opposition, as a means of making people believe THERE ISNT A NEED (even though there is one)?

    Did you not consider that...or did you just assume that 26 million was a better number, because it supported your own beliefs?

    August 19, 2009 at 12:34 pm |
  64. Joe

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

    The 85% that are insured pay for the 15% who are uninsured. Why can't we understand that insuring all is more efficiant than insuring some.

    Remember, an ounce of prevention is worth a pound of cure!

    August 19, 2009 at 12:33 pm |
  65. Lou Allin

    Here's a Canadian speaking up. For $53 a month, I get medical care in British Columbia. The fee differs slightly from province to provice, but is overseen by the federal government to make sure standards are maintained.
    I see my doctor within a few days after asking, or immediately if it's an emergency. I have been referred to specialists, and yes, there is a wait....if the situation is not urgent. Otherwise you are fast tracked. I've had a mastectomy, chemo, and the best of care in Ontario and here on the coast. If you can't afford the $53, it is paid for you.
    No bills. No charging on Visa. No talk of pre-existing conditions. No losing the house or business.
    Are we taxed for this? Probably, but I'm satisfied and so are my fellow Canadians. We are not a "I've got mine. Too bad for you" society. We wouldn't trade this system for the world.

    August 19, 2009 at 12:33 pm |
  66. JimSouthFloridaLiberal

    Tort Reform? Wow. After ranting about how those who quote the official statistic of 45M uninsured you finish with the 'Tort Reform' topic? Thanks for defining hypocrisy to those who are not familiar with the term.

    What type of 'Tort Reform' would you propose? If a surgeon sews be up with a scalpel inside my stomach am I allowed to sue? If a physician molests my wife while she is anesthetized am I allowed to sue? If a physician mis-diagnoses my brain tumor as a headache and I die as a result, is my family not allowed to sue?

    'Tort Reform' is thrown out just as much as health care reform, but with even LESS detail. I keep seeing this comment which makes me believe you are being paid to publish it, so please prove me wrong. Explain how 'Tort Reform' will save our health care system, and how doctors' paying less in lawsuits will pass the savings on to the American people and magically cover those millions who are currently without insurance.

    I'll be checking back shorty for a response...

    August 19, 2009 at 12:33 pm |
  67. ACE

    Yes Medicare and Medicaid have helped many, but these are socialistic programs that monetarily have failed. They are broke, they are in the negative, they have a deficit. Social Security same scenario, post office same scenario, Amtrak same scenario. I don't care if it helps people in the short term, how do you pay for these things long term, no one can seem to answer that question. Right now you could take all the paychecks of every individual in the US and not begin to touch the debt. This is not sustainable. Read your histroy, Russai, the Romans, these policies will fail in the long term. You can argue all the good these programs will do, but if you can't pay for it how will it last. Print more money out of thin air, which in turn inflates the dollar and makes everything more expensive. People wake up, stop fighting amongst Republicans and Democrats, it is the same snake with two heads!

    August 19, 2009 at 12:33 pm |
  68. Claudette

    Barney Frank finally said what America was waiting to hear. For those who choose not to know the facts, but fight healthcare reform with hate, “Talking with you madam, is like taking to a table” was his appropriate response. This woman chose to toss the word nazi to the wrong man. Barney frank clearly knows that words have meanings. If you want to discuss healthcare, fine. If you want to cause disruption and speak hate, go way.

    August 19, 2009 at 12:32 pm |
  69. Thomas

    Before even thinking about heath care reform each person needs to ask themeselves whether or not our society has developed to a point where basic health care has become a right rather than privilege. We crossed that point with grade school education and working conditions and rarely is it argued today that our public school system (which requires i child be schooled) or federally mandated job safety guidelines are socialist. Some people argue they don't want to pay for another individuals "handout" but maybe that sick, uninsured person with an intelligent child doesn't want to be taxed to educate your less intelligent child. It could also be argued that federal wage and safety standards are bad for business since it cuts into overhead to keep you relatively safe and paid, yet most of us want these regulations. I can't argue the degree of correlation but these two socialist ideas seem to coincide with our national development. It is unrealistic to believe that a federal plan will be perfect since some kids still don't get taught and people still get cheated by employers. That said, I find it hard to argue government intervention made education and employemnt worse for America and Americans.

    August 19, 2009 at 12:32 pm |
  70. Alan

    George E Coles states: "This is just another uneducated guess at what will happen with Healthcare under the government option."

    You might not AGREE with his assessment, but I would hardly call the opinions of a Professor of Bioethics at Princeton "uneducated."

    Does ANYONE on these blogs understand NO overhaul of health care will be perfect? That no overhaul will include everything you want? That what we will have without it is something you definitely don't want? That it can be changed and modified later, to improve the system?

    Everybody sounds like little kids crying because they want a candy bar but it's got too many or too few nuts on it so they don't want it after all.

    August 19, 2009 at 12:31 pm |
  71. MikeWI

    I believe health care is rationed already because my mother has good insurance, or so she thought. When she needed a biopsy done, her insurance company told her they wouldn’t cover the doctors recommended way, which was to use Laparoscopy (introduced in the 1970s). Instead, her insurance company would only cover having the procedure done the “traditional way” which was to spread her chest opened and gutted her like a fish. This would have taken weeks, if not months of recovery time. The Laparoscopy procedure took about a half an hour and cost her approximately $10,000, which she has no means of paying back. After having the biopsy, they discovered it was cancer. This week she finally started chemotherapy after being bullied around by the insurance company to have it done their way. Insurance companies only have you in mind when they gain record profits and you go bankrupt. So yes, healthcare is already rationed in order for insurance companies to have record profits.

    August 19, 2009 at 12:31 pm |
  72. G. Clare

    A couple of errors: The difference between US and other countries is that in those countries, the government will "fund" (not reimburse) medicines/treatments. If a drug gets approved based on efficacy/safety in those countries, then the government determines whether it will be funded or not. So, if drugs have comparable efficacy and safety for respective diseases, and the government has one bucket of money they have one simple choice: they can use the bucket to treat 15 million type 2 diabetics OR 1 million cancer patients. They almost always will fund the diabetics. I know this for a fact as I have battled funding institutions in other countries on behalf of patients needing access to truly life-saving medicine. That is NOT the case in the US. First, one insurance company may reimburse when another doesn't; an insurance company generally will reimburse (it may not be a lot but they will) if the efficacy is proven and its better than existing treatments. They do not evaluate treaments based on comparing one group of patients versus another as the government and public health systems do. Pete Singer and all the others comparing our system with others really better do their homework on how these things are done. There are certain benefits of the other systems for sure, but not enough to try to duplicate the whole system. Given the US is one of the most innovative countries EVER - the 'brains' in congress should get a legitimate task force together to not REFORM our system but to fix the gaps and make better what in essence works. They have no idea in truth how the systems in other countries work at the very down-to-earth, individual patient needs basis. The "47" million uninsured and those who want improved health insurance systems deserve better than the 'either-or' approach congress seems to want to ram down peoples' throats.

    August 19, 2009 at 12:31 pm |
  73. Sarah Raz

    I live in Israel where we get free health care and I and most Israelis have no problem with the ultra-generous 'rationing' we have here.

    Let's take the rationing for IVF.

    Unlimited free IVF treatments for the first two children and up to seven attempts per subsequent child. Our co-pay for medication each cycle is $43.

    For donor eggs we are limited to up to $10,000 payment for the donor whether in Israel or abroad each treatment.

    Besides the most fantastic free at the point of receipt health care in the world, I pay an additional approximately $90 each month to be able to enjoy major surgery or treatment anywhere in the world should i become seriously ill. I would also get up to six months of nursing and a large cash benefit if I needed an organ transplant or cancer treatment.

    All in all, Israel's health care is extremely comnprehensive and almost every Israeli Arab and Jew raves about our healthcare system. I am MORE than satisfied with it! It is literally the most comforting thing in the world to know that if sick I'll be cared for at the highest standards at no cost to me.

    August 19, 2009 at 12:30 pm |
  74. Bill

    Outraged taxpayer-What good are "pharmaceutical Miracles" if you cannot afford them? Why should we pay more for medicine supplied to other parts of the world at a cheaper price just because of the health system we have. I understand supply and demand but for our population to allow this is just stupid. Pharmaceutical companies are essentially telling us, we are charging you these prices because we can. By the way, every state already has programs for the most needy in their state. It's called Medicaid and your already paying for it. What we are talking about is the rest of the people who do not qualify for these programs but cannot afford individual plans because of rising prices, so these "miracles" really don't matter. Finally, 45 million is not 85% of the population.

    August 19, 2009 at 12:30 pm |
  75. Hello!!

    Rationing is already here. Several years ago I needed orthodics for my shoes and my insurance company paid them in full. LAst yeat, my tennage daughter needed them and the same insurance company that paid for mine (under the same employer) didn't pay one cent. In addition, our deductible doubled this year even though we get less from them.

    For those of you who think that your company pays so its no big deal, understand that if the company has to pay larger percentages for health care, that dips into any money they have for raises or bonuses.

    August 19, 2009 at 12:30 pm |
  76. Common Sense

    It amazes me that so many people are so misguided, taking little sound bites for facts. If you don't understand that insurance companies pay a lot of money to circulate disinformation, just do a little resaerch – you are obviously near a computer.

    Our current system is BROKEN. The US Helathcare system is ranked #37 out of all countries by the World Health Organization. We are one ranking above Slovenia – SLOVANIA PEOPLE. (look for yourself if you don't believe me or trust the WHO) So don't beleive it when a politician says the US healthcare system is the best – they are simply playing to your sense of pride. It's ok to acknowledge that our system needs help – republicains agree, hospitals agree, doctors agree – even the insurance companies agree and they stand to lose a lot of money.

    Second, why is everyone so outraged that the public option would include practices that EVERY OTHER insurance company does? This is nothing new – your insurance company will not pay for a procedure or medicine if there is no scientific research to prove that it will work. They often deny procedures even when their is proof that it will work becuase it is too expensive. If you don't understand this, you need to educate yourself.

    Lastly, I don't understand why anyone is OK with paying more for medicine when other countries don't. The argument that we have to pay for R&D is outragoues – why do we have to pay? Make the other countries pay for it and give us the discount.

    August 19, 2009 at 12:30 pm |
  77. SCOTT O'CANADA

    I haven't seen this much debate in the U.S. since the great "fork vs. spoon" Chunky Soup commercials appeared. My uneducated and unsolicited advise is look at the numerous variations of health care systems throughout the world, look at what seems to be working, what doesn't, and create your own American hybrid. To those of you contesting health care reform without a public option, don't use a fork.
    You might hurt yourselves.

    August 19, 2009 at 12:29 pm |
  78. Grant

    Ian, who's the idiot? Might want to face a mirror.
    Price is determined by supply and demand, any first year business student learns that. They aren't going to sell to anybody at a loss and hope that some other suckers take up the slack like you suggest. That is called a "loss leader" and is a strategy used to entice you in the door so they can sell you other items/services.

    They charge what they charge here because they can. End of story.

    August 19, 2009 at 12:29 pm |
  79. Mike

    Well, if we already have rationing then why make a change. It's just a matter of who rations it. The point is rationing will be worse under gov't controlled health care. One of Obozo's top advisors on this subject has written that people under 15 and over 50 that are not "contributing" to society because of medical problems from disease, birth defect, etc. should be denied care. In other words terminated. Does any health insurance company sponsor that kind of
    barbarity now?

    Drugs are expensive because of all the R&D the companies have to spend to develop a safe drug. This stuff is not difficult and is just common sense. If you're a capitalist.

    August 19, 2009 at 12:28 pm |
  80. John in Michigan

    We would not need the government to reform healthcare if it wasn't for the greed of corporate America. Seems employers no longer want to offer healthcare as a benefit anymore. Insurance companies want a piece of the pie to make big money as do the healthcare providers and big drug manufacturers. And it is all at OUR expense. The high cost of healthcare keeps many from being able to get it. I tried shopping around for a decent plan that meets my needs and it would take over half my weekly pay check to get even the the slimmest of plans. The costs are unreasonable of out of touch with the wages that many make. This is why healthcare reform is needed. The corporates out there won't police themselves, and they are all out to make big money for themselves while a good many people suffer.

    August 19, 2009 at 12:27 pm |
  81. tim

    Have Prof. Singer ever been subjected to the rationed health care that he does not like. I do, not the kind of rationed carehe talked about here. Go to Hong Kong, where the government is a lot richer than US government. Most people have to wait more than 6 months to see a specialists in the "public optoon". For US with that huge deficit, probably we will nee to wait a year. Prof. Singer had not been in such situation, but I did. Tgat is why he is now talking nonsense that he does not know about and he did not experience it himself yet. All is garbage.

    August 19, 2009 at 12:26 pm |
  82. Michael D

    @John Dolan: "Tort reform is a red herring as malpractice costs constitute about 2% of total healthcare expenditures."

    There are general surgeons in Florida who pay $175,000 a year in malpractice premiums alone. That cost is passed on to patients. The real cost isn't in the actual lawsuits but in the 'defensive medicine' that doctor's now practice in order to avoid lawsuits, where they check off every test on the books so they can't be sued for not trying.

    Health and Human Services (HHS) 2002 report: "Defensive medicine that is caused by unlimited and unpredictable liability awards not only increases patients’ risk but it also adds costs. The leading study estimates that limiting unreasonable awards for non-economic damages could reduce health care costs by 5-9% without adversely affecting quality of care. This would save $60-108 billion in health care costs each year. These savings would lower the cost of health insurance and permit an additional 2.4-4.3 million Americans to obtain insurance."

    August 19, 2009 at 12:26 pm |
  83. Adam

    Tort reform needs to be a part of this. You cannot look solely at malpractice costs because they grossly underestimate the actual cost. Specifically, it does not account for the testing, medications, etc., that is not likely to benefit the patient but is done when providers practice "defensive medicine" to prevent getting sued.

    August 19, 2009 at 12:26 pm |
  84. jpw

    The health insurance industry brought this on themselves.Look at the terribly excessive amounts of money the health insurance executives are putting in their pockets every day by overpricing the premiums to their policy holders, and preventing a person from changing policies because of pre-existing conditions.

    What we need is a single-payer system to run these guys completely out of business. A public option is better than nothing.

    August 19, 2009 at 12:25 pm |
  85. Michael Bartosiak

    Why is the right wing being viewed as the problem here in many of these comments? The dems have the majority in the house and the senate. They are in complete control. More likely the issue is that properly addressing health care reform with adequate research and a well thought out plan rather than the shot gun approach to lets fix the problem now is the real issue. America can't keep writting blank checks to solve everyone's problems. We have to be smart about how large sums of government funds are sent. If they can't even estimate the true number of people that are uninsured, how can we trust that their estimated costs of this program are realistic? This plan if not well thought out could bankrupt America. Who wants to live in a country where the current and the future generations have to shell out 50% or more of their wages to fund this program because the cost estimates are low?

    August 19, 2009 at 12:25 pm |
  86. paul coke

    I've worked in Medi-Call for almost 27 years, and Mr. Roberts is correct that ration goes on all the time. The 46 million can be reduce by first identifying those who are eligible for medicate and direct them for coverage, have universal coverage for those who can't affort health care coverage and reduce usage of emergancy room service, by law, have to see each patient regardless. We as a society should think in terms of providing health care, preventative care and wellness rather think in narrow constructs. Most americans who have health care like their coverage until they have to use it, and than they find the shocking details of rationed care, or denial because of some stupid reason, or jumping through loop holes to get coverage. Those who argue about social issues are single minded zealots who believe in their dogma and manifest their general haterate at anything that smells like social change or improving the quality of life. Why do we spend more on health care and still rank one of the lowest in quality of care? think about the cost of doing nothing?

    August 19, 2009 at 12:25 pm |
  87. JMBarrett in No Prov RI

    In these town meetings, those with insurance should stand on one side, and those without on the other. When you face your neighbor, whose company doesn't offer health coverage, or you learn your neighbor can't afford it or is disqualified because of pre-existing conditions, when you face him, know him, and listen to his concerns, perhaps you can then understand the unfairness of it all. So many people are out of work...more than a million have lost jobs. Add those to the list of uninsured. They're losing cars, homes, everything, and God forbid they should get sick. But if they do, those of us WITH health care are paying for them every time they enter an emergency room anyway, through our ever-rising premiums. I have health care. I'm willing to pay more in taxes so that my friends and neighbors whose companies don't offer health care can have access to coverage, whether it's a private plan or a government funded plan. And I think that everyone should be entitled to the exact coverage of their neighbor....no "Delux" packages for company CEOs that cost upwards of $70,000 a year that they, themselves, don't have to pay for...it's a company perk. And yes, force pharmaceuticals to lower drug costs. One drug I take costs my insurer more than $1400 a month. No wonder my premiums are so high!

    August 19, 2009 at 12:25 pm |
  88. Rich Campbell

    I've worked in the healthcare field for over 20 years and can tell you if you don't place limits on physicians treatment options we will never control cost. The cost/benefit structure doesn't apply when procedures are done out of curiosity verses medically necessary for the patients health. Cost control should trump all else in the healthcare debate.

    August 19, 2009 at 12:23 pm |
  89. NE

    His comments omit two critical elements:

    1. One reason (not the only one, mind you) that drugs in the US are more expensive is that the FDA approval process is much more stringent than in Europe. Most drugs have been available in Europe for years prior to release in America. In order to bring a drug to market, a pharm company will likely spend tens to hundreds of millions of dollars in research and testing. That has to be recouped somewhere.

    2. As an MD, the biggest waste that I see is in the procedures that have a low chance of success, but if successful can dramatically improve a pt's life. Extreme example (but not too uncommon) a lifesaving surgery for a near dead patient. If someone tells a family that a member is near death and will likely die, but a given procedure could be used with a slim chance that it would change anything (but possible), what will most families do? There are no guidelines or "evidence" to tell us what to do in an individual patient's case. We are faced with making calculated guesses everyday. From a societal standpoint, these "heroic" measures are expensive and offer no benefit. Yet from the individual's perspective, it could offer a dramatic benefit. Further, if we fail to offer such treatment, we are faced with potential litigation.

    If we are to decrease health care costs, then we will clearly have to start "playing the odds." That is, we will undoubtedly have to start using only treatments that show clear benefits and reduce the treatments that show benefit only in a handful of situations. Most MDs would be fine with this plan, but the public has to accept such a philosophy and the MDs can't be held responsible for not offering a low-benefit treatment.

    August 19, 2009 at 12:23 pm |
  90. julie

    Sorry Ron – when I call for a doctors appt, I usually can get in the same day or the next. If it's urgent, my doc will tell me to come in right away. Cannot say I ever wait longer than 1-2 days for an appointment (except when I schedule a checkup – and I call to schedule it weeks ahead of time). So if other countries have to wait longer than a day or two to get in to see their doc, than that would be longer than I have to wait.

    August 19, 2009 at 12:22 pm |
  91. Little Hawk

    Long story short – my doctor wanted an MRI of my neck but said the insurance company will require a catscan first which the doctor said would be inconclusive. The doctor requested the MRI, the insurance company denied it, the doctor requested a catscan, the insurance company approved it, it was inconclusive, the doctor requested an MRI, the insurance company approved it, the doctor found out I had spinal stenosis. Result – an unnecessary catscan, 2 months of additional pain and suffering before a conclusive prognosis provided the correct course of treatment. Bottom line – our current health system is broken.

    August 19, 2009 at 12:22 pm |
  92. Greg

    Now a word from a Canadian who has lived in the US. True, we have the most expensive, worst delivered public health care, compared to other countries, but that is a political issue and hopefully resolved soon. Problem is, health care is a sacred cow and any attempt to modify it or how it is delivered (i.e Swiss system that contracts suppliers with public money and is more efficient overall) lead to outrage as you are seeing now, with calls that it will result in an "American style" system. Hyperbole on both sides of the border. Fact is, health care here, for the most part is just fine. Less MRI's etc, just because they are not required, but are available if you want to pay for it yourself. My wife had breast cancer and total time from seeing the family doctor to surgery (after considerable diagnostic testing) was about 3 months and could have been sooner, but she had some other issues to deal with as well. Cost to us – zero. I can call my family doctor and get in in one or two days or same day if urgent or use emergency facilities. Again, cost zero. There are NOT hundreds or thousands of people here "lying in the streets" for want of medical care, but maybe that is not the case south of the border. Just need to decide that you prefer all to be taken care of and not just the few who can afford it (and who subsequently may be denied coverage leaving them in a big financial hole or bankrupt). This is no way to run 'the best country on earth". The solution may be to cap liability for doctors – to quote Shakespear "first, we kill all the lawyers".

    August 19, 2009 at 12:22 pm |
  93. Dena

    Healthcare in this country is rationed daily by insurance companies. I have had care refused or denied by my insurance company twice. Long waits exist at MD's offices. When I changed insurance companies due to a change in my job, I was required to wait 3 months for a "new patient" appointment at my new MD's office which was required by the insurance company because my previous MD was not "in network". Yes, I could continue to see my MD instead of changing but the insurance company would not pay for it and if I was to need to be hospitalized by this MD, the insurance company would only reimburse the hospital at 60% and the doctor not at all. Now please understand, this was all taking place while I was one of the insured persons in America. It make me insance to hear the pundits talk about how wonderful the healthcare system America has is. We rank below most European nations statistic wise as far as longevity survival rates. Our obesity statistics are ridiculous. We rank with third world countries when it comes to maternal-newborn survival rates. Now this is coming from a nation that loves to pride itself on their "technological advances". Yeah, we might have the best technology in the world but we are not saving or improving lives as a result. In this country, if you don't have or can't afford a primary care MD or you can't get an appointment with said MD, you are referred by his/her office to the ER where, depending on your condition, YOU WILL WAIT SEVERAL HOURS to be see by a doctor. But the critics keep saying over and over that Americans don't have rationed healthcare, they don't wait in this country to see their MD, they have the best healthcare in the world.

    Yeah, right!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    August 19, 2009 at 12:21 pm |
  94. David

    I'm more concerned that a public/government run health insurance system will NOT have rationing. Costs will be huge if there is no cost/benefit analysis applied to various treatments. Down the road I can see people claiming a "constitutional right" to some unproven treatment and the Supreme Court agreeing with them. People hate health insurance companies, but they are trying to control costs by "rationing" treatments.

    August 19, 2009 at 12:21 pm |
  95. Katsky

    To those saying they don't want Canada and the UK's systems – that's grand. Because it is not under serious consideration here. The plans in the works would subsidize insurance for people who can't afford it and would provide a public option (similar to Medicare) for people to choose if they want it. Insurance company profits are outrageous. If the government starts paying for people's premiums, what is to stop the insurance companies from raising the premiums even faster to absolutely exorbitant rates? A public option to compete with – that's what. Singl;e payer isn't on the table here, so you are really wasting your breath by railing against it.

    August 19, 2009 at 12:21 pm |
  96. CAA

    "'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! "

    No, drug companies DO NOT sell them for less overseas because they sell them for more here. Each of those drug companies makes billions of dollars per year in net profit for their products; billions of dollars over and above the cost of developing them (check out the drug companies spread sheets and net worth-it's an education!). Add in the relative long time they own the patents before the drugs are eligible to be produced as generics and you're looking at profit potential approaching our national debt.
    We've been a nation of "profit at all costs" for all business, and now the costs have caught up with us. Basic health care keeps a population healthy enough to work and be productive, and thereby adding to the growth of the country. It's that simple. The panel discussing "rationing" by insurance companies is totally right. I've struggled with chronic illness for most of the last twenty years. My insurance company will pay to have my knee replaced, but won't cover the cost of one visit per week for physical therapy to keep my real knee functioning. THAT"S why we need reform.

    August 19, 2009 at 12:21 pm |
  97. JCM

    On a second, and separate note: my current employer is switching from a no-deductible plan to a high deductible plan this year. I will go from paying $20 to see a doctor and $10 for generic anti-biotics to paying $150 to see the doctor and $36 for generic anti-biotics all for the exact same premium. My employer says that otherwise our rates will go up. I'd rather pay a higher rate than have to pay the first $5000 out of pocket and STILL pay the monthly premium. At this rate, my annual insurance cost me about $1300 and saved me $900, so they made $400. Next year for the same health care it will cost me $1300 and save me zero, they'd make 1300. I'd be better off with public insurance or no insurance than that. By the way, Thanks Health America for your high deductible plans and thanks Aetna for your reluctance to pay in-network providers for making this post possible.

    August 19, 2009 at 12:21 pm |
  98. Jonny

    Exactly, rationing goes on now, so it is a lie by the president to say it won't happen with a government option. THe difference is now, it is determined by what you are willing to pay as opposed to the government deciding what care you can get. No reasonably intelligent person can believe Obama when he says there will not be rationing (or that it will cost nothing because of the savings).

    I love how this professer just completely called the president a liar and half the people don't even realize it!

    August 19, 2009 at 12:21 pm |
  99. JOHN

    RON ,,,,DUH ...they ussually call them emergency rooms , You normal Practiciner FAMILY DOCTOR will not take you on a Emergnecy.
    When I or our family gets sick we go to a WALK-IN or after hours a Emergency room.....NEVER DENIED ..if NO INSURANCE ...then you talk to them and you make payments.......if it is $100 a month for payments ...GET RID OF YOUR STUPID CELL PHONE .......duh

    August 19, 2009 at 12:20 pm |
  100. Greg

    Good to see that someone recognizes rationing currently exists, but let's take the source(s) of rationing further:
    1) If you can't afford the premiums or emergency medical care, you are rationed out of the system
    2) Insurance companies impose life time caps on what they will pay for an insured individual or family. So, if you have cancer or MS, you are likely to run up against the cap in your lifetime. Then, you will be cut off from your insurance.
    3) If you have a prior existing condition, you cannot get insurance. If you do, when it comes time to get treatment, insurance companies will practice what is called recission, which is they will take away your coverage and deny the benefits even though you have been paying and they have had access to your medical history all along.
    4) Finally, insurance companies are for profit. If they think a less costly treatment exists, they will only approve the less costly treatment. If they think a treatment is unproven, they won't approve it.

    Now, to Mr. Norm Chadwick. You say the 46 million is hotly contested. The only people really contesting it are those representing the status quo. Let me ask you, if not for Medicare, how many senior citizens would have health insurance? How would they get it? They are not employed any more. So, is it safe to say the 36 million on Medicare would not have health insurance if not for Medicare (most of those with supplemental choose Medicare Part B rather than a strictly private option)? Also, we have Medicaid, which is available only to those below the poverty line or who are handicapped. Medicaid also has 35 million enrollees. So Medicare and Medicaid together have 71 million enrollees. So, even if I take your 26 million number, if it were not for government sponsored health care, we would really be at 97 million without health insurance. That, my friend, is one third of this great nation.

    Do you really want to argue 26 million versus 46 now? REALLY?

    August 19, 2009 at 12:20 pm |
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