Reader Question – What's the deal with rationing?

Another question I can’t seem to answer enough:

Tonight you had Dr Carroll on talking about health care reform. I have a question for him. I work in health care, specifically the pharmaceutical industry…. I also want to comment on the fact that insurance companies are being vilified on every talk show out there. I have worked for insurance companies and they have been for the most part very concerned with their patients well being and follow evidence based medicine when making coverage decisions. There is not an endless supply of money, something has to give…

Let me start by saying that I don’t think that the people who work for insurance companies, nor the companies themselves, are evil. Granted – SOME are, but most are not.

But let’s face facts. Health insurance companies can only make money in certain ways. That’s by covering more healthy people than the next company, and by trying not to pay claims. That’s really it. And both of those things run contrary to what we want out of a health care system. It’s not a moral judgment. It’s just that the business model runs counter to what we consider the best thing to do. I’m not running for office, so I get to be honest and say I agree with you that there is not an endless supply of money and that everything can’t be covered. But we ration is horrible ways now, and can do a much better job.  Per Ezra Klein:

A 2001 survey by the policy journal Health Affairs found that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent. This, Americans will tell you, is the true measure of our system’s performance. We have our problems. But at least we don’t sit in some European purgatory languishing without our treatments. That’s rationing.

There is, however, a flip side to that. The very same survey also looked at cost problems among residents of different countries: 24 percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn’t fill a prescription. And 22 percent said they didn’t get a test or treatment. In Britain and Canada, only about 6 percent of respondents reported that costs had limited their access to care.

The numbers are almost mirror images of each other. Twenty-seven percent of Canadians wait more than four months for treatment, versus only four percent of Americans. Twenty-four percent of Americans can’t afford medical care at all, versus only 6 percent of Canadians. And the American numbers are understated because if you can’t afford your first appointment, you never learn you couldn’t afford the medicine or test that the doctor would have prescribed.

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