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Tags Affordable Care Act , AHCA , donald trump , health care issues , health insurance issues , obamacare , Trumpcare

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Old 17th January 2017, 04:52 PM   #161
Giordano
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Originally Posted by fromdownunder View Post
In Australia there is of course rationing (unless you also have Private Insurance above the compulsory 2% Medicare levy), based in general on the following:

Life threatening - free and immediate and available to everybody. (e.g., a car accident, a Heart Attack, a Stroke, even a broken leg)

Semi-elective - Defined as a potentially future life threatening illness which requires monitoring but is not immediately life threatening (e.g., Bladder Cancer, some tumours) where you may be checked out once every 6 - 12 Months depending on the change in status of your illness. All free under the Universal Health Care system.

(However if you start peeing blood again, you move up the list awfully quickly - you are back to life threatening)

Elective Still free, but the waiting lists can be quite long. Hip replacement, Cataract operations again free, fall under this header. The waiting list can be years long.

Cosmetic As far as I know, not covered at all.

And as I mentioned above, Private Health Insurance is readily available in Australia to either reduce/eliminate co-payments or get that Cataract operation next week instead of waiting 2 years.

Oh, and anybody on a health care card - aged pensioners, unemployed, Disability Pension, Carers - pay no ambulance fees, pay scripts at around $6 each with an annual cap, and can often go to Medical Centres who Bulk Bill Government and do not ask for the co-payment ("the gap"). And of course, you can also buy Ambulance Insurance at quite low rates.

Norm
I used the word rationing deliberately to be provocative. Given the many views of it in posts upthread, perhaps it was too ambiguous as well. I simply mean that what therapies are reasonable to use to treat certain conditions is always going to be a decision that must be made, and it is not only based on the preferences of the individual patient/doctor. Nor, I venture, on pure medical considerations, but on larger public health decisions and yes the finances available. It has to be. And frankly I don't think that is wrong. I applaud the Gates foundation for funding third world vaccinations ( a cheap intervention that saves many millions of lives) rather than funding ways of helping first-country 100 year olds to more likely live to 101.
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Old 17th January 2017, 04:54 PM   #162
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Originally Posted by BobTheCoward View Post
They choose to do those things.
Of course any action people take is because they choose to do it. Choosing to carefully test drugs before widely using them is a good choice. As mentioned, thalidomide provided an except example of what happens if one chooses to do otherwise.
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Old 17th January 2017, 05:30 PM   #163
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Originally Posted by Giordano View Post
Of course any action people take is because they choose to do it. Choosing to carefully test drugs before widely using them is a good choice. As mentioned, thalidomide provided an except example of what happens if one chooses to do otherwise.
I wasnt commenting on the goodness of the choice.
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Old 17th January 2017, 07:08 PM   #164
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Originally Posted by pgwenthold View Post
Obviously.

I mean, come on! Think about it! There is no Sooper Sekrit Solution to health care that covers everyone and cuts costs. Anything that could possibly be done has already been suggested and discussed extensively. If it were as easy as having some people of Trump's transition team sitting down over the course of 2 months and getting it done, it would have been done years ago.
Obama only had the democrats to work with. He needed every single vote which means that every representative who demanded pork for his constituents had to be paid off.
I don't know to what a degree that happened, though.
I doubt the democrats will put the party ahead of the country, as well. Having more potential votes available should, in theory, make it easier to bring down costs.
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Old 17th January 2017, 07:52 PM   #165
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Organ transplants are probably a good area to see how services are rationed in your health care system. Finite supply, variable need.

This isn't rocket science - you get what you are willing to pay for.
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Old 17th January 2017, 09:42 PM   #166
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Originally Posted by Loss Leader View Post
That is just completely wrong.

Case in point: immunizations. The MMR vaccine doesn't treat early stages of those three diseases, it prevents them from occurring.
Oh sure, I should have included immunizations as the one big example of preventive medicine that actually prevents a disease from occurring. However, I kind of think of immunizations as more of a public health issue; yes, there is an individual benefit but the larger benefit is a public benefit. I'd support making those free through a government program to encourage more people to use them and thus reduce the risk to the general public.

But you skipped over the larger point being made in the rest of the post. Any comment on that?
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Old 17th January 2017, 09:45 PM   #167
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Originally Posted by Bob001 View Post
I get your point, but my point was that just pulling a tooth is much cheaper than, say, a root canal and crown. Of course routine preventative treatment earlier would have been better.
And what would have that consisted of? Brushing and flossing twice daily. If you don't do that bare minimum then there's nothing your dentist can do to prevent squat. The onus of prevention is on the patient.
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Old 17th January 2017, 10:01 PM   #168
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Originally Posted by xjx388 View Post
And what would have that consisted of? Brushing and flossing twice daily. If you don't do that bare minimum then there's nothing your dentist can do to prevent squat. The onus of prevention is on the patient.
If you think that's all it takes to avoid serious dental problems you've been very lucky.
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Old 17th January 2017, 10:14 PM   #169
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Originally Posted by GnaGnaMan View Post
Obama only had the democrats to work with. He needed every single vote which means that every representative who demanded pork for his constituents had to be paid off.
I don't know to what a degree that happened, though.
...
What evidence do you have for the highlighted claim? You admit you don't know in the next sentence. Looks like you have a self-made version of reality there.
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Old 17th January 2017, 10:38 PM   #170
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Originally Posted by Bob001 View Post
If you think that's all it takes to avoid serious dental problems you've been very lucky.
Well, I did say it was the bare minimum. Someone who does that everyday is much less likely to develop cavities, periodontal disease, etc. Add regular professional cleaning and the risk is negligible. But take away brushing and flossing and what happens? No professional preventive measures will prevent problems. The point is that the patient, in all realms of health care, has the primary responsibility to do preventive care on themselves. If we don't take care of ourselves, no doctor or dentist in the world can save us from ourselves.

This is the thing that gets me. If we just took care of ourselves we wouldn't need doctors anywhere near as much as we do now. But we don't. We want to smoke, drink, sit on our asses, eat all the tasty garbage we want ... and then we whine that we can't afford to pay the bill for the diabetes, heart disease, cancer etcthat results from our lifestyle. To my mind, that is the definition of "crazy."

And just to be clear, yes, I understand that not all disease is the result of lifestyle. However, is venture to say that a significant portion of it is directly tied to our lifestyles. If we take care of ourselves and limit the lifestyle related problems it would significantly lower our utilization of healthcare as a whole.
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Old 17th January 2017, 10:51 PM   #171
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Originally Posted by xjx388 View Post
And just to be clear, yes, I understand that not all disease is the result of lifestyle. However, is venture to say that a significant portion of it is directly tied to our lifestyles. If we take care of ourselves and limit the lifestyle related problems it would significantly lower our utilization of healthcare as a whole.
Hard to say off the cuff. Maybe you just shift the dollars to end-of-life care or pay for more hip replacements and cataract surgeries. No one gets out alive.
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Old 18th January 2017, 12:04 AM   #172
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Originally Posted by BobTheCoward View Post
That is a "when did you stop beating your wife" question because you are trying to take one narrow type of rationing and call it the whole thing.

Rationing is the controlled distribution of scarce resources. In this case, they ration care by setting limits on which services they will purchase.
No I am not, I am trying to help you understand what NICE's role is. It is to determine what treatments are available in NHS England and what constitutes good practice. What "rationing" takes place in the NHSs are at a different point.
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Old 18th January 2017, 12:16 AM   #173
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Originally Posted by marplots View Post
Organ transplants are probably a good area to see how services are rationed in your health care system. Finite supply, variable need.

This isn't rocket science - you get what you are willing to pay for.
Organ transplant isn't a matter of you get what you pay for, at least in the UK it isn't. You can't buy organs for transplant in the UK.
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Old 18th January 2017, 12:24 AM   #174
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Originally Posted by Darat View Post
Organ transplant isn't a matter of you get what you pay for, at least in the UK it isn't. You can't buy organs for transplant in the UK.
But if you have the money, you can travel and get one. (Or so I've heard.)

Someone in your government probably isn't allowing human organ imports. But the idea of rationing the ones you have arises. Unless the UK has enough to meet all the demand? If not, then someone has to sort out who gets one and who doesn't. I would call that rationing, but I understand it may go by a different term. No matter, it's a finite limit like any other.

ETA: This is from an article on the NHS site (from 2015):
Almost 49,000 people in the UK have endured the wait for an organ transplant in the last 10 years and over 6,000, including 270 children, have died before receiving the transplant they desperately needed, new statistics reveal.
https://www.organdonation.nhs.uk/new...e-last-decade/

Last edited by marplots; 18th January 2017 at 12:27 AM.
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Old 18th January 2017, 12:49 AM   #175
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Originally Posted by marplots View Post
But if you have the money, you can travel and get one. (Or so I've heard.)
I'm sure you can but that's really outside the scope of this part of the discussion.


Originally Posted by marplots View Post
Someone in your government probably isn't allowing human organ imports.
No, it's just there isn't the availability.

Originally Posted by marplots View Post
But the idea of rationing the ones you have arises. Unless the UK has enough to meet all the demand? If not, then someone has to sort out who gets one and who doesn't. I would call that rationing, but I understand it may go by a different term. No matter, it's a finite limit like any other. ...snip...
There are finite resources so of course there are limits on what can be done. In the UK NHSs' organ transplants are "rationed" according to clinical need, and often it can also be a matter of where you are geographically because (for most) organs there is a very tight window of opportunity to use an organ. Outside of that the organ may as well go into making a pie. (And of course having a suitable match with the donor etc.)

My objection to how Bob is using "rationing" is that he is using it so broadly that anything could be described as being rationed. Given the breadth of his useage it would be accurate to say that food is rationed in the USA and the UK. I don't think people would recognise that useage.

In my opinion he is also not understanding what NICE's role in the NHS is - i.e. a gatekeeper. That's why asking what rationing does NICE impose on the treatment of broken bones is entirely on topic and relevant to the discussion because such treatments are "rationed" in the exact same way as the latest cancer treatment.

NICE sets what is clinically "best practice" in NHS England, it reviews the evidence of a treatment's clinical effectiveness and cost and decides if it should be provided by the NHS or not.

Also NICE's decisions are not binding, what treatments are actually funded is down to "clinical commissioning groups" (don't get me started on the stupidity of the change to "clinical commissioning groups" that's a separate discussion entirely.) Individuals can also challenge NICE's recommendations even via the courts.
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Old 18th January 2017, 06:51 AM   #176
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Originally Posted by Darat View Post
My objection to how Bob is using "rationing" is that he is using it so broadly that anything could be described as being rationed. Given the breadth of his useage it would be accurate to say that food is rationed in the USA and the UK. I don't think people would recognise that useage.
Would you prefer "budgeting?"
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Old 18th January 2017, 07:14 AM   #177
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Originally Posted by Darat View Post

My objection to how Bob is using "rationing" is that he is using it so broadly that anything could be described as being rationed. Given the breadth of his useage it would be accurate to say that food is rationed in the USA and the UK. I don't think people would recognise that useage.
My objection to your objection is that I am using it correctly. In the social sciences it is far more broadly used. While the food market as a whole isn't rationed, every single individual purchasing food is rationing.
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Old 18th January 2017, 07:31 AM   #178
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Originally Posted by marplots View Post
Who do you have to deny service then? It's an important part of any health care system - the authority able to ration care.

An organistaion called NICE use the QALY.

https://en.wikipedia.org/wiki/Nation...are_Excellence

https://en.wikipedia.org/wiki/Qualit...sted_life_year
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Old 18th January 2017, 07:39 AM   #179
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Originally Posted by mikado View Post
my god, no one. our health care is not rationed.
Where are you?

In the UK, healthcare is rationed.
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Old 18th January 2017, 08:27 AM   #180
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Originally Posted by Beelzebuddy View Post
Would you prefer "budgeting?"
Not if referring to NICE's role.

Money and availability of treatment is of course a limiting factor in all health systems, don't think anyone would deny that and there is rationing in the UK NHSs, but what NICE does is not the rationing that happens in the UK NHSs, NICE has no control over budgets etc. It's simply not what it does.

From the NICE website:
Quote:
...snip....

NICE's role is to improve outcomes for people using the NHS and other public health and social care services. We do this by:
  • Producing evidence-based guidance and advice for health, public health and social care practitioners.
  • Developing quality standards and performance metrics for those providing and commissioning health, public health and social care services.
  • Providing a range of information services for commissioners, practitioners and managers across the spectrum of health and social care.

...snip...
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Old 18th January 2017, 08:31 AM   #181
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Originally Posted by BobTheCoward View Post
My objection to your objection is that I am using it correctly. In the social sciences it is far more broadly used. While the food market as a whole isn't rationed, every single individual purchasing food is rationing.
Have to say I've not seen the USA food supply described as rationed. But I have no reason to not believe you. I would however say that I doubt most people seeing the word "rationing" would think that you were meaning "everything that is finite is rationed".

But my main point remains (even with your definition of "everything that is finite....") NICE is not the one doing the rationing.


ETA: Sorry if you think this is semantic/pedantic squabbling but in terms of the UK and our rapidly deteriorating health care system it's a very important distinction that is often confused.
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Old 18th January 2017, 08:39 AM   #182
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And by total coincidence how rationing actually happens in NHS England is part of the topic of Inside Health a Radio 4 programme as I'm typing this.
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Old 18th January 2017, 09:07 AM   #183
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Originally Posted by Darat View Post
Have to say I've not seen the USA food supply described as rationed. But I have no reason to not believe you. I would however say that I doubt most people seeing the word "rationing" would think that you were meaning "everything that is finite is rationed".

But my main point remains (even with your definition of "everything that is finite....") NICE is not the one doing the rationing.


ETA: Sorry if you think this is semantic/pedantic squabbling but in terms of the UK and our rapidly deteriorating health care system it's a very important distinction that is often confused.
A cost benefit analysis requirement is a form of rationing healthcare.
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Old 18th January 2017, 12:25 PM   #184
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You can see the difference (in the food supply parallel) by noting the US throws out a huge amount of food. There's an oversupply that gets dumped. Is that also the case with healthcare in Britain?
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Old 18th January 2017, 01:04 PM   #185
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Originally Posted by BobTheCoward View Post
My objection to your objection is that I am using it correctly. In the social sciences it is far more broadly used. While the food market as a whole isn't rationed, every single individual purchasing food is rationing.
In non-academic circles, "rationing" strongly implies that a governmental authority is setting limits on purchases and supplies: Food rationing in war zones, gasoline rationing in the '70s etc. If you think rationing just means "limited by how much you can pay for and how much there is to buy," then everything is rationed to everybody. Even Jeff Bezos and Bill Gates don't have infinite resources, and even if they did, supplies are not infinite. It's not useful concept for discussing health care. The fact is that in the U.S. you can buy all the health care you can pay for, including expensive and often misguided cosmetic procedures. The question on the table is how to pay for ordinary care for ordinary people.
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Old 18th January 2017, 01:19 PM   #186
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Originally Posted by marplots View Post
Organ transplants are probably a good area to see how services are rationed in your health care system. Finite supply, variable need.

This isn't rocket science - you get what you are willing to pay for.
I'm not sure organ donation works that way. There is a shortage of organs, and patients are prioritized by how much benefit they will receive and other factors. I'm not sure costs figure in at all. You can't buy your way to the top of the list. At least in theory, per my understanding.
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Old 18th January 2017, 01:22 PM   #187
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Originally Posted by Bob001 View Post
In non-academic circles, "rationing" strongly implies that a governmental authority is setting limits on purchases and supplies: Food rationing in war zones, gasoline rationing in the '70s etc. If you think rationing just means "limited by how much you can pay for and how much there is to buy," then everything is rationed to everybody. Even Jeff Bezos and Bill Gates don't have infinite resources, and even if they did, supplies are not infinite. It's not useful concept for discussing health care. The fact is that in the U.S. you can buy all the health care you can pay for, including expensive and often misguided cosmetic procedures.
You can pretty much in EU too, there is after all private clinic.

Quote:
The question on the table is how to pay for ordinary care for ordinary people.
Bull's eye.
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Old 18th January 2017, 01:40 PM   #188
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Originally Posted by Bob001 View Post
In non-academic circles, "rationing" strongly implies that a governmental authority is setting limits on purchases and supplies: Food rationing in war zones, gasoline rationing in the '70s etc. If you think rationing just means "limited by how much you can pay for and how much there is to buy," then everything is rationed to everybody. Even Jeff Bezos and Bill Gates don't have infinite resources, and even if they did, supplies are not infinite. It's not useful concept for discussing health care. The fact is that in the U.S. you can buy all the health care you can pay for, including expensive and often misguided cosmetic procedures. The question on the table is how to pay for ordinary care for ordinary people.
That's a pretty silly statement. How to ration is the crux of the issue in health care.

Anything tangible that people value is rationed. If they don't value it, then there would be no unmet demand and hence no need for rationing. If they do value it, then there must be unmet demand. Health care resources are perhaps the most rationed resources in existence. This is because, unlike water, or food, or oxygen, or shelter, or transportation, or sex, or smartphones, there is almost no limit to the amount of health care resources that a person can consume in one's lifetime. If some health care resource is developed which can extend quality life by one day more, then it will have value and there will be demand. There won't be demand for the 8 billionth iPhone because an extra iPhone is just junk - a liability rather than an asset.

So societies ration health care resources. The only interesting question is how they go about doing it. Do they do it by bureaucratic fiat? By waiting time (also known as first come, first served)? By price? Or by some combination of the three? The best way to do it, in my opinion, is by price. It optimizes utility on the consumer side, and it has the side benefit of stimulating production in precisely those areas which need it the most. Most people understand and accept that the price system works best in other areas of the economy, but for some reason rebel against the idea when it comes to health care. I think this is due to cognitive bias and simplistic thinking. Alas, that's humanity for you.
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Old 18th January 2017, 01:51 PM   #189
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For probably the first time I find myself aligned with Bob the Coward.

In using the word rationing I was referring to the broad idea that when a resource is not unlimited, rationing is some method (governmental or not) that controls/restricts who gains access to it. Not person by person so much as by criteria required for access. My original post indicated that I believed availability of health care controlled by personal wealth was indeed a form of rationing, and that this is essentially the same concept as when availability is controlled by the decisions of government expert panels.

And yes, in that regard almost everything is "rationed." My point in using the word for health care was to emphasize just that- that in virtually all societies there are limits to the access of individuals to at least certain potential treatments (saying nothing about the value of those treatments). In many cases this rationing is completely rationale, fully humane, and even often beneficial (particularly when done by experts to maximize the most effective delivery of health care to the people in the society). It is similar to other issues in public health as to what are the most effective ways of maximizing the health of the population as a whole: should one offer free vaccinations for poor people against polio (which is very rare in the USA), and if no, would that allow financing of a free vaccine against a disease that is currently a problem in the USA? If there is only enough money for one or the other- rationing (in a way) reflects in a way the choice of the decision of how to best spend it. Rationing is meant as an insult or a negative- just a reflection of the almost inevitable limitations in any resource.
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Old 18th January 2017, 02:00 PM   #190
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Originally Posted by sunmaster14 View Post
That's a pretty silly statement. How to ration is the crux of the issue in health care.

Anything tangible that people value is rationed. If they don't value it, then there would be no unmet demand and hence no need for rationing. If they do value it, then there must be unmet demand. Health care resources are perhaps the most rationed resources in existence. This is because, unlike water, or food, or oxygen, or shelter, or transportation, or sex, or smartphones, there is almost no limit to the amount of health care resources that a person can consume in one's lifetime. If some health care resource is developed which can extend quality life by one day more, then it will have value and there will be demand. There won't be demand for the 8 billionth iPhone because an extra iPhone is just junk - a liability rather than an asset.

So societies ration health care resources. The only interesting question is how they go about doing it. Do they do it by bureaucratic fiat? By waiting time (also known as first come, first served)? By price? Or by some combination of the three? The best way to do it, in my opinion, is by price. It optimizes utility on the consumer side, and it has the side benefit of stimulating production in precisely those areas which need it the most. Most people understand and accept that the price system works best in other areas of the economy, but for some reason rebel against the idea when it comes to health care. I think this is due to cognitive bias and simplistic thinking. Alas, that's humanity for you.
Oddly now I find myself also agreeing with several points made by Sunmaster! What a day. I am okay with much of what you say in this post until the last paragraph. Then I rebel strongly. The price system works in many aspects of society, but fails miserably (in practice and in ethics) in others. I believe it is clear from most people's moral point of view that personal wealth should not be allowed to determine who suffers serious, otherwise-treatable illnesses and who lives or dies. This is not simplistic or a cognitive- this is an ethical "bias" that I think and hope most people have. It is not just limited to health either- for example most societies believe that access to police/military protection and to fire protection should be independent of the wealth of the given individual. "Oh sorry- I know you are being assaulted but unless you can pay us $5000 we can't send any police over to help you..."

Pricing might work as a simple method of "rationing" resources, but that alone doesn't make it moral or ethical.

Last edited by Giordano; 18th January 2017 at 02:02 PM.
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Old 19th January 2017, 05:32 AM   #191
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I found this interesting. I'm wondering if it's accurate.


http://imgur.com/gallery/4eKNq

Edit: For those who can't/don't want to click:

“It’s estimated the repeal would cost $1.5 trillion,” Colbert cited. “Now, $1.5 trillion might sound like a lot, but for that much money, you also don’t get health insurance.” The problem with the repeal and replace plan is that the Congressional Budget office does reports by law that outline a law’s impact if it costs over $5 billion. “With one, this is kind of funny exception, thanks to new rules passed by the Republicans, this law shall not apply to repealing the Affordable Care Act,” Colbert revealed. “That’s right. The GOP is so confident the repeal will save money, that they don’t want to know if that’s true, and if congress can make it illegal for us to know how much it costs to repeal Obamacare.“
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Old 19th January 2017, 05:45 AM   #192
uke2se
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Originally Posted by 3point14 View Post
I found this interesting. I'm wondering if it's accurate.


http://imgur.com/gallery/4eKNq

Edit: For those who can't/don't want to click:

“It’s estimated the repeal would cost $1.5 trillion,” Colbert cited. “Now, $1.5 trillion might sound like a lot, but for that much money, you also don’t get health insurance.” The problem with the repeal and replace plan is that the Congressional Budget office does reports by law that outline a law’s impact if it costs over $5 billion. “With one, this is kind of funny exception, thanks to new rules passed by the Republicans, this law shall not apply to repealing the Affordable Care Act,” Colbert revealed. “That’s right. The GOP is so confident the repeal will save money, that they don’t want to know if that’s true, and if congress can make it illegal for us to know how much it costs to repeal Obamacare.“
Apparently this isn't true. The law exempts the repeal of the laws constituting the ACA from long term analysis required by other measures over $5bil.

It's still a stupid exemption, but the CBO can still analyse a repeal's cost over shorter terms.

http://www.politifact.com/truth-o-me...cost-obamacar/
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Old 19th January 2017, 05:50 AM   #193
3point14
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Originally Posted by uke2se View Post
Apparently this isn't true. The law exempts the repeal of the laws constituting the ACA from long term analysis required by other measures over $5bil.

It's still a stupid exemption, but the CBO can still analyse a repeal's cost over shorter terms.

http://www.politifact.com/truth-o-me...cost-obamacar/

Thank you!
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Old 19th January 2017, 06:12 AM   #194
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We need to bring back one form of rationing: death panels. Grandpa is going to die in 2 weeks. But if we do this expensive procedure, he will die in 4. Do you kids want grandpa to die before or after Christmas? Yey! No ruined Christmas.

We are allpaying for that.
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Old 19th January 2017, 08:37 AM   #195
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Originally Posted by sunmaster14 View Post
The best way to do it, in my opinion, is by price. It optimizes utility on the consumer side, and it has the side benefit of stimulating production in precisely those areas which need it the most. Most people understand and accept that the price system works best in other areas of the economy, but for some reason rebel against the idea when it comes to health care. I think this is due to cognitive bias and simplistic thinking. Alas, that's humanity for you.
Not all differences in opinion are because someone is wrong. Some differences in opinion are just that.

Many people believe that all people are equal and have an inalienable right to live. In some circles of US-American thinking this is a hugely important tenet.

Those who believe that, will not accept that life-extending treatment is withheld based on an individual's economic performance.

That does not mean that they do not understand the price argument. It is simple enough: If it costs more wealth to save someone than his labor is worth, then letting him die leaves more resources for the rest of us. We can use those resources for something better, like luxuries or waging war.

The question is simply what someone values. A right to live, the glory of the nation, or luxuries.

(Of course, where luxuries are concerned we have the additional question of who gets to enjoy those. The people doing the early dying and the people doing the consuming tend not to be the same.)
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Old 19th January 2017, 01:18 PM   #196
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I saw the phrase, "cost the states" used in that. It makes me suspicious because the money might just be a shift away from federal payments to the states (and back to the status quo ante). If that's the case, then a "cost to the states" might just mean "costs the feds less" as money is moved around in new ways.

Where does this figure come from? What is the money spent on? I hope it isn't one of those "stopping preventative care means we pay more later" deals.
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Old 19th January 2017, 02:24 PM   #197
sunmaster14
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Originally Posted by GnaGnaMan View Post
Not all differences in opinion are because someone is wrong. Some differences in opinion are just that.
Of course, but in this case I've found that the differences of opinion do not arise from different values or different starting principles (axioms, if you will), which would all be well and good. They arise because, in almost all cases I've seen - especially here - those who believe the free market couldn't or shouldn't apply to health care resources have done no more than a skin-deep analysis. They don't appear to understand that the vast majority of health care resources produced and consumed are not urgent and life-saving and no more crucial to human happiness and comfort than resources for which we accept free market allocation. Furthermore, they don't appear to understand that there are non-health care related resources which are urgent and life-saving, for which we accept free market allocation.

Quote:
Many people believe that all people are equal and have an inalienable right to live. In some circles of US-American thinking this is a hugely important tenet.
What do you mean by an inalienable right to live? You don't have an inalienable right to live if you are starving and the only food available belongs to me. Or if you need shelter from the freezing cold, and my house is the only one available. As we become richer and develop more health care resource capacity, we can guarantee more and more health care to those who need it, but we will never be able to guarantee an unlimited amount. Or even the amount that the richest 1% of the population can afford. Right now, thanks to our wealth, we can afford (without putting too much of a burden on others) to treat a traumatic injury in the emergency room regardless of the ability of the victim to pay. But we can't provide state-of-the-art cancer treatment or the fanciest robotic brain tumor surgery to everybody who needs it.

More importantly, those resources wouldn't be available to anyone, even Bill Gates, if we hadn't allowed the free market to work to some extent in health care. I have argued here before that the US ends up carrying the lion's share of the R&D burden in health care because we have largely avoided price controls on health care whereas other developed countries have not. Even worse, we have to hear the ungrateful wretches from other countries talk down to us and brag about the health care that we effectively subsidize.

Quote:
Those who believe that, will not accept that life-extending treatment is withheld based on an individual's economic performance.
You use the word "withheld" to put a moral spin on your claim. But it is not withheld any more than the car dealer withholds the fully-loaded BMW with all of the newest and fanciest driver assist and safety features from somebody who can't afford it. If life-extending treatment for some ailment is available in limited quantities, then rationing has to be done in some manner. Would you rather it be by who has the best political connections? That's how it is done, in the end, in most countries with socialized health care. Or by queue? Maybe the guy at the head of the queue got there by pulling some strings. Or by going abroad to get a diagnosis first. Or by racing to the clinic in his BMW while the poor schlub behind him had to take the bus.

Quote:
That does not mean that they do not understand the price argument. It is simple enough: If it costs more wealth to save someone than his labor is worth, then letting him die leaves more resources for the rest of us. We can use those resources for something better, like luxuries or waging war.
Well, given what you just wrote, it does appear you don't understand the price argument. That is not how the pricing system works in any free market. Nobody measures how productive you are when you come in to buy something.

Quote:
The question is simply what someone values. A right to live, the glory of the nation, or luxuries.
I value human utility. But everybody has their own utility function. Some people value their own life or the lives of their friends and family members more than others. Some people value certain qualities of life, or health, or the ability to do certain physical things, more than others. If I'm not active, then perhaps I don't need to get that knee surgery so I can keep playing tennis. But, hell, if it's free, I'll take it.

Quote:
(Of course, where luxuries are concerned we have the additional question of who gets to enjoy those. The people doing the early dying and the people doing the consuming tend not to be the same.)
Everything is a luxury from a certain point of view. I do not decide for other people how to rank their luxuries. If somebody enjoys smoking cigarettes more than living a few extra healthy years, who am I to judge?

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Old 19th January 2017, 06:43 PM   #198
GnaGnaMan
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Originally Posted by sunmaster14 View Post
Of course, but in this case I've found that the differences of opinion do not arise from different values or different starting principles (axioms, if you will), which would all be well and good. They arise because, in almost all cases I've seen - especially here - those who believe the free market couldn't or shouldn't apply to health care resources have done no more than a skin-deep analysis. They don't appear to understand that the vast majority of health care resources produced and consumed are not urgent and life-saving and no more crucial to human happiness and comfort than resources for which we accept free market allocation. Furthermore, they don't appear to understand that there are non-health care related resources which are urgent and life-saving, for which we accept free market allocation.
I am not sure where you are going with this.

Quote:
What do you mean by an inalienable right to live? You don't have an inalienable right to live if you are starving and the only food available belongs to me. Or if you need shelter from the freezing cold, and my house is the only one available.
Inalienable means that it never goes away. That means one still has it in these situations you describe.

Quote:
As we become richer and develop more health care resource capacity, we can guarantee more and more health care to those who need it, but we will never be able to guarantee an unlimited amount. Or even the amount that the richest 1% of the population can afford. Right now, thanks to our wealth, we can afford (without putting too much of a burden on others) to treat a traumatic injury in the emergency room regardless of the ability of the victim to pay. But we can't provide state-of-the-art cancer treatment or the fanciest robotic brain tumor surgery to everybody who needs it.
Source?

Quote:
More importantly, those resources wouldn't be available to anyone, even Bill Gates, if we hadn't allowed the free market to work to some extent in health care. I have argued here before that the US ends up carrying the lion's share of the R&D burden in health care because we have largely avoided price controls on health care whereas other developed countries have not. Even worse, we have to hear the ungrateful wretches from other countries talk down to us and brag about the health care that we effectively subsidize.
It is unusual to ask for gratefulness for positive externalities.
Is there actual evidence that this is even the case?

Quote:
You use the word "withheld" to put a moral spin on your claim. But it is not withheld any more than the car dealer withholds the fully-loaded BMW with all of the newest and fanciest driver assist and safety features from somebody who can't afford it.
I do not understand why your interpretation of the word "withheld" is important here. I think you want to say that you do not share those moral beliefs?

Quote:
If life-extending treatment for some ailment is available in limited quantities, then rationing has to be done in some manner. Would you rather it be by who has the best political connections? That's how it is done, in the end, in most countries with socialized health care. Or by queue? Maybe the guy at the head of the queue got there by pulling some strings. Or by going abroad to get a diagnosis first. Or by racing to the clinic in his BMW while the poor schlub behind him had to take the bus.
What countries do you mean here? When I hear socialized health care I think of countries like the UK or Canada. Those countries are not known for high levels of corruption; quite the opposite, in fact. Maybe you have a narrower definition in mind.

Quote:
Well, given what you just wrote, it does appear you don't understand the price argument. That is not how the pricing system works in any free market. Nobody measures how productive you are when you come in to buy something.
Maybe this needs to be thought through. Let's start with a think about the free market:
Say, there's a boat-load of oranges that gets put up for auction. Two juice factories make bids. The higher bid wins.
Both factories have to sell their at the same world market price. So which factory makes the higher bid?
The one that is more 'productive. That factory can afford to spend more for raw materials while still turning a profit.
No one literally measures which one that is but if you like metaphors you could say that the invisible hand measures it.

Now let's say a guy needs medical treatment to remain able to work/live. The treatment costs $X more than he has. What now?
If his potential income is high enough that he can be expected to pay back $X + interest, then lending him the money for the treatment becomes a good investment.
In this case we need someone who measure his expected income: A credit lender, investor, or insurance company. If you want to buy on credit someone will indeed measure how productive you are.
But as with the oranges, we find that the market directs the resources where they will get a good return.

Quote:
I value human utility. But everybody has their own utility function. Some people value their own life or the lives of their friends and family members more than others. Some people value certain qualities of life, or health, or the ability to do certain physical things, more than others. If I'm not active, then perhaps I don't need to get that knee surgery so I can keep playing tennis. But, hell, if it's free, I'll take it.
Seems reasonable but what's your point? It sounds like you want to propose a scheme where personal utility determines what treatments someone gets. How would that work?
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Old 19th January 2017, 07:55 PM   #199
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Originally Posted by Tero View Post
We need to bring back one form of rationing: death panels. Grandpa is going to die in 2 weeks. But if we do this expensive procedure, he will die in 4. Do you kids want grandpa to die before or after Christmas? Yey! No ruined Christmas.

We are allpaying for that.
The ACA included a provision that paid doctors for talking to patients about end of life options. This was removed after Republicans claimed it was a death panel. The removal of this provision did nothing to stop the claim that the ACA had death panels.

The interesting part is that patients who forgo that last heroic attempt at a cure in favor of hospice care often live longer. Most have a better quality of life during those final days.
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Old 19th January 2017, 08:45 PM   #200
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So, without reading every post, is Trump going to make sure everyone is covered or should we just disregard that statement?
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