Health Care Rationing Isn’t Fun, But It’s Unavoidable
Sad stories abound in the world of health care, because health care has a few peculiar features. First, when you get it wrong, people die. Heck, sometimes if you get it right, people die. Second, it’s terribly expensive. This is actually a good thing, in a way. The cost of advanced western health care is a function of its capability. Each level of “hard new problem” usually requires a lot of time, energy, and research to solve, and that cost must be recouped in some manner. But the expense is such that for difficult problems, it’s extremely unlikely that any normal person could afford his or her own care out of pocket.
When you take a highly emotionally charged issue, which happens to be so expensive that it is unaffordable on a self-financed basis, you’re going to get problems. When you can’t afford to pay for calamity, you try to find a way to risk-pool with others to distribute the cost. But when the calamity is too expensive even for the group you’re risk-pooling with, the sad answer is rationing. And when it’s your insurance company telling you that they’re not going to pay for your care — and you’re going to die — you feel betrayed.
That’s what people are faced with, relayed by Karen Tumulty for Time:
Every story is different, but the contours of the problem tend to be depressingly similar: the 10-year-old leukemia patient in Ohio who, after three rounds of chemotherapy and a bone-marrow transplant, had almost exhausted the maximum $1.5 million lifetime benefit allowed under her father’s employer-provided plan; the Connecticut grocery-store worker who put off the radiation treatments for her Stage 2 breast cancer because she had used up her company plan’s $20,000 annual maximum and was $18,000 in debt; the New Hampshire accountant who, unable to work during his treatment for Stage 3B stomach cancer, had to stop paying his mortgage to afford a $1,120 monthly premium for coverage with the state’s high-risk insurance pool.
What makes these cases terrifying, in addition to heartbreaking, is that they reveal the hard truth about this country’s health-care system: just about anyone could be one bad diagnosis away from financial ruin.
That’s a soft way to put it. In fact, you’re one bad diagnosis away from death. Of course, you’re one wrong step off a curb away from death, too, but I’m not here to trivialize this. These are life-or-death issues, and when your insurance company stops paying for something, it’s common to blame the insurance company for your death instead of the disease which is killing you.
Ezra Klein, writing in response to the same piece, talks about the fact that this is the emotional wedge that will push through the vaunted “health reform” he desires:
But the final outcome of health reform will be less about Beltway moments like today’s event and more about the pressure applied by stories like the one Karen Tumulty tells on this week’s cover of Time magazine.
Karen — a bone fide health care wonk — writes of the trouble she’s had navigating the insurance market with her brother, who was recently diagnosed with kidney failure. And the trouble is not because he didn’t have health coverage and it’s not because Karen doesn’t know how to speak to an insurance representative or read the policy details. The trouble, in other words, is not for the 15 percent of Americans who are uninsured. It’s for the 85 percent who have health care coverage.
The promise, of course, will be that you won’t have those cold-hearted insurance men with their uncaring actuarial tables and desire for profit making your rationing decisions. What is left unsaid is that the rationing decisions will still occur. (H/T QandO)
The Government’s rationing body said two drugs for advanced breast cancer and a rare form of stomach cancer were too expensive for the NHS.
The National Institute for Health and Clinical Excellence is expected to confirm guidance in the next few weeks that will effectively ban their use.
The move comes despite a pledge by Nice to be more flexible in giving life-extending drugs to terminally-ill cancer patients after a public outcry last year over ‘death sentence’ decisions. Leading campaigners last night said Nice had failed the ‘acid test’ of whether it really intended to give new priority to people with just a few months to live.
One drug, Lapatinib, can halve the speed of growth of breast cancer in one in five women with an aggressive form of the disease.
Dr Gillian Leng, Nice deputy chief executive, said ‘The committee concluded that Lapatinib is not a cost-effective use of NHS resources when compared with current treatment.’
Rationing is painful. Rationing sucks. When you buy insurance, or it’s given to everyone by the government, the assumption is that everything possible will be done to save your life — but it just isn’t true. You may believe that a few more months of your life is worth $100,000, or $500,000, or $500,000,000. But you’re not paying for it. The question isn’t “what is a few months of life worth?” The question is: “Who decides?”
I sincerely hope that nobody reading this is ever in the situation where a life-or-death medical decision is being made by someone thousands of miles away. But if it has to occur, do you really trust the government to make that decision? At least with private insurance, you have a choice between competing insurers based on who you think will make the decision in your best interest, and you can balance the cost of the insurance with the maximum payouts they’ll support. If we get single-payer, you get one-size-fits-all, even if it doesn’t fit you.