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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.”

Prof. Peter Singer says rationing is already happening in private health insurance companies.

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. Tesseract

    Um, Does anyone know the profit margins for each insurance company and each drug manufacture?
    I want real hard numbers here.
    I can apply imagination base on my personal research and experiences.
    I image it's a staggeringly large number.
    I image their lobbying expense is equally staggering though more then likely a drop in the hurricane of profit.
    I think that if you make a profit off of human illness that sick humans are a commodity.
    Don't you think that privately run NON-PROFIT ORGANIZATIONS which are design to self sustain but not make a profit from such a horrible source might a good solution?

    August 19, 2009 at 1:34 pm |
  2. M Rodriguez

    I have been doing lots of research and readings on the healthcare reform. I am also preparing to enter the medical field as a physical therapist. I have worked with many patients in several settings. I have seen many exceptional treatments redefine medicine. My concern of rationing is the effect it will have on research and development. If health care is only going to pay for known methodologies doctors are going to be less inclined to find newer better treatments. Universities will probably continue to do research but doctors are not going to be able to use them. The acceptance of new treatments will be greatly slowed down. How is this going to keep the united States the leader of medical technology?

    August 19, 2009 at 1:34 pm |
  3. Michael

    To those people who say the Constitution doesn't say anything about giving health care to people... If I can remember it doesn't say anything about having the right to clean water and having clean vegetables to protect against diseases.... The constitution can't cover everything that is why we have amended the constitution over time...Its always funny how people don't like the government but when something happens they cry out to the government for help.... These people who don't like the government then back it up and don't take Social Security or Medicare when you are old enough to get it... then you have somewhere to stand on your opinions....

    August 19, 2009 at 1:31 pm |
  4. Craig

    The debate continues, and there is really no good or right answer. Funding a government plan for a country of 300 million is going to be expensive, even covering the 25-45 million disputed uninsured is bound to be costly. The current system dosen't work, just ask a health care professional, (i have two in my family) Unnecessary tests are run routinely, patients stay in hospitals longer then need be and so on. But ask youself this, do you want all Americans to be covered, to possibly be healthier in a generation? If so the government plan can work, But, as this article is about rationing, we will have to ration our scarce resources, what gets cut from the budget, that is for the voters to decide (military, infrastrucure, education) all will be weighed. Its not about adding to the budget, but deciding what we spend the scarce tax dollars on.

    August 19, 2009 at 1:31 pm |
  5. Forest Gump

    Try this, lazy Americans, start eating the correct foods and exercise. Stop being Greedy (I mean reduce the size of your food portions) Lose some weight!!!

    Maybe your health will improve. Maybe you won't have to worry about poisoning your body the toxic waste better known as medication. Maybe you won't have to worry about how much health care cost.

    The cost of health care might be cheaper if there is less of a demand. In case you haven't noticed, there are so many people that were over weight, as soon as they lost the weight they also lost their health problems or atleast the majority of them.

    If you really want to do your part LOSE WEIGHT!!!

    August 19, 2009 at 1:31 pm |
  6. Nonsense

    No, NIck, what everyone is saying is – the rationing argument is bogus. It's not an argument. there's rationing now and those making an issue of it are implying there's not – to sway people. we're saying – stop trying to fool us with that argument.

    that said, yes, there will always be some form of rationing, just like there is all forms of rationing at your house – when you have to decide what you can afford and what you can't, a salary you negotiate at a new job, some compromise you make with your family... it's the nature of existing. let's just get everyone on an equal playing field. there's something reprehensible about keeping only those people who can afford it healthy and alive. some day, YOU may be the one laid off.

    August 19, 2009 at 1:31 pm |
  7. lmh

    Has it not occurred to these people that using "unproven" treatments contributes to our knowledge and helps improve and build on our treatment options. If my uncle had not agreed to experimental treatments for Hodgkins Disease many decades ago, there would not be a 90% cure rate now.

    August 19, 2009 at 1:30 pm |
  8. Jeff

    Despite what some some conservatives say, studies looking at the impact of tort reform has shown that it accounts for less than 1% of medical spending. This includes not just the cost of lawsuits but also the impact of resulting defensive medicine.

    Tort Reform is not the answer – it is just one more way that people have tried to distract from the real issues.

    August 19, 2009 at 1:30 pm |
  9. Todd Wheeler

    We will only have our fellow liberals to blame if a national health care plan isn't voted into law. WE control the legislative and executive branches of the government, and we don't need a single Republican vote. Therefore, we must stand united in this, or become our own worst enemies.

    August 19, 2009 at 1:30 pm |
  10. Peggy

    Honestly, I don't like the way my insurance company tells my Doctor what he can prescribe for me or that his or her diagnosis is wrong, or that because I was diagnosed with an illness that I may have had for years and didn't know, is a preexisting condition. We just need an overhaul on what the insurance companies are allowed to screw us and our healthcare professionals on. By the time my Dr gets paid, what the insurance company allows him to charge, there sure isn't much left to pay the people who work in his office.

    August 19, 2009 at 1:30 pm |
  11. Douglas

    And so its not OK for our government to negotiate with druggies, but it remains OK for Canada, the UK, Japan, Germany, France, Antigua, Bosnia ... ?

    Lets level the playing field between US insured's and the rest of the world.

    Further moose my own insurance has been saying no to treatments, or making me pay more more more and covering less since 1980.

    and if you think you won't fall prey to "recission" (being dropped unceremoniously) ... dream on..

    BTW its is looking as though we'll just go ahead and pass the bills
    using "reconciliation" – we tried to work with you, but we're perfectly willing to do it without you ;-p

    August 19, 2009 at 1:29 pm |
  12. Leviathon

    Ian, the reason pharmaceutical companies sell cheaper accross the border is because governments there impose restrictions on how much they can charge for medecine. If they don't abide by those regulations, they can't sell in those markets. In this country no such price regulations exist, so they can charge as they please.

    August 19, 2009 at 1:29 pm |
  13. Dean

    As a Canadian I simply cannot understand how the cost of NOT having a health care plan isn't being defined. Its this belief, that the insurance companies can drive cost down that is astonishing. If the hospitals and doctors drive the costs up, the more money is needed by the insurance company to cover cost – the more money required drives premiums up- more money in the pool the more money made by the insurance company. There are no checks and balances. If you changed the view of the health care dollars spent in the US is a tax on the healthy, opinions would certainly change about the value equation you have in the current system.

    August 19, 2009 at 1:29 pm |
  14. Personal Responsibility

    Health Economist:

    You make a good point and I certainly don't disagree in principle. Also, I am not heartless, I agree that we should provide "emergency" treatment to all when necessary and I acknowledge that many poor people do not make bad decisions but just can't afford insurance. However, we are not merely talking about emergency care here. We are talking about general coverage that will provide them full health care. Moreover, my understanding that those who are too poor to afford any insurance get Medicaid and Medicare, which would pay the bill and yes I do, like all taxpayers, pay for that. It is those who make "too much" money to qualify for these programs that my comments are directed.

    In addition, I find interesting another poster's suggestion that we should tax unhealthy behavior to pay for health costs. That might be a better solution. If you are too poor to afford health insurance (below the medicare/medicaid threshold for example) and you live a healthy lifestyle than you will essentially be treated free of any cost in emergency situations. However, if you drink excessively, smoke, eat a lot of fast food, etc., you will be charged a tax and will indirectly pay for at least some of your own care.

    What I don't want is to create more opportunity and justification for the federal government to reach even further into my pocket.

    August 19, 2009 at 1:28 pm |
  15. maxtoo

    It's great if you've got health insurance: up to a point. At the current rate of increase, companies will not be able to insure employees in a few years. Nothing is FREE – wages don't go up, because the cost of health insurance is shouldered by the worker. Who pays for it? Every working American. Is this a BARGAIN? Don't think so. I pay for my own health insurance, and it is outrageously expensive even though my family is in good health. Without health reform the costs will continue to rise exponentially. It's estimated that in ten years a family of four will pay over $36,000 per year for health care. Naw, we don't want the government messin' in our business 'cause we ain't no Socialist country. WAKE UP, morons. The time is coming when you won't be able to have health care unless you make at LEAST 100K,

    August 19, 2009 at 1:27 pm |
  16. RanDY

    To "George E Coles" I'd be curious to know what experiences you've had in Canada that would make think that a private system does the deed any better. In my experience, having lived in both countries, the Canadian system is vastly superior (though still in need of work), I'll take having to wait a little longer in line over nearly bankrupting myself any day of the week. You've also got to remember that Canadian economy is roughly 1/10th that of the U.S.. The fact that they can still maintain a first rate health care system is a testament to the benefits of UHC.

    August 19, 2009 at 1:26 pm |
  17. P. Lee

    Totally agree. And I also want to add, people should watch that documentary on PBS on the Drugs Co. and how they Lobby in the US to keep Drug prices sky high. It was quite an eye opener. I knew quite a number of that stuff before but to hear and see the details just make me so angry that this is happening in the US! And we as citizens continue to contribute to the status quo by blaming it on Congress and the Gov.
    —I also want to say that for certain cases, Generic work even better or about the same as some of the new ones coming out. But pharmas need to come out w/ New and so called impoved products so that they can sell more. And in a lot of cases, they only alter the generics just a little bit or just enough to qualify as a new and improved drug. It’s a lot of waste in research if you asked me. But it rakes in lots of profits so they keep on doing it!

    August 19th, 2009 1:01 pm ET
    To all the people saying that the people in the US are paying the higher drug cost and footing the bill for Canada and the UK that have capped the price are forgetting one important detail:

    When the pharma is granted the ability to sell the new drug by the FDA that they spent all the R&D money on, THEY PATENT IT. All fo these “name” brand drugs you see advertised “to ask your Doctor about…” DO NOT HAVE GENERICS BECAUSE THEY HAVE THE EXCLUSIVE PATENT.

    That is the point. The pharma has the time period of the patent (I believe 20 years) to be the EXCLUSIVE source of the drug, and have this exclusivity to repay the R&D before anyone else can sell a generic.

    So if the US does like other countries and caps what they would spend on a drug (which I believe they already do with Medicare/Medicaid reimbursement), the R&D will still be paid, the pharma will still make a profit, but maybe it’s only in the billions instead of the trillions.

    Wake up.

    August 19, 2009 at 1:26 pm |
  18. David D.

    Finally, an expert on an issue gets some air time. I agree completely with Dr. Singer. We must ration care more intelligently. The painful truth is that we must restrict care for those whose lives we cannot improve, such as those with Alzheimers or other terminal, debilitating conditions. Keep them comfortable as we can but don't bankrupt the country trying to keep them alive. We spend 25%-33% of Medicare costs on those in the last year of life, or about $100 billion each year. That is ridiculous. Conservatives would prefer we would ration non-emergency care for the poor through excluding them from insurance; Liberals would prefer we ration based on the benefit to society. The choice is obvious.

    August 19, 2009 at 1:25 pm |
  19. JR

    Interesting. I keep hearing about the insurance company's denial of payment for this or that service as denial of the service, itself. That is not true. Example: If a 90 year old man/woman needs a heart transplant to live some indeterminant time, they can certainly have that procedure performed on the assumption they can find a surgeon willing to do it. However, they are not entitled to reimbursement/payment by the insurance company. The service is not denied; payment by others (insurance, US Gov't/taxpayers) is. My fear is once again we are confusing what we are entitled to receive (nothing) versus what we choose to provide/provide for.

    August 19, 2009 at 1:25 pm |
  20. Kevin O'Grady

    Yes, there are millions of Americans without health insurance.....45 Mill? That's an inflated number....but regardless, where in our Constitution does it guarantee the right to health insurance?

    There are millions without it the government's job to provide all of them with homes?

    There are millions without jobs....Should the government employee each and every one to wipe out unemployment?

    You have the right to "Life, Liberty, and the PURSUIT of Happiness"....meaning it is YOUR job to obtain the happiness....whether it be within a job, a home or your health care. We are guaranteed that the government is not going to block the ability for you to pursue happiness.....not the right to happiness.

    We do need reform.....a way to cut the costs so that private insurance is affordable for most Americans....that can be done without spending taxpayers money to give insurance to the lazy people that don't want to get a job that has benefits. There can be longer extensions of an affordable COBRA type insurance to allow people who have lost their jobs to continue coverage. It is an individual's responsibility to be a go getter, get out into the marketplace and get themselves a job with benefits.

    I was laid off for 5 months in 2002 when my wife was pregnant with our second son. I was able to get out there, do some consulting work and keep enough money coming in to cover my medical insurance. Granted, we pulled from our 401K, we drained our savings account to pay bills, but I ensured that I had insurance. That was MY responsibility to my family and I made sure I fulfilled that responsibility. I didn't sit on the sidelines and wait for the government to give me welfare or pay my medical bills.

    August 19, 2009 at 1:25 pm |
  21. Michelle

    My twins were born at 23 weeks. They are now 3.5 years old and doing just great! If they had been born in Great Britain, they would not have even ATTEMPTED to resuscitate them. The rule there is, if they aren't at least 24 weeks gestation, they don't try–it's too expensive for the "return on their investment". Go ahead, look it up–it is pure fact. So they are going to tell me that my children weren't worth the million dollar bill that my insurance company paid? Don't even think about it–without the care they received, they wouldn't be alive, period. There is the "rationed" health care that people are afraid of.

    August 19, 2009 at 1:25 pm |
  22. Gee Alabama

    The notion that 26 million is much better than 45 million is lost on me, 26 million is still an awful big number.

    August 19, 2009 at 1:24 pm |
  23. Jean

    "Rationing" of health care based on sound, commonly accepted standards of medical practice and evidence based research seems to be quite logical. (Assuming we can get the insurance provider to do adequate research and make sound judgement; perhaps working with an organization such as the AMA). You're asking physicians to only use proven treatments for their patients, if they want to be reimbursed. Currently, patients who have diseases non-responsive to established treatment, cancer for example, can be put on research protocols and their experimental chemotherapy treatment is "free" (paid for by whoever is funding the research). I know I personally wouldn't want any treatment other than a well-established protocol or put me on a research protocol if it's my last hope.

    August 19, 2009 at 1:24 pm |
  24. Michelle

    Shut the border and kick out all of the illegals. With the extra tens of trillions of dollars we would save you could pay for Healthcare and a new hybrid for everyone. The Left thinks illegals have a 'right' to free healthcare too, what a joke. If we gave out free healthcare to illegals too you couldn't build a fence high enough to keep everyone out who needed a root canal, surgery, kidney transplant.....

    August 19, 2009 at 1:24 pm |
  25. Matthew in NYC

    I'm reasonably recent immigrant from Australia. The care I receive here is comparable to the care I received in Australia, save that it is much more expensive. In Australia Medicare provides essential care for all permanent residents and resident citizens, with pretty low copays. Nobody in Australia goes bankrupt because of medical bills and doctors and hospitals do not have significant bad debts. My doctor's office in Melbourne had six full-time MDs, one RN, and one full-time and one part-time administrative person dealing with appointments and fees. My doctor's office here has four MD's, one RN and four people to do all the admin work for the insurance companies. My doctor in Australia charges half what my doctor here does (actually less because the AUD is worth less than the USD). I recently had a colonoscopy that cost five times more here than the identical procedure in a private clinic in Melbourne, Australia.

    Medicare in Australia pays for what you need, not for everything you want. Because it's a single payer system, doctors know exactly what is covered and what is not and don't need to ask permission to do what is necessary.

    August 19, 2009 at 1:24 pm |
  26. Tim

    Its time to fight fire with fire. The democrats need to start calling the republicans what they are, people who want grand ma and grand pa to die in their own bed with an illness instead of getting medical help.

    August 19, 2009 at 1:23 pm |
  27. JJ

    Everyone is afraid of losing health care, yet we look at how much better it is in Britain and Canada. Why is this a debate? Don't we want to be covered by health care? Do we think the poor should suffer because they are poor? Would people change their minds if they lost their job and health coverage? Do we like not getting the care we need because the insurance companies that we pay money too don't want to cover the cost?
    I'm also tired of hearing the wealthy oppose this. It's larger than "pulling your own weight." I know people who can afford health insurance but get denied due to a pre-existing condition. Or people who lost their jobs and coverage. The top 10% aren't rich because they pulled their own weight in society. They were born into that illusive club. Poor people are the backbone to this country, work the hardest, and make sure it keeps going. Without them, this country has nothing. Time to wake up and give back.

    August 19, 2009 at 1:23 pm |
  28. DJ

    I have an idea to reduce the cost of healthcare: live healthier!

    One good example:
    Q: What conditions cause Americans to need care the most?
    A: Heart and lung diseases.

    Most of these cases are from people who can prevent themselves from becoming ill through diet/exercise or quitting their nasty smoking habits. There are millions of people who can prevent themselves from becoming ill, yet these folks suck away resources from people who suffer from unpreventable illnesses and injuries who need care and drive up the cost for folks who can't afford it.

    We provide the fuel that feeds this fire.

    August 19, 2009 at 1:22 pm |
  29. Gene

    The pharmaceutical companies aren't doing a lot of research. They spend their profits trying to find ways to make more profits.

    The colleges and universities are doing most of the research and getting most of the results with little funding. I say take a portion of the drug comp. profits thru tax and adequately fund the colleges and universities – then we will get real results. Not ones that reap in profits and keep costs high.

    August 19, 2009 at 1:22 pm |
  30. Marc P

    Ian... your comment on drug pricing means you obviously missed the point. what is your opinion on treating illegals for "free"??? My bet is that you don't want it... Yet you support the US subsidizing the price of drugs in other countries with our higher price??? get on the same page. We don't have any reason to be paying more than anyone else. The drug companies care about their distribution and profit by bleeding the American system to their benefit. Therein lies the problem. dolt...

    August 19, 2009 at 1:21 pm |
  31. Jeff

    I'm convinced that health insurance should be sold in exactly the same way that car insurance should be sold. Free market, no employer contributions or group plans, all individual, with a law requiring all citizens to have health care, no pre-existing conditions exclusions, and some subsidies for the unemployed and impoverished to have very basic coverage. If you want super-deluxe insurance, fine, but you have to pay extra for it out of your own wallet.

    I am a college professor at a major University, but as an adjunct I have no benefits. I have a history of heart conditions, so I cannot get individual coverage. It's not all just the poor and the illegal aliens trying to soak up those tax dollars. I would love to be able to pay for some health insurance, and know a lot of other people in my exact same boat.

    August 19, 2009 at 1:21 pm |
  32. heart attack waiting to happen

    To all of those that don't think that our system needs fixing, I offer this true story from just last week.

    I went to the doctor complaining of chest pains. I have a history of heart disease in my family, I have hereditary high cholesterol, I am slightly overweight, and I have been under extreme amounts of stress for the last few months. The doctor wanted to perform an EKG test on me to make sure I wasn't going to have a heart attack, and my insurance company came back stating they didn't think it was necessary. I work for a fortune 500 company and have their top PPO plan. Its with Blue Cross/Blue Shield and the combined rate that the company and I pay is $1350 per month. I never go to the doctor and have only visited twice in the last three years. I definitely don't abuse the system. So when I hear people are afraid that the government is going to "ration" health care, I have to ask, what are private companies already doing? Doe anyone else see a conflict of interest when your healthcare is being decided on by a corporation that is more concerned about profits then about your well being. The government may have many short comings, but I doubt they want to sell you out to increase their bottom line.

    August 19, 2009 at 1:21 pm |
  33. Dustin

    Check out Health Care Facts at good info

    August 19, 2009 at 1:20 pm |
  34. dismayed

    Medicaid copays are "high"? The Medicaid copay for an office visit around here is $3, yes, three dollars. The fast food that many Medicaid patients bring into the doctor's waiting room costs them much more than their medical visit. And yes, many complain about the $3 copay or insist that they don't have the money to pay it. As long as people's spending priorities follow this order - McDonalds before health care - we will continue to have health care results below those of other countries.

    August 19, 2009 at 1:20 pm |
  35. nahmed

    The money we are spending here on drugs are costly i would say we can import those in cheap price from abroad. What i believe you don't need 1000 pages health care bills. As long as people need it the governement should provide the best care. Getting sick is natural. No one intentionally wants to become sick and go to doctor/hospital for recreation. This system is created for only rich people not for the middle class. I was in Russia as a student. During my 5 years study i wouldn't pay a single dime to doctors there. Even i got a backbone surgey free of cost. only for the medicine i paid like $30.00 around 900 rubol. Can you people expect this in USA.... hahaha i think if it would have been done here in USA i would be in debt. Anyway we really need the reform. The people who are in GOP they really don't want but they want to send our money in war, and send people in moon and mars.

    August 19, 2009 at 1:20 pm |
  36. Joel

    Why are people so scared of a public "option" while leaving the current system in place? Canada has no private option and the US has no public option. Seems like parallel system would be the best of both worlds, or at least a perfectly fine compromise.

    People can recite plenty of "scary" one-off stories from any system (US, Canada, England, etc) which at the end of the day contribute very little to the debate other than to get morons yelling and scared (the intended purpose of course). All the systems have rationing (whether its a corporate insurance bean counter). But let's be honest. The only statistically meaningful way to look at a system is with relevant data not scary stories. According to Wikipedia the US ranks 38 in life expectancy, with all the countries above it having government run systems (e.g. Canada ranks 11, UK 22). If they live meaningfully longer in these countries, it really can't be that scary and terrible. Some would say it's better to have a healthcare system whereby people live longer. Others would say how terrible that sounds cause the government is involved and tell scary stories to get people away from the facts. I would say, having either "option" sounds perfectly reasonable and responsible and would probably raise the life expectancy in the US.

    As for drug prices, the $50bn in expected Vioxx litigation costs alone might have a small bit to do with prices being higher in the US...

    August 19, 2009 at 1:19 pm |
  37. Mike M

    What rationing would the governement do that the insurance companies don't already do? There are any number of drugs that the insurance companies either do not pay for, or pay for only a small part of the cost.
    You don't here medicare recipients complaining about rationed medical care, do you?

    August 19, 2009 at 1:19 pm |
  38. P. Lee

    Amen sista! If only everyone of those who oppose Health Care reform w/ realize this!
    —Heck, I have said before, this is not even an Ideal reform but at least there is a public option that would give access to those uninsured. Or ones that have been dropped from their plans due to illness and or inability to pay grossly high premiums! I do have to give Obama credit for wanting to address Health Care reform even though I think he needs to be more firm and stand his ground instead of giving hints that he might waver.

    August 19th, 2009 11:55 am ET
    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 1:18 pm |
  39. Jeff

    So the point of all this is what exactly? Are we supposed to be "OK" now with rationing?

    Shouldn't be happening in the first place, you sign a contract, insurers should have to give the treatment that's in your plan. Unfortunately the plan doesn't fix that problem, just adds another few layers of reasons to deny you care.

    Sadly nobody is pointing out the DANGERS of government lead rationing, instead the pro side is just saying "well it happens anyways, so get over it".

    Instead of fixing that problem what do we get? Rationing based on "lifestyle" choices.

    Smokings in there, how long do you think it'll take before you get denied for coverage because you're overweight? Alcohol consumption?

    And those are just a few of the arguments that could be used by the left to ration. Anybody stop and think about what the right will come up with? That's truly the biggest problem with rationing on a government level. Our government has the potential to change spectrum every 4 years. Do you idiots not get that? You're putting your health care into the hands of POLITICIANS. Not just government.

    August 19, 2009 at 1:18 pm |
  40. ep

    People take a look:
    Socialism? Take a look at US Post Office and UPS and FedEx.
    Can't afford? Would saying "can't afford" that the sick uninsured person heal immediately? Eventually, you and I will have to pay for it.
    Rationing? My dental plan just old me it will not pay for my crown. Rationing is already here.
    UK and Canada Health care are bad? – It doesn't mean the idea is bad. It means there are two examples for us to learn from to make our's better.
    People, let's don't lose our integrity to greed, fear and self-serving purposes. We need reform. We need it badly.

    August 19, 2009 at 1:18 pm |
  41. Adam

    I am all for healthcare reform, and, if done correctly, even a public option. UNFORTUNATELY the healthcare debate doesnt take into account many of the factors that drive the exhorbitant costs.

    1. America is the fattest most unhealthy country in the world. Until Americans take responsibility for their physical fitness costs will continue to rise.

    2. Prescription drugs. Not so much the costs, but the number prescribed. Prescription drugs are WAY over prescribed in this country. Antibiotics, pain killers, antidepressants and anti-anxiety medication among the top. Then of course there are the diabetes and coronary artery disease treatments that if Americans stopped being so unhealthy would drastically be reduced.
    2b. OTC prescription drugs. You can now purchase Claritin over the counter. Take the old off patent prescriptions that still work and sell them OTC. More often than not it is less than your co-pay.

    3. Doctor compensation. Doctors have created a perfect system. For most basic tests and visits you have the schedule two or three appointments all completely reimbursed to the doctor. If you cut this down to one visit (i.e. IMPROVE efficiency) then the additional 26 or 50 million people (whichever number you prescribe to) wont affect you access.

    4. Add more payers. This is obvious, but politically unfavorable. If you want more coverage, then the people you extend coverage to, or improve the coverage of, will undoubtedly have to cough up more money, its simple economics. Even with cost savings, you cant add more hands to the pot without it getting bigger.

    5. Remove the profit. Dont cry socialism here, there are ways to do it that arent socialist. The concept of co-ops indicates that the policy holders "own" the company, NOT shareholders. If the co-op makes money due to good risk management (minus a savings buffer of course for years when they miss) the money gets returned to the owners. This is considerably more difficult to do with the drug companies without being socialistic. I admittedly dont have a very good solution for that.

    6. Advertising. Get rid of the drug company advertising and free lunches to doctors. I am sick of seeing commercials for prescription drugs that make half the country think they have a condition. They then schedule an appointment with their doctor who runs countless unnecessary tests because they really dont have the condition. Again this points at the antidepressants/anti-anxiety medications. Even worse, are the drugs that dont really work for their intended use that are repackaged for made up diseases. What the hell is peripheral artery disease? Fibromialgia has almost no fundamental medical backing (most likely psychosomatic).

    7. Elective proceedures. These are proceedures that are medically not necessary, even if they could potentially reduce future complications. I am not saying eliminate these, but make the patient pay a larger share.

    Just a few of my thoughts that seem reasonable, but havent heard anything about. If these are included in the debate somewhere, please let me know, I would love to read about it further. Let us have a real debate about the issues weighing the pro's and cons of each solution. Lets not eliminate debate based on singular issues (i.e. abortion or end of life issues).

    August 19, 2009 at 1:18 pm |
  42. JonM


    Tort Reform is a great idea and I'm all for it, but reforming tort law related to health care is a drop in the bucket in our healthcare costs – the CBO and others have done detailed analyses of the change in costs based on different types of tort reform and the results were marginal at best. Besides, the so-called Republican plan also has no meaningful tort reform in it either. If conservatives would stop screaming about pulling the plug on Grandma, I'm sure they could get stronger tort reform built into a compromose bill, but they're entire approach is to kill reform rather than get issues like tort reform included in it, which is why you here far more about tort reform on talk radio and blogs than from members of Congress (many Federalist Society members are trial lawyers too, by the way).

    August 19, 2009 at 1:17 pm |
  43. mandy

    Peter Singer also wrote that mother should be able to kill disabled babies up to three months old.

    Additionally, Singer advocates bestiality.

    So fittingly, he is OK with the government controlling what took many independent innovators to create: the world's greatest health technology. It doesn't grow on trees and letting the leeches in Washington determine who gets service will lead to all around misery and early death.

    August 19, 2009 at 1:17 pm |
  44. Gene

    If all you white GOP dolts out there want to bend way over for the Insurance companies, you go right ahead.

    Just don't expect anyone with any brains to follow you. Get you guns and get your dumb white power friends who are all used to bending over – but we are tired of it.

    Oh and by the way – you lost the election – stop your screaming and crying. Talk to you mother about it.

    And we know what you want next – you want to take away medicare and social security. So those favorite companies of yours can make even more money off you and your family.

    August 19, 2009 at 1:16 pm |
  45. Don F.

    I don't understand that if the "public" health care system is so X#? awful, why the conservatives are soooo affraid that if it should be offered as an option here, masses will flock to it leaving the private sector options unsupported. This is a non-sequitur. Basic economic principles state that the market will migrate to the best product at the lowest price. So if there is such a disparity in quality and quality really matters then the public option would be doomed.

    It is disengeniuous to argue that the public option will be a terrible product yet its popularity will threaten the existance of the private option. Such an argument only holds IF the public option is viewed as SUPERIOR to the private options.

    August 19, 2009 at 1:15 pm |
  46. Robin in SC

    Rationing goes on evey day. If your health insurer requires a pre-authorization for a procedure, exam, or surgery...guess what...your care is being rationed. Those who oppose have obviously never had a procedure or treatment denied by their insurer. It happens every to any radiologist or surgeon or even your family doctor. They'll tell you that private insurers are telling them what procedures they can and can't perform or order for their patients. And they have to employ more staff just to ensure that the pre-auths are done correctly, further increasing the cost of the service to everyone. You can get the services without the pre-authorization, but the money is out of your pocket. Get A Grip, Folks! INSURERS ARE THE ENEMY HERE!!!!!

    August 19, 2009 at 1:14 pm |
  47. JIm

    Earlier user "WBN" stated:

    "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!"

    This is exactly what the house plan (I have not read the Senate bill) does. The public health option is only a component, the importance of which is what is being hotly debated in DC now. The house plan does, in addition to some other things such as improving Medicare:

    (1) sets up an commercial exchange through which private insurance companies can sell, and employers and individuals can purchase, insurance policies that meet a set of minimum standards (such as maximum out of pocket expenses for a year, no co-pay for preventative care, etc.). These minimum standards at a federal level mirror many states' standards, but provide a level of standardisation that is welcome by doctors and insurance companies alike.

    (2) establishes a publicly run health insurance company that will provide competitive insurance policies for sale in the commercial exchange (along side the private insurance plans). The costs of running this public insurance company will be paid (according to the explicit language of the statute) by premiums, not tax dollars directly (see number (3) below).

    (3) establishes a system of need-based health insurance credits that are available to any needy individual to assist them in purchasing from the commercial exchange (a) an insurance policy from a private provider OR (b) an insurance policy from the publicly run provider.

    We can debate the viability of any of these three topics. However, we should focus on the reality of these three topics instead of the falicies being floated by both sides to "sell" one side or the other.

    August 19, 2009 at 1:14 pm |
  48. Kronos

    As stated , our health care is already being rationed. Business decisions are being made by insurance companies on weather you or worth the money or not. I'm all for the capitalist system and making a profit by not when it comes before people's lives. I'm tired of the Republicans and Fox news using scare tactics to protect the huge profits of the insurance companies. To hell with the Republicans and Fox news, reform now!

    August 19, 2009 at 1:13 pm |
  49. Steve

    Norm Chadwick, since when is 26MM uninsured a small number? Whether it is 26MM ( a number I have only heard form you), or 45MM (the genrally accepted and promulgated figure) – they are both big, unacceptable numbers.

    Regardless of the exact number of unisureds- – does it have to be 45,000,001 –with you being the 1 - before you'll understand the importance of universal coverage?

    No particular argument on Tort reform, but lawsuits are not the primary driver on heathcare costs. Red herring.

    August 19, 2009 at 1:12 pm |
  50. Tyler

    The problem is no one is talking about a true reform of the US health care system. We continue to try to put band aids on sucking chest wounds!

    "We won't need to ration care – keep the care you currently have".

    Dump 45 million people into a system that wern't there before and extend to them the same rights and priviliges as everyone else with out increasing costs? I am a veteran in VA healthcare. Ask a veteran who is cared for completely in the VA system what the increased number of veterans in the system from the war on terror has done to thier wait times?

    If we assume the 45 million people without healthcare don't have a primary care physician and we already have a shortage of primary care physicians. What will adding 45 million more patients do? I would think it will impact the care I receive.

    Medicare and Medicaid costs have risen at a higher rate than private insurance (with a cap/cost control on physician payment) how will a government plan save money. We have 44 years of proof the government is not capable of cost containment in health care programs.

    August 19, 2009 at 1:12 pm |
  51. CraigB

    Norm says (below): "....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...."

    Isn't this a little like suggesting that the Holocaust 'only' involved 6 million Jews? 26 million uninsured is still a deplorable number to think about in the wealthiest nation on the planet. The only wealthy nation, btw, that can't seem to do national health insurance. Doh!

    August 19, 2009 at 1:12 pm |
  52. pat

    It comes down to this: I trust the government with anything better than I trust any for-profit instiution.

    August 19, 2009 at 1:11 pm |
  53. Rick McDaniel

    The issue is......bluntly, that SOMEONE has to pay the bill. If you can't pay the bill, you can't get care.

    What the government wants to do, is to redistribute the wealth, by taxing the middle class to pay for the poor. Obama's statement that only incomes greater then 250K, will be impacted, is simply nonsense. That will not raise sufficient funds, which any decent economist will tell you.

    What the middle class is saying to Obama, and the government, is that we choose NOT to pay more taxes. Period.

    It all comes down to, let those who want health care, pay their fair share, to get it. At least enough to cover major medical, even if they don't have coverage for smaller needs. Let them pay for smaller needs on a pay as you go, basis.

    It is up to all of us, as citizens, to pay our own way. If we have kids, we have to be prepared to pay for that, as parents. Otherwise.......DON'T have the kids! That is simply irresponsible, and in today's overpopulated world, totally the wrong thing to do.

    I for one, am sick of hearing "we do it for the kids"! If you can't pay for their medical care, their education, their clothing, and their have no business having kids!

    Don't expect those who pay for their's, to pay for yours too!

    August 19, 2009 at 1:11 pm |
  54. Kevin Meyer

    Sick of this August 19th, 2009 1:00 pm ET

    Here’s an idea. Why don’t the drug companies stop employing all those sales rep to visit doctors all day long and waste their time pitching the same product over and over. The doctors will have more time to treat patients, and thus make more money, and keep their rates low. And the drug companies will save money on the salaries of all those high priced, plastic surgery enhanced, waste of space flunkies that don’t provide any value anyways.

    Here's a fact. They already have started doing that a couple years ago. Open up your health magazines and see all the drug pages in there now. It's cheaper for them and instead of trying to 'swoon' the doctors, they just put the drugs right in front of everybody to read so the patients can ask the doctors about the drugs. Smart idea and saved them lots of money.


    todd k August 19th, 2009 1:00 pm ET

    i beleive what i beleive no matter what the facts are. i beleive obama is a kenyan, no matter the facts. i beleive the government is trying to kill my baby, and the govenment is bad, except for the armed forces which i support no matter what. i beleive that taxes are bad and that Medicare is not government insurance. and i vote. i hope you all feel better now.

    I think that you should move to some other country then if that is how you really feel about the government. Maybe Cuba? Russia? China? North Korea? This statement just really resonates about how misinformed some people really are and that we aren't that advanced as a country.

    August 19, 2009 at 1:11 pm |
  55. Dave B

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

    What's your perspective on the number of people killed on 9/11? Only 3,000 people killed or millions of New Yorkers not killed.

    August 19, 2009 at 1:11 pm |
  56. mp

    If anyone is actually interested, Anne Doig said the following in the Canadian Press article:

    "Doig, who has had a full-time family practice in Saskatoon for 30 years, acknowledges that when physicians have talked about changing the health-care system in the past, they've been accused of wanting an American-style structure. She insists that's not the case.

    'It's not about choosing between an American system or a Canadian system," said Doig. "The whole thing is about looking at what other people do.'"

    In other words, this is not an ideological debate. It's about what works and what doesn't. Singer is a utilitarian. So, apparently, is Doig.

    August 19, 2009 at 1:11 pm |
  57. Dan Hennigan

    In regard to Norm Chadwick's comment that he would take health care reform more seriously if we had tort reform. Tort reform is code for protecting incompetent and negligent doctors and hospitals. We have tort reform in Texas and maybe Mr. Chadwick should be aware that if some incompetent health care provider mistakenly amputed both of his legs they would only be liable to compensate him for his medical bills and lost wages. The pain and suffering, disfigurement and deprived of the ability to walk around unassisted the rest of your life is limited to $250,000.00. The same limitation applies if Mr. Chadwick would suddenly be rear ended by a freight liner causing him not only to lose both legs but both arms as well. Be careful what you wish for Mr. Chadwick.

    August 19, 2009 at 1:10 pm |
  58. Pietro

    "The discoveries of healing science must be the inheritance of all. That is clear. Disease must be attacked, whether it occurs in the poorest or the richest man or woman simply on the ground that it is the enemy; and it must be attacked just in the same way as the fire brigade will give its full assistance to the humblest cottage as readily as to the most important mansion. Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available." (Winston Churchill, 1944)

    Meanwhile Americans arguing about health care. In the rest of the world we see US as a very curious country...a black and white country...what about a combination and balance between public and private sector? that is how it works in socialized medicine, government take care that everybody has that as a right (like fire department maybe?) but that I doesn't mean to cap the private for who can afford it. It has been on this way in the the rest of develop world during decades that it the reason why US ranks in any health care statistic (outcomes for specific diseases and general outcomes like infant mortality or longevity) like a second world country, similar to Poland or Turkey.

    August 19, 2009 at 1:10 pm |
  59. KD

    It's not rationed like it will be if the government runs it. We have the greatest health care in the world–We need to get rid of fraud.

    August 19, 2009 at 1:10 pm |
  60. paul

    The reason that universal healthcare works better at keeping costs down is a simple capitalist, NOT SOCIALIST idea... collective buying power. For us in Canada, our government acts in much the same way as a Walmart, or a club store. How do you think Walmart can afford those "Falling Prices." They have a facility that invites potential suppliers to give their sales pitch, price point expectations etc. Walmart tells them what they are willing to pay for that particular product... take it or leave it, this is how you gain access to Walmarts customers... Our government acts in much the same way, if they want access to 30 million customers(citizens), they will meet that price. I sense though that Americans have a much more adversarial view of their government. Canadian politicians and regular everyday citizens both seem to realize that it is the electorate in charge. Plus having our healthcare paid for with taxes through our government, we have someone we can fire if they aren't doing it properly. Trying doing that with your insurance providers.

    August 19, 2009 at 1:10 pm |
  61. R Scott Greentown, IN

    It seems that the conservatives and the insurance companies have banded together to prevent health care reform 1994 all over again. Same grandious lies and probably even bigger one than death panels.. I think to be conservative is to protect the common working person but in this country to be conservative means to help the rich get richer and big business to take advantage of the common person. We give major tax cuts to the rich because of the faer that they will not spend and invest, the trueth they will still invest because they still want to get richer anyway. Conservative are now screaming about cost and government spending. Maybe they shouldn't have given Bush his huge tax cuts and all the spending increases he asked for. Mr McCain made a comment during the debate for Bush's tax cuts that we are at war and everybody needs to make sacrafices, and he was ridiculed by the conservative establishment for that comment and he was a man that made many a sacrafice for this country.

    August 19, 2009 at 1:10 pm |
  62. Philip

    Alex said, "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."

    Do you think that doesn't go on in our country today? We are currently trying to correct this and will continue to do so under any system. This idea that we don't have bad doctors is rediculous. You can find individual situations to support anything. That's how witch doctors and snake-oil salesmen operate. The aggregate numbers suggest that the UK NHS is better than our health system, if you can call what we have a system. Doctors here are even trying to block report cards so that poor work goes unnoticed by patients. Currently you can only identify a bad doctor by lawsuits that end in judgements and not settlements.

    August 19, 2009 at 1:08 pm |
  63. P. Lee

    Are you serious? Oh yeah, the drug co. sell stuff cheaper South of the border because they sell them More here! Right, why would a hungry profit driven drug co. do that?
    —The main reason they have to sell at an affordable rate because the governments elsewhere negotiate prices of Drugs. We in the US no longer do that for Medicare! Remember? Bush had that axed out! How about that for an eye opener.
    —Drugs Co. make most of their money in the US through the so called Lifestyle enhancing ones such as viagra, stomach upset stuff and all of those non life threatening ones. They usually don't make huge profits on the ones that truely save people lives! (Turn on your TV and you'll see a bunch of viagra and derivativesn Pepto Bismol alike)

    At least be informed about it before uttering nonsense.

    August 19th, 2009 11:35 am ET
    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 1:08 pm |
  64. Jonathan

    Ian and everyone – the point regarding drug cost "over the border" and in America is this:
    Stop subsidizing other countries health care cost on the backs of America. We have more citizens than both Canada and Britain, so we should be able to get drugs at least at the same cost as them. That might mean the the other countries have to pay more, and we can then pay less.

    August 19, 2009 at 1:07 pm |
  65. Stan

    First ,If I get an email from the WhiteHouse then I know where it was sent from CNN. Second, 46 million can we get it right!!! Talking points are old, this number is really not representative of the uninsured but the Dems are out to force people to pick insurance who don't want or deserve it.

    August 19, 2009 at 1:07 pm |
  66. Hello!!

    JIm the doctor:

    Please go on CNN, MSNBC and Faux news and tell everyone how much money the insurance companies are siphoning off. Maybe they'll believe you!!

    August 19, 2009 at 1:07 pm |
  67. Sgt.Serge

    As I read more, I want to clarify, only the comments abouthow doctors are better in the US, or how other systems are failing, or, how the sky will be falling if we follow Canada or Britain.........

    I don't think that the proper solution for America has been presented yet, but how will anything get done with so many people are so ignorant to how the world works, and ignorant to the fact that this is a global economy.

    I love America but finding more and more that "some" people are brain washed and "some" make up crap to force their opinion and the rest of America has a valid opinion one way or another.

    Ignor the people who will never change and are just forcing an opinion on others, and focus of the people that are growing with the world, these are the people that will drive the bus, not the ones standing around knowingly or unknowingly creating a smoke screen.

    Sorry if my comment above offended anyone.

    August 19, 2009 at 1:07 pm |
  68. Kenyon

    If universal coverage is the goal in this country, why the unholy rush to get a healthcare bill passed by this fall? How about if we did it this way:

    1. The Congress and President determine how much it will cost to provide basic care to the 45 million uninsured Americans for two years.

    2. They pass a law expanding Medicare to cover all 45 million for two years only. With all the money we've given banks and "stimulus" surely we can scrape up the cash to cover Americans health care for two years. For our government not to do this while spending $787 billion on stimulus is almost criminally negligent.

    3. During those two years, our country takes ameasured approach to really figure out what the best heatlhcare solution for our country is. Then they execute it.

    I don't believe this can happen given our sclerotic political process. We only hurt ourselves the longer political realities gum up the works. And that is the reality – oh well!

    If universal health care is NOT the goal, then why is the government taking over health care? What other legitimate reason is there?

    August 19, 2009 at 1:06 pm |
  69. Anders

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

    Actually, the current U.S. population is around 308 million people, which means that only about 14.5% of Americans would be considered uninsured.

    August 19, 2009 at 1:05 pm |
  70. Stephen

    1). We have already insured nearly 300 million people without a government plan. To say there is no other way to insure the rest seems short-sighted.

    2). Yes, rationing will take place as a measure of cost control. The problem is that a). the government keeps trying to reassure people they won't be like the insurance companies, despite doing the same job and having the same concerns about how to pay for all this care, and b). if an insurance company is inadequate, you can go to another insurance company. If you withhold premiums, your plan gets canceled. People railroaded into a public plan will have no recourse if the care is inadequate, and if you dare to withhold even a portion of the tax money funding the plan, you go to jail. The government will be forcing its health care policies on the masses under force of law, which is way more clout than the insurers have. That kind of power requires much greater care and scrutiny about what liberties to surrender to them.

    August 19, 2009 at 1:05 pm |
  71. Scott

    Very clear that the opinions expressed in this interview are from an academic with no actual concept of the real world.

    Not being able to afford care is NOT rationing.
    The government telling you you can't have a treatment or creating a system that results in a shortage of doctors IS rationing.

    Every country that has implemented a government run HC system has seen:
    1. Exploding costs because people will always consume more of something when it's "free"
    2. Price Caps set by the government in an attempt to contain costs
    3. Shortages of doctors because they can no longer make enough money to pay insurance, pay their student loans, etc
    4. Waiting lists for treatment
    5. People dying while waiting

    I'm not sure why our President thinks that every nation before us is stupid, but we've got the ability to do it right...I mean Medicare, Medicaid, and the VA Hospitals are all government Healthcare and abject failures.

    August 19, 2009 at 1:05 pm |
  72. Peter

    I realize this is an ad hominem attack, but after all the hysteria we have been through of late with the so-called "death panels" Peter Singer, author of "Taking Life" is just about the worst possible choice of advocate for government-run health care. To wit:

    "On the contrary, once we abandon those doctrines about the sanctity of human life that – as we saw in Chapter 4 – collapse as soon as they are questioned, it is the refusal to accept killing that, in some cases, is horrific." (From "Taking Life: Humans", by Peter Singer; excerpted from [i]Practical Ethics[/i], 2nd edition, Cambridge, 1993, pp. 175-217.)

    August 19, 2009 at 1:04 pm |
  73. Mike

    Ok, so even if the comment below is true wouldn't that mean that If we demanded a lower price we would get a lower price? If the only reason these meds are sold for a lower price in other countries is because we pay more why don't we make those other countries pay more so we can pay less?

    Everyone yells about we can't take from the rich and give to the poor, in the comment below the US are the "rich" and we are giving reduced price meds to the other countries aka "the poor".

    "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 1:04 pm |
  74. David

    I have Blue Cross/Blue Shield. For the last two years I have had to appeal every test I have taken, that is one MRI that found two compressed discs and two blood tests for my high colestrol and ratio of 1 to 7. I have had to make numerous calls, send letters and have the doctors send letters. To date they are still being reviewed. I do not think any government agency, who must respond to a Congresional inquiry, would be that calous and uncaring. I am at wits end, and this costs me over $600 a month for this alleged coverage.

    August 19, 2009 at 1:04 pm |
  75. Kathy

    I've got news for the people who think that the government will ration healthcare at a greater rate than private insurers.

    I've got a husband with Crohn's disease and his care is rationed quite frequently. He's denied drugs, treatment and we're probably lucky he hasn't been dropped, probably because he's insured through his employer.

    On the other hand, my parents are on Medicare and have never been denied ANYTHING! You can't even compare the two.

    As far as the drug companies, the profits that are being pocketed along with the expenditures for TV commercials and the millions spent every year at a doctors office – providing lunch EVERY DAY for the whole office, to say nothing of the give-aways – could go along way toward the "research and development" that they're always ranting about.

    Americans really need to wake up as to what's happening in corporate America.

    August 19, 2009 at 1:04 pm |
  76. DL

    I keep hearing tort reform....many states already have tort don't hear about it because it doesn't work..period. It's great for providing protections from negligent Physicians, but in terms of costs it affects NOTHING...Texas is a great example. Some of you really need to research what you are complaining about.

    And like it or not, Republicans have also said system needs a MAJOR overhaul. So their approach is to stall and kill this attempt and enforce theirs next time they are in power. Given their stances you can guarantee it means no medicare and everything will be handed to the insurance companies to regulate themselves (and that works great just look at Katrina). People need to seriously wake up, Dem plan may not be perfect but it's night and day compared to what the GOP has planned down the pipe.

    August 19, 2009 at 1:03 pm |
  77. Mike

    I am not against Healthcare. I am against the following;

    (1) Giving government MORE control when it already is wasteful and inefficient with MY tax dollars.

    (2) The Constitution grants you "Life, Liberty and Pursuit of Happiness". It does not mean I, as a taxpayer, have to get stuff paying for your healthcare too.

    Stop looking for government to solve your problems. This is not about Healthcare at all... it is about yet MORE government intervention and control in our lives. If you want to have government do for you and like that approach so well... go live in one of those countries that already do that... but wait... THOSE people come here for our current system... which you want to undo. Smart!

    Government is not the solution to problems.... government IS the problem.

    – Mike

    August 19, 2009 at 1:03 pm |
  78. Ed

    I understand that of the 45 million uninsured, the average income is over $50k per year. Many people, particularly young healthy adults, CHOOSE not to buy health insurance. They'd rather buy concert tickets or apple-tinis. In addition, a large portion of the uninsured are actually qualified for medicare, medicaid and other programs but they simply FAIL to sign up. The real group that we all should be concerned with are those that WANT insurance but can't afford it after TRYING to do so. When you do the math, it apears that that particular group is something like15 million or only about 5% of the population. I'm not sure about the accuracy of that number but the order or magnitude is correct from what I have heard from multiple sources.

    August 19, 2009 at 1:03 pm |
  79. Alex

    The 26 million vs. 45 million figure isn't hotly debated. There are 26 million HOUSEHOLDS without insurance, totalling 45 million INDIVIDUALS. It comes from the same study by HHS.

    And this doesn't mean 85% are covered. People over 65 and under 18 make up 35% of the population and are covered by medicaid or medicare. That means just over 60% of the workforce has health coverage.

    Nobody is saying that you couldn't pay extra for what you want, just that the basics are covered. Think of it like education. Everybody is entitled to a high school education. If you don't like the education you are getting, or feel that it isn't enough, you can pay for private education instead.

    August 19, 2009 at 1:02 pm |
  80. dacs

    [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?]

    yes "we" if it was all your money you would have no need for the insurance. the point of insurance is for the collective to cover the rare expenses that an individual member can not. If you can afford what you want then fine. cancel your insurance, pay for it yourself and get out of the debate

    August 19, 2009 at 1:02 pm |
  81. anonymous

    One more thing I forgot to mention...I also have an MBA from a top 25 business school and graduated #2 in my class from that program. I could have given up medicine completely and made a lot more money doing investment banking or in other areas of finance. But I didn't because I can still support my family comfortably in medicine. If that ever changes, though, I can assure you that I will not be the only one leaving the field.

    And having gone through both, I can also tell you that medical school is FAR more difficult than business school. They aren't even in the same league. Consider that when you think about who earns what in this country.

    August 19, 2009 at 1:02 pm |
  82. boggsie

    Baloney – if I wanted commentary, I would go to the Op Ed pages. I came to this page for news and John Roberts delivered commentary.

    The professor defined rationing in his opening statement and Mr. Roberts failed to provide questions that spoke in those terms, exposing either his gross ignorance or bias on the subject.

    August 19, 2009 at 1:01 pm |
  83. Mike Kromer

    I wish people would quit using the 45 million to 50 million uninsured number, suggesting that there are that many Americans who CAN'T get insurance. The truth is only a fraction of that number actually want insurance. The rest either don't need it (healthy college students and/or younger people) and folks who choose to take the risk.

    August 19, 2009 at 1:01 pm |
  84. doh!

    To all the people saying that the people in the US are paying the higher drug cost and footing the bill for Canada and the UK that have capped the price are forgetting one important detail:

    When the pharma is granted the ability to sell the new drug by the FDA that they spent all the R&D money on, THEY PATENT IT. All fo these "name" brand drugs you see advertised "to ask your Doctor about..." DO NOT HAVE GENERICS BECAUSE THEY HAVE THE EXCLUSIVE PATENT.

    That is the point. The pharma has the time period of the patent (I believe 20 years) to be the EXCLUSIVE source of the drug, and have this exclusivity to repay the R&D before anyone else can sell a generic.

    So if the US does like other countries and caps what they would spend on a drug (which I believe they already do with Medicare/Medicaid reimbursement), the R&D will still be paid, the pharma will still make a profit, but maybe it's only in the billions instead of the trillions.

    Wake up.

    August 19, 2009 at 1:01 pm |
  85. U.S. Citizen

    Glad to see some discussion about the insurance company rationing on the corporate media. However, the type of rationing he is talking about is not necessarily the way it should be done–based on cost. But he is correct that the insurance companies are doing this and it is not good and should be eliminated. They are also denying claims–rescission. The type of rationing that we have which will continue and is not necessarily bad is the prioritizing of treatments based on severity of the problem. He did address the rationing by having so many uninsured which is a good point.

    In any event, we need to encourage more people to become doctors. Also, it is absurd that we are so concerned about the insurance companies. Our legislators are considering the profits of their campaign contributions over the public good. This is true in just about all areas of our government, not just this reform.

    This is why Medicare for all is not even being considered. Medicare for all is the best solution. It could be phased-in over a five year period, within a year of enactment. It could be paid for with a security transaction fee and a payroll tax. The payroll tax would be paid 1/4 by the employer and 1/4 by the employee, with the other half negotiated between the two. The specific rates would be determined after a CBO cost analysis.

    We need democracy, not corporatocracy.

    August 19, 2009 at 1:01 pm |
  86. todd k

    i beleive what i beleive no matter what the facts are. i beleive obama is a kenyan, no matter the facts. i beleive the government is trying to kill my baby, and the govenment is bad, except for the armed forces which i support no matter what. i beleive that taxes are bad and that Medicare is not government insurance. and i vote. i hope you all feel better now.

    August 19, 2009 at 1:00 pm |
  87. David Thomas

    What I am sick and tired of is our news organizations they only seem to report what our politicians want them to report, where is the investigation. In politics on each side of every argument someone benefits. Now the politicians will tell you how it helps or hurts us, but that is just the spin all they really care about is who contributes to their campaigns or their party. So we know some of the players who can get hurt or get helped by this, the pharmaceutical companies can be impacted, but they will adjust their pricing around the world to compensate and they will still make tons of money for their investors and senior leadership. The doctors and the medical community, now this is a tough one because they are being overrun by insurance companies with paperwork, follow-up and cost control so it seems they will have more of this, because we all know how the government manages most processes and paperwork is king and cost control is what this is supposed to be about, yet somehow i think this will work in their favor just a hunch. Health insurance companies big losers, they created a model of how to maximize shareholder return by eliminating coverage and increasing consumer cost. This is what we are presented with as the main reason the government is getting involved. I would prefer CNN or Fox to actually investigate but the best I can figure is that large and medium sized corporations are the ones who will benefit, the cost of health insurance for them has gone through the roof and the government offering a plan at reduced cost will allow these corporations more control when negotiating with health care companies or provides them an option to eliminate those other choices. Now they spin that by saying that this will beneift us because our companies are spending money that should come to us in raises, but we all know when are companies have more money the senior leaders and investors are the ones reaping the rewards. I wish these news organizations would do their jobs and investigate but I think they have forgot how to do that and in this case they are one of the groups that benefits from this reform, Time Warner, Fox or the other large organizations that now control our news all benefit from this reform. So they will confuse us by providing you what the politicians want you to hear but no real investigative reporting will be done.

    August 19, 2009 at 1:00 pm |
  88. Sick of this

    Here's an idea. Why don't the drug companies stop employing all those sales rep to visit doctors all day long and waste their time pitching the same product over and over. The doctors will have more time to treat patients, and thus make more money, and keep their rates low. And the drug companies will save money on the salaries of all those high priced, plastic surgery enhanced, waste of space flunkies that don't provide any value anyways.

    August 19, 2009 at 1:00 pm |
  89. Chris

    After all the debate, I think that I have a solution to not only the health care debate but the economy as well!

    Let the insurance companies take care of everything! Fire, Police, National security. Think of all the money we'll save! Part of your home owners insurance goes to pay for police, fire, and national security. We would save trillions! And our taxes could be reduced!

    Of course our home insurance premiums would be twice our mortgage payments (if not more). And if you live in an area with statistically high crime rate and your house is broken into, well the police may not show up because your neighborhood had a "pre-existing" crime rate. Or you may end up with a bill after the fire is out because you should have know there was faulty wiring behind the drywall. If you can't afford the insurance well just don't pay it, you may be lucky and never need it and think of the money we would all save!

    When you apply the same argument against health care to other things we take for granted, the argument seems ridiculous. Americans you can't afford to be this stupid.

    August 19, 2009 at 1:00 pm |
  90. deanna

    I don't know where you live but here in Texas hardly any mexican pays for health insurance and they get the same care I do while i have to pay for my insurance. that' the first thing they ask me, but if its a mexican they ask first for their Medicaid card. hardly fair.

    August 19, 2009 at 1:00 pm |
  91. John



    In the simplest of economic logic. The bill as currently written will increase the demand for health care with 45 million new insured. The supply of health care will not increase. Therefore, the price of health care will increase.

    Feel free to point out the portions of the bill that will decrease the price of health care.

    August 19, 2009 at 12:59 pm |
  92. Muditha

    Calling others idiots is not helpful.

    Do you really think that your income give you the right to better healthcare? Does your income give YOUR children the right to better healthcare than MY children?

    Healthcare is a right not a privilege. In a moral and just society a government has the duty to protect all its people, not just the wealthy.

    Resources are LIMITED and have to be allocated based on need not income. You could lose your job, you could be sued and your business could fail, anything could happen. How would it feel to be on the OTHER side of the equation?

    August 19, 2009 at 12:58 pm |
  93. Bill (Houston)

    More cheerleading from CNN and MSNBC...Now, we stupid Americans have our facts wrong. FOX News is to blame...Why not admit the truth CNN??? Americans have the facts and have figured out that the President is not being honest. The plan will increase healthcare costs for the taxpayer and eventually lead to a single payer goverment system that insures Democratic constituents (which will lead to higher taxes for everyone else).

    August 19, 2009 at 12:58 pm |
  94. John Luma

    I'm just one example of why we need HC reform now. Age 62, excellent health, exercise every day, eat for health not for taste, never get sick... and the last quote I got for health insurance for my wife (the same shape and weight as in high school) and I, was $750 X 2 X 12 months a year. That's $18,000 a year. So we don't have health insurance, and probably won't need it when we do. Until we have a problem. Yet now the Republicans have at last given their final answer on health reform - "The system is working fine, we back no major coverage changes, HC is a privilege and not a right, and those tens of millions who can't afford the rising costs of our current system can go to hell."

    The people who voted for change in the last election need to start backing it. In a few more years, the employers and individuals who now pay for the current system will drop their coverage, and the new millions without this "privilege" won't be covered either. Changing the system is an absolute must, because it does not work.

    August 19, 2009 at 12:57 pm |
  95. stan turecki

    Jeff – what about gardasil? it doesnt just cure many cervical cancers, but keeps them from ever forming!

    The argument that pharmacutical companies want to manage symptoms rather than cure is bunk. If you could just take a pill to CURE impotence or restless leg syndrome that little pill would sell for 1000's of dollars! The companies that make them would be able to charge whatever they wanted for them (within reason) because insurance companies would realize that a high cost, one time medication is much less expensive in the long run than a life time of prescriptions.

    August 19, 2009 at 12:57 pm |
  96. a health economist

    Personal Responsibility,

    You make many good points. I'd just like to point out you, as well as every other insured individual, are already paying for the uninsured. When they need care they go to the ER where they cannot be turned away. If the hospital does not get payment they do not eat the lose. It gets shifted to those that are insured. This results in our premiums being higher than they really should be. That's a natural thing in capatialism. Same thing happened when fuel costs went up, everyone started charging fuel fees and shifted the increased cost to their consumers.

    August 19, 2009 at 12:57 pm |
  97. Bill

    Do those who argue against a single-payer plan or a public option truly believe that the poor and underinsured do not deserve adequate health care? As citizens we have an obligation to make our nation strong. A healthy populace is a vital part of that effort. If the question is one of funding a public plan, then let us raise money through "health taxes," say 30 percent at once on alcohol and soft drinks. Health taxes would go a long way to meeting our obligations as citizens to do the right thing for all American people.

    August 19, 2009 at 12:57 pm |
  98. vanisle500

    I am Canadian and I don't understand why Americans are so resistant to having a national plan when all the other healthcare options will still be in place. To put the record straight on the Canadian system; I have never waited to see my doctor, I can usually get in the same day or next day; when I have gone to emergency I have always received prompt treatment; the system did a wonderful job when my 2 daughters were born; I have always received the treatment I need upon recommendation of my doctor; I pay $108 month for coverage for the whole family under the govenment system but also pay about $100 per month for private medical insurance that covers treatment over and above the basic system such as private rooms in a hospital (ie Canada does have private health insurers). In short it's a good system but can always be improved as any system can. There will always be individual examples of where it fails but that happens in the current US system as well. Why such a fuss in the States?

    August 19, 2009 at 12:57 pm |
  99. Kenyon

    I think this economist quoted in the article is offbase because he assumes the rationing in US health care is the same type of rationing that would occur under a single payer system.

    My understanding of the article is the rationing that is "already happening" is the result of individual entities responding to a market price mechanism – in other words, the rationing is occurring through the market allocating the goods. In contrast, the public option being discussed could evolve into a single buyer (Medicare/US govt) deciding what services it will pay for at what price. This type of rationing is entirely different – it will result in queues for service and service level limits, for the benefit of seeing everyone insured at the same basic level of care.

    My understanding of this public option is the choice between two scenarios: the current status quo and "public option" where essentially Medicare expands to cover 100% of the American populace, instead of the 1/3 of population it covers today.

    The Status Quo: 1/3 of our health care system is already run by the federal government through Medicare, 2/3 is provided through private insurance. Medicare distorts the market a bit because you have 1/3 of the market negotiating for price. However, if a medical provider doesn't like the price on offer, they are free to serve the remaining 2/3 of the market that have less volume and less negotiating power. We see this through higher rates for services paid by private insurers, and still higher rates paid by out-of-pocket patients. As a result, we don't have queues waiting for medical procedures because of the market clearing price mechanism.

    The Public Option : Assume this means Medicare takes over for 100% of the US. Now there is no "market clearing price mechanism". Now you have a single provider determining what it will pay for medical services, and if a provider doesn't like it, they need to exit the US or stop doing business entirely. The result of this is rationing. It is rationed because a single arbiter, Medicare/US gov't, will determine what services will be offered at one price. This is entirely different from the "rationing" that the article says is already happening.

    August 19, 2009 at 12:56 pm |
  100. Roger College Station Texas

    There is a very simple answer to the problem of rationing health care. If the patient dies the person at the insurance agency who denied the treatment goes to prison for life if it can be shown in court that the treatment could have saved the patient's life. If the patient is significantly harmed by denial of a treatment that has been shown effective the person at the insurance agency who denied the treatment goes to prison for a specified time period according to sentencing guidelines. Quit saying, "Oh, you naughty boy." and get serious about caring for people and the nonsense will stop.

    August 19, 2009 at 12:56 pm |
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