Comments on Secondhand Smoke: Your 24/7 Seminar on Bioethics and the Importance of Being Human: Continued Meltdown of UK National Health Service

I don't know if it's for unnecessary surgeries onl...

2007-02-27T12:00:00.000-08:00

I don't know if it's for unnecessary surgeries only in the case Wesley is listing. Haven't had time to research it. And "necessary" can be a little difficult to define. Is anything that's not an absolute emergency (emergency appendectomy) considered "unnecessary"?

I think "rationing" is different from simply not funding things and that real rationing doesn't follow from the fact that resources are limited. Think of food: There are limited resources for food, too, as for anything, but that doesn't mean that we get our food paid for by some third party who then looks at various things we ask for and says, "Hmmm. No, I think you don't need chocolate chip cookies, so I won't pay for that, or you'll have to go on a waiting list for that." Instead, we decide how to spend our _own_ limited money resources for food, using necessity as one factor.

This means that there's a difference between a high-deductible health insurance plan that lists ahead of time what it covers and, say, an HMO that decides "as it goes" what drugs to put on the formulary and so forth. The former can be more "up front," and the reason certain surgeries aren't covered is because the people making up the plans think people are going to be more concerned about other things when buying insurance. Sure, "necessity" comes into it, but at a different level. It can still be more oriented to what the consumer wants to spend his money on, though at one remove, so to speak.

I think the trouble with some HMO's is that they develop the same paternalism and ad hoc "necessity" judgments, which really are rationing, that one sees in a nationalized system.

But I fear I'm thread-jacking here.

I wrote that with a severe Oscar night hangover. ...

2007-02-27T06:01:00.000-08:00

I wrote that with a severe Oscar night hangover.

Yes, that is what I meant.

I guess I was commenting to the general morality of "health care rationing." Given that resources are limited, I don't think it's possible to eliminate it. Rather, it's inevitable if we choose socialized or privatized medicine.

Now, as for the waiting time for surgery in Britain, if I'm not mistaken, I believe that's for "unnecessary" surgeries. American insurance agencies play the same game by just choosing not to fund them.

Royale,Did you mean "why the U.S. should _not_ nat...

2007-02-26T07:28:00.000-08:00

Royale,

Did you mean "why the U.S. should _not_ nationalize health care"? I'm just guessing there's just a missing "not" there as a typo.

Sure, insurance plans ration. But these things come in degrees. In the U.S. you don't have these kinds of waiting periods. That's widely acknowledged, as far as I know.

My impression, too, is that the rationing in U.S. insurance plans has arisen as they've gotten more like full-fledged healthcare coverage for ordinary care (and in that sense more like a national care system) instead of being properly speaking insurance plans--bets taken against large-scale loss. Otherwise, there wouldn't be coverage for these drugs but also not rationing. They'd just be bought by whoever could buy them, up to a fairly high deductible, and this direct relation to the ability of the consumer to pay (rather than a third-party payer) might well bring the price down.

I'm not even saying this would necessarily be better. But it wouldn't involve rationing, and it might bring the overall cost of healthcare (to whoever pays) down significantly.

Stuff like this is typically used to show why the ...

2007-02-26T05:39:00.000-08:00

Stuff like this is typically used to show why the US should nationalize healthcare. Indeed, it's quite compelling.

But I can't say the US current system is better.

As for "rationing", what about insurance companies selecting particular drugs to cover? A lot of plans only cover 1 drug within a group of similars, but no drug's effect is 100% identical to another and some patients might benefit from A, but not B.

It's rationing.

What I'm taking bets on is how long it's going to ...

2007-02-25T14:53:00.000-08:00

What I'm taking bets on is how long it's going to be before everyone who's pocketing from this is going to end up crunched themselves by their own agenda. Eventually, if you let the government keep running the system the way it has been, everybody's going to get burned - too many people have too much at stake when they're all in charge of the same thing.

I myself definitely think the government should no...

2007-02-25T11:43:00.000-08:00

I myself definitely think the government should not be running the healthcare system directly as in the NHS. But even if one is open in _principle_ to a nationalized health care system, I think the outcome in the case of the UK should give one pause and make one think it's a very bad idea in practice. This sort of thing (rationing, waiting periods) is inevitable in such a system until Santa Claus starts delivering goods and services to countries that nationalize industries in order to keep said industries going at high quality and volume.