Read the article Why We Must Ration Health Care by Peter Singer. Does the author make a good case for rationing? Why or why not?
Due Friday, December 14, 2012
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I think the author makes a good case for rationing health care. I believe that there should be limits set so that health care costs are not extremely high. I value life and think that everyone should have the chance to receive the treatment they need to survive, but not at the cost of other people having to live without health insurance and go without treatment.
The author Peter Singer does make a good case for rationing health care, and I do agree with his ideas. First off, Singer gives an scenario where we would have to imagine having advanced kidney cancer and we would have the option of taking Sutent (a drug that slows down cancer), but the catch would be that it would cost 54,000 dollars for only 6 more months. He then goes onto say of course if we had the money to pay for the treatment we would more than likely do it and there would be no problem. But if we could not afford to pay for the treatment then we would have to rely on our insurance to pay for the cost, and in doing so affect everyone else around us. The question that comes to mind is whether or not it is ethical for us to allow someone to get treatment that only prolongs there life for a limited amount of time, versus telling someone they can not have a treatment because of the expense. I agree with Singer in that rationing should be considered, but only to a point. Two factors should go into deciding whether or not someone should be given an expensive treatment, and those are their quality of life during their treatment and the amount of money. For instance, if someone has incureable brain cancer and the treatment for the person is 100,000 dollars, for only a few months with low quality of life then this should not be allowed. Versus have someone who is a quadriplegic like mentioned in the article, if their treatment is 100,000 dollars but their quality of life is improved and they are given the ability to live a better functioning life then I agree they should get the treatment. Again it all depends on the cost, and the quality of life the person will receive after the treatment. In the end, I agree with Singer’s perspective on rationing of health care.
Yes, he does make an arguable case for rationing right here, “If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades.”
No, he does not make a good case for rationing. This current situation is eerily reminiscent of the movie out of time, wherein people have internal clocks that they have to put time into- time is their currency. They purchase everything with time, and they work to be paid in time. When their time goes to zero, they die. This is a direct synonym for what is happening right now in the American healthcare system. The poor die. The whole thing upsets me horribly, and I don’t think that rationing or limiting healthcare is the way to go. I took micro and macro economics this semester, and I was exposed to the world's healthcare system and where we rank in it, and it is sickening. Our spending is quadruple that of any other country, and there are countries spending a tenth of what we do on healthcare and they have some of the best healthcare systems in the world, without an ever-growing healthcare debt. Healthcare reform absolutely has to happen, its just a matter of how. We need to cut out unnecessary spending, not the necessary spending on providing healthcare. Everything should be made electronic, which would eliminate mountains of paperwork and an army of bureaucrats to sort them, which constitutes 30% of healthcare costs. Pharmaceutical companies that want to fill their pockets by selling a drug at a 2000% markup should be illegal. Companies should be allowed to make a profit, but not 10 times as much profit at the cost of peoples lives. Rationing will only hurt the patients.
Two problems that contribute to the lack of Americans receiving healthcare; cost and access. Because of the rising cost of healthcare, the number of people able to access it is decreasing. In order for healthcare to continue as a successful business in this country, a reformation of the system has to take place. The healthcare system as it stands today, can not and will not continue. It will collapse, much in the same way as the Still There Motel mentioned in our book. Considering that in 2009, the U.S. Spent 17.3% of its GDP on healthcare, and Singapore only spent 3.8%, yet they have some of the best healthcare in the world, yet Singapore is rated number one in terms of the affordability. If you look at figure 21.1 on p436, you can see the percentage spent on healthcare. How does Singapore provide healthcare as good as ours, yet spend so much less? What is it about our system that isn’t working then? There is plenty of funding, we have spent more than double as much as the next leading nation in the world on healthcare, so funding certainly isn’t the issue; so what is the issue?
Singapore currently has a combination of government-mandates that encourage competition and high out of pocket costs for consumers. Hospitals are required to post the prices for their procedures as well as their track record of these procedures. This allows consumers to shop for the best deal. High out of pocket costs for the consumer sounds bad; it sounds like something we don’t want here in the U.S. However, this is actually a great system that prevents consumers from over-consumption of service, which is one of the reasons why healthcare in the U.S. Is continuing to go up. This is in our nature as Americans armed with insurance; we are more prone to seek medical care when none is even needed. In Singapore, 92% of all non-governmental spending are represented by out of pocket costs to the consumer, whereas that figure is only 12% in the U.S.(McConnell p448) It seems to me that the people of Singapore are doing something right, but I do not like the idea of government-mandated savings programs like their “Medi-Save” program. We already pay taxes, I feel like our government should make wiser use of their money before even considering telling us to set aside 6% of our income to health insurance. I much prefer the approach that Ben Carson takes on reforming our healthcare system, I will get into that later though.
The decrease in access to healthcare is a direct result of the rising cost. As an individual's income decreases, the chance of them being uninsured increases. Conversely, as an individual's income increases, so does the probability that the individual will have healthcare coverage. In 2008, 15% of the American population had no health insurance for the entire year; and as the cost of healthcare (and therefore annual healthcare premiums) continues to increase, so will the number of uninsured. Medicaid is designed to provide health care for the poor who are on welfare. But many poor people work at low or minimum wage jobs without health care benefits, earning “too much”to qualify for Medicaid, yet not enough to afford private health insurance.(1) So if healthcare availability is influenced by its cost, then what influences the cost? If we can lower the cost then we stand a chance to decrease the number of Americans that are uninsured.
So now let's take a look at what causes healthcare costs to increase. If we can decreases these factors then we can increase the number of uninsured in the U.S. I found a website that provides a pretty comprehensive list of contributing factors to the rise in cost of healthcare. However, they all fall into one category, which is waste. This is no surprise, America is a wasteful society. We do have governmental programs for the environment but it is in our nature to be wasteful. We consume more than we need to sustain ourselves. Unnecessary services, including high cost services (full body scans to perfectly healthy individuals), the frequency of care (unnecessary visits), and defensive medicine.(2) Now just what is defensive medicine? “Defensive medicine occurs when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or solely) to reduce their exposure to malpractice liability.”(3)
In addition to unnecessary procedures, administrative waste, inefficiently delivered services, fraud, and missed prevention opportunities all contribute to the rise in price of healthcare. So what are all of these things? Administrative waste is categorized by the duplicative costs of administering different plans, and unproductive documentation. Inefficiently delivered services include medical errors, uncoordinated care, and inefficient operations.(2) Fraud is self explanatory, but includes Medicare and Medicaid fraud, as well as an insufficient investment to detect these fraudulent occurrences. Missed prevention opportunities basically indicates a poor delivery of clinical prevention services.(2) A good example of this is a man with diabetes comes in and has to have his foot amputated. The cost of this is much higher than preventative measures such as regular checkups and educating the man on his condition, teaching him how to deal with his illness.
Now that we have identified the causes of the decrease in access and the rise in the cost of healthcare, what can be done to repair it? There has been much talk on both sides of the fence about how effective Obama-care is going to be. I understand what nationalized healthcare is, but I am not informed on this program at all, so far as the specific details, or why some say it is going to work and others say it is a futile, stupid program. So I really don't know if this is going to be a good thing or a bad thing. I have many friends in medical school who are working very closely with physicians and other workers within many hospitals, and they are unanimously against this new plan. They say that it is going to be even harder for doctors to make money; yet, other doctors scoff and say, “go look in the parking lot, there aren’t any doctors driving a Nissan. We all have Porsches and Maseratis, we are going to be fine.”
Again though, I don’t know enough about the topic to argue one way or the other. However, about six months ago I saw a movie called “gifted Hands: the Ben Carson Story.” It was about a black child growing up in a single family home with his mother who had a third grade education and his older brother. Over the course of many years, with the encouragement of his mother and living in what he called “the no excuses household,” he essentially went from being the “class dummy” to being a top student, he got a full academic scholarship to Yale, and is now the Director of Pediatric Neurosurgery at Johns Hopkins. After watching this movie, which was a true story, I started watching interviews with the real life Ben Carson, and he is one of the most insightful, thoughtful individuals that I have ever heard speak. In one particular hour long interview, he outlined a plan.
First of all, he said, he doesn’t know anybody who thinks healthcare reform shouldn’t be done; it is absolutely crucial, and it should be available to everybody, and the cost should be reasonable. So, how do we get there? Certainly not by throwing money at the issue; we have already spent twice as much per capita on healthcare as the next leading nation in the world.(4) So that certainly will not do anything to remedy this problem. So the problem certainly isn’t a shortage of money, we are already spending more than double the amount as the next leading nation in the world is on healthcare. The real problem is that we are not utilizing this money as efficiently as we cold be. So in order to repair this broken system, we need to take real measures to get costs under control. Billing and collections is an expense that most practices spend between 20-30 percent on, and it is completely unnecessary.(4)
In this portion of his plan, he says that every medical diagnosis has what is called an ICD9 code, and every treatment has a CPT code. This means is that all billing and collections can be done immediately, electronically, by computer, and without producing piles of papers massive workforces of people to push them around, which is completely unnecessary. We can do everything electronically at a fraction of the cost.(4)
There is question as to the integrity of this option, as a healthcare practitioner could simply enter in a procedure once that he only did twice, and get paid double, and nobody would ever know. Ben Carson said that he doesn’t know anyone that would ever do such a thing. But, there are certainly a few that may do such a thing. In his own words, “the answer to this is not to build a gigantic bureaucracy that is very costly, but what I call the Saudi Arabian solution.” In Saudi Arabia, if you are caught stealing, they will cut off your hands. The penalty for stealing is so steep that nobody would even think of stealing in Saudi Arabia. So the same approach can be taken in this program. Not necessarily cutting off the doctor's hands, but the penalty would be so steep that cheating would never even be considered. If a doctor were caught cheating this system, they would automatically lose their license to practice forever, go to jail for no less than 10 years, lose all personal assets. Not only would people not cheat, but NO mistakes would be made because everyone would check entries multiple times.(4) Carson later draws a parallel between this new system and why people don’t drive drunk in Sweden; the penalty for it is so severe that nobody would even think about it. With these extreme consequences in place the result would be the same. So, eliminating bureaucracy and putting in their place severe punishments for violators would dramatically reduce costs.
Some might say that putting such a system into effect would be impossible, but I think it is safe to say that stranger, more extreme things happen every day. It just seems impossible because people will always take the devil they know over the devil they don’t know. It seems hard to conceive of such a system replacing the one that we know so well. However, the system that is currently in place is costly and grossly inefficient. Howe is it that we are spending twice as much on healthcare as any other county in the world but there are still those who cannot afford it? If we are putting this much money into a system why is it still not available to everyone? Like Carson stated, it is because we are not spending the money as well as we could be. It is also stated in the book that one of the most important contributors to rising costs is the fact that most of U.S. Healthcare is paid for by private insurance companies. When people overuse and take advantage of having insurance, the costs go up due to unnecessary services, and as a result, the premiums go up so the insurance companies can cover their expenses and still make a profit.
The next thing that Carson suggests to reduce costs is to make the government responsible for catastrophic healthcare. What is catastrophic healthcare? I had no idea, this is what I found: “Catastrophic health insurance plans are one option for individuals or families who do not have coverage through an employer or cannot afford the cost of private health insurance plans. Coverage is generally limited and deductibles are high through a catastrophic health insurance plan, but an individual’s or family’s assets are still protected in the event of an illness or injury. Catastrophic healthcare is also known as high deductible plans because that is a primary feature, with deductibles as high as $15,000. These plans cover hospital stays, surgeries, major medical costs, but not routine visits. The good thing about these plans is the super low premiums, but the trade off is the high deductible.”(5) So, what in the world would we accomplish by making the government responsible for catastrophic healthcare? It was too difficult to try to put this into my own words that were still understandable and to the point, so I am going to quote him directly.
“Now a lot of people say the government shouldn’t be responsible, and they cant do anything right, but that’s not exactly true. The government has done a number of things that have helped all of us. For instance, the reason we can own our homes is because we have homeowners insurance. Now, we wouldn't be able to get homeowners insurance if there were not a government agency known as FEMA. Your insurance company would say “there may be a hurricane, there may be an earthquake, there may be this, that, and the other.' So we have to be prepared for all of those things and the premiums would just skyrocket, and you would have to have that through your employer too. The same thing would apply for healthcare; if the government is responsible for catastrophic healthcare, and the insurance companies are responsible for routine healthcare, then it will be pretty easy for the insurance companies to predict what their outgoing expenses are going to be, as well as how much money they need to take in. This will allow them to be regulated the same way as the utility companies are regulated. I guarantee that if the government didn’t regulate utilities, the utility companies would be finding all kinds of reasons why water and electricity should be a lot more than it is.” This would dramatically reduce the cost, and the ideal would be to get the cost down to the point where people could afford their own insurance and they wouldn’t have to have it through their employer. Also, if you own your own insurance, I can say to you, 'if you get an annual physical exam, you get a 2-3% discount.' Then you are inscentivized to get that physical exam, and we catch stuff early, which ties to preventative care, and a whole new level of savings.”(4) Can you imagine what homeowners insurance would cost if it wasn’t regulated? Why not take the same approach to healthcare?
What about this idea of nationalized healthcare? Well, in this hypothetical scenario where there are no longer have 44 million uninsured Americans, how can we save money? Well first of all, these people do not exist today. If needed, we can go to the emergency room and be treated without insurance. But, if we have a nationalized system how can we “inscentivize” these people not to go to the ER? Since we are already paying for them, why pay for an ER visit that is going to cost quadruple what it would at a clinic? What we would need to do to prevent this is to encourage them to go to the clinic instead of the ER. To do this, Carson has suggested a program similar to the food stamp program. If people are given a monthly allocation of money on a card, they will learn very quickly not to to exhaust the money at the beginning of the month by going to the ER. This is the same thing that happens when people on food stamps learn not to go out and buy lobster their first week. He gives an example of “Now, when Mr. Brown has that diabetic foot ulcer, instead of going to the ER, he's going to go to the clinic; he doesn’t want to blow half of his budget on that one night.”(4) The other noticeable difference in the two facilities, other than the cost, is not treatment; he gets the same quality of care for his ulcer at both facilities. But at a clinic, they are going to provide additional resources at a lower cost, with the idea being that he doesn't come back in three weeks with another ulcer, something to the effect of,”Okay Mr. Brown, lets get your diabetes under control now so this doesn’t happen again.”(4) Clinics take a more focused approach toward preventative care than and ER, which is a patch and fix, and then we will see you in a couple weeks, basically. This was mentioned in our texts, “It is estimated that hospitals provide about $36 billion of uncompensated(“free”) healthcare per year. The hospitals then try to shift these costs to those who have insurance or who can pay out of pocket”(438) So if we were to implement a system like this (the “food-stamp” health program), the cost of healthcare would essentially start to repair itself. Once people learn to go to the clinic instead of the ER to save themselves money, they will in effect be saving the governmental dollars and therefore, our dollars. They will also get a more focused approach on preventative care which will hopefully prevent these catastrophic costs from ever occurring.
So, like I said before, I am not informed enough to speak about whether or not Obama-care will work, I really don’t know anything about it. However, after listening to what Ben Carson has suggested be implemented as our new system, I think this would be an excellent way to reform our healthcare system. I am sure that there would be a period of several years of transition, and several more to iron out the kinks, but from everything I have read in the textbook, and what I have gathered from various documentaries, the system cannot continue the way that it is. Even as a student, if I take a few steps back and look at the numbers in the book, it looks the same to me as the Still There Motel; it is not sustainable, the system will cannibalize itself and it will end. That is, unless, we make some changes and consolidate our expenses and eliminate the unnecessary ones. I don’t know enough about the system to say whether or not Carson's ideas would work, but to me, he is a man that works in the field of medicine, so he has a better idea of what needs to happen than I do. However, as he said, all we need to do is apply a little logic to this situation, and I feel that logic is a universal language, or at least to me it is. I tend to me very logical and without emotion when I make decisions, and when I listen to what he is suggesting as a fix, it makes sense to me, and I do not see why it would not work.
So no, I don't think rationing healthcare will help. It will keep the money coming in for pharmaceutical companies and the only people this will impact will be those who need treatment, and it will impact them negatively. I think Carson's approach is more appropriate and will be more effective. However, I can agree with the idea "“If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades.” But if it were my father in kidney failure, I would feel very differently. It is easy to get behind an idea like this until it is us, or someone we care about, that is getting the shit end of the stick. Then that wonderful idea doesn't seem so wonderful any more.
I think that he makes good point and argues his point very well, and I think that it should not matter the cost insurance should pay for the medical drugs that will prolong anyone's life even if it is only for one year. In that years time they could get a cure or they could find him a donor and he could live a lot longer life than without the medicine. Everyone deserves that time to say good bye to there families and friend to live the last year to the fullest with no regrets. Yes he made his case and this is what I believe.
I believe that the author makes good case for rationing health care. For a second he was able to convince me, change my views and opinion regarding the healthcare system and rationing healthcare. First, we cant compare USA to other countries healthcare because most of them either have oil and gold and they can provide healthcare to everyone regardless if you have money or not (ARAB NATION) or they dont give alot of money to third world country like US does. This year alone US gave my home country so many billion dollars its crazy i believe that if we cut this spendings then we can allocate this to the healthcare funds and USA can come up with a better system. Iam a firm believer that USA should take care of its own people first, with regards to the health treatments if the rich can afford it without the help of their insurance then so be it but as far as the rest of the people the government should help this people more. Rationing health insurance to me is not a good idea,moreso its not ethical because who are we to say or decide which treatment goes to a patient first. It is not fair and it doesnt make USA better, it just makes us worst as it is. we have to reform the system to be able to provide healthcare to everyone making it affordable and attainable without prejudice of age or whatsoever. That is the only time that we can say that our healthcare system has improved tremendously
I think that the author does make a good case for rationing health care. However I do not agree with him. He does give examples of how and why this should be done. Although he does have some valid points, I don't think that it is appropriate to tell someone "yes this drug could give you 6 more months to live, but your insurance company thinks it's a waste of money". He does convey his point quite well as to how this could keep costs down and make it more affordable for more people to obtain health insurance. I just don't agree that insurance companies have the right to say that another persons life isn't worth the cost of a medication just to keep the cost of insurance down for another person.
Chelsea Holgate
Yes, I believe Peter Singer makes a good case for rationing health care. Because at what cost, is it too much to support someone with a terminal illness. Of course the family will do whatever they can and pay as much as they need to keep a loved one alive but you must look at the big picture. Every year the U.S. goes further and further into debt. Healthcare finances have gotten out of hand. If the government passed a law saying that hospitals cannot pay for drugs that will only increase the termination of someones life, then their would be a lot less debt. If one family has the money to pay for the drug but another family didn't then that might cause an unfair advantage. So the best thing would be for that law not to let families pay for the drug either.
I mean this is tough. Because i know that if i was in the shoes of a family member of the ill person i'd want to do anything i could to elongate their life. But that would be selfish, and i must put the people of this country in front of my own self wants.
Evan McFarland
I do believe author Peter Singer makes a valid point on rationing, but I do also sit on the fence
on the other side as well. Why you may ask? I do believe that at some point we need to draw a line of what Is being covered and for how long. For example, it does not make any
since, for me to get a drug that cost over $54,000 or perhaps 1 million to up to 10 million to extend my life for six months. However I just recently went to the Emergency Room and I guarantee you that my visit on the amount of things I got done should not have cost me $10, 000 that was my bill. So in the scheme of things it got me to questioning is 54, 000 worth me possibly extending my life after I just went in the hospital for 10, 000. However in the minute scheme of things I can visualize why this person may want to extend their lives so. Also, I believe that healthcare is rationed when we opt into a HMO vs. any other higher up plans; pretty much were saying “Hey I don’t care what kind of treatment nor service I get as long as it being covered to a certain point. I believe that we are being rationed when we opt for the generic vs. regular medications than the regular. We may have a choice but it going to cost you dearly for the regular version. However I do believe as a healthcare provider this may or may not have an effect; It truly to me is hard to say.
Also I believe that in hospital when you do not have coverage; you at time do believe that the amount of customer service or treatment is being rationalized by the way that they treat you. So yes I see where the author states if we ration we wont be writing a blank check to pharmaceuticals companies and so forth; which were pretty much doing now. We need to be able to draw the line and stick to it and put pressure on the pharmaceutical companies and so forth to design a more realistic approached to making sure “affordable healthcare or treatment can be accessible to all. So I believe in the author but at what cost do the poor or the one’s who can not afford it have to pay.
The author does make some interesting points throughout the article, but overall, I don't agree with him. He says "healthcare is a scarce resources and all scarce resources are rationed one way or another". This couldn't be further from the truth. However, rationing healthcare effects the poor. Why should a person's money decide whether he or she lives or how much longer he or she lives? It's highly immoral to refuse such drugs as the life prolonging one to people for the simple fact that they can't afford it. I think everyone should have access to such drugs regardless of how much money have. Poverty isn't a choice, it's a circumstance and a very trying one at that.
Health Care Rationing
The author, Peter Singer, does make a good case for rationing health care. Healthcare is so important because it’s what keeps people from dying. Without a Healthcare system more and more people would be dying daily. Since the concept of the Health care system is so important in our daily lives many controversial issues arise. Some of those issues could be the costs of certain procedures. Some procedures could save the life of a person however; the issue might be the cost of those procedures. The cost of those procedures might be really expensive when the person might only be guaranteed another six months. Is it really that necessary to pay for a procedure that will only help a person live six more months? In a professional view, I would say that procedures like that shouldn’t be conducted. Healthcare should be rationed. One reason is because that is why America was a huge debt. In the article “Why We Must Ration Healthcare’’ President Obama stated that America’s health care system is broken. He also stated that it’s by far the most significant driver of America’s long-term debt and deficits. America spends nearly a third of what they earn on healthcare.
However on the other hand, I wouldn’t want healthcare to be rationed because the only reason we have a healthcare system is to insure the well-being of the people. If organizations and other authorities started to cut down some procedures just because they are too expensive then why have a healthcare system in the beginning. Might as well not have one and have everyone die naturally. I understand that conducting these $50,000 procedures is a lot of money; especially if it will only keep a patient alive for a short period of time but there’s always faith that a person will live much longer than that. I know that if a family member is sick, the family will do anything possible to keep that person alive. It’s just how society is; no one wants to see a loved one pass away. I know that if it was someone in family I would do anything I could to keep them alive.
So yes the author does give a lot of good points towards why we should ration healthcare. For instance, he stated that “if we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend.” However, I still don’t agree with the idea of rationing healthcare. I see his point because its true those people might end up dying and that money just goes to waste. But like I mentioned earlier people always have that faith that those people can overcome their sickness and survive.
Miracles like that do occur because when I was in Kindergarten I had a friend that suffered from cancer. She was always sick in the hospital that I never got to see her at school. I would go visit her and she would tell me that she was going to die. We were only five years old and we were already talking about dying. Michelle didn’t want to die. She wanted to live and still go to school and have friends and grow up one day. Her medications and surgeries would cost a fortune but her parents didn’t care. They wanted to do anything possible to keep Michelle alive, even though the doctors would say that she would die eventually. However, that wasn’t the case in Michelle’s life. She ended up being a survivor of cancer when she was in 4th grade. She lived, and she was cured. I sit with Michelle in class and she is loving life every day 100% healthy.
I think that the healthcare system is there for a reason and it should abide with its duties. The life of a person is much more important than that of financial issues.
-Stephanie Galaviz
I think he makes a strong case, however, I do not agree with everything he says. Who are we to decide who should receive treatment/medicine and who should not even if the person could live for one year or ten years? What does not make sense to me is why some medicine is so expensive. My stepfather has been diagnosed with pancreatic cancer and was prescribed Gleevac (which by the way was mentioned in this article.) His monthly Gleevac prescription costs $7,000 and his insurance only pays some of that. What I don't understand is why it is so expensive. Is it because it can save the person's life? Either pay and take the medicine or die? Who gets to decide how much the medicine costs?
I think Howard Singer makes a strong case, however, I think that the whole heathcare system is screwed up and people need to be less concerned about their bank accounts and more concerned about human lives.
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