Comments on: Why Rationing of Care Won’t Work in the US

By: Ezra Klein on HCR cost control « Blunt Object

Ezra Klein on HCR cost control « Blunt Object — Tue, 23 Mar 2010 22:04:25 +0000

[...] away with. Suppose Klein’s notional diabetic-on-Medicare goes to the hospital for, I dunno, renal failure. Let’s think through the [...]

By: Osh

Osh — Sat, 06 Jun 2009 12:54:44 +0000

I truly hope that as the health care system crashes around us ~ we will have MORE doctors such as Kevorkian ~ who will stand up for an individual’s right to die peacefully. I’m disabled with severe pain, am not terminal, sick of the drugs & side effects, sick of being treated like a “drug seeker”, sick of being bedbound & housebound – and don’t have the gonads to end life myself. I’d be more than happy to save American taxpayers the expense of my disability check and Medicare bills.

Please remember me – and stand up for Assisted Suicide or Independent Suicide one day.

Thanks for the blog.

By: Eat it « DUNCAN CROSS

Eat it « DUNCAN CROSS — Tue, 02 Jun 2009 14:07:29 +0000

[...] Whitecoat, in a characteristic snit: You see, EMTALA [that is, the law that requires emergency rooms to offer care to all comers] requires that hospitals provide stabilizing treatment, but it says nothing about who will pay for the stabilizing treatment. Hospitals will be forced to eat the cost of providing care. As more of the costs are passed on to the hospitals, more and more hospitals will close. Then less medical care, and less emergency medical care will be available for everyone. [...]

By: jb

jb — Thu, 28 May 2009 14:05:59 +0000

I agree. I commonly have people demand admissions for their elderly relatives despite a normal workup. When I tell them medicare might not pay and they might be saddled with the cost, they tend to be more amenable to outpatient therapy.

By: WhiteCoat

WhiteCoat — Wed, 27 May 2009 21:26:20 +0000

Instead of saying hospice care should be “mandatory,” you can have the same effect by making hospice care is “free” or low-cost.
Then patients and families choose between paying large amounts of money for futile care or letting relatives die with dignity at little or no cost. See what happens when consumers have some skin in the game?
The argument that CrankyProf raises is the same one frequently used in England when the socialized system won’t pay for expensive treatments. The government is “letting the people die.” I think that we will see a lot more of these type of sentiments in the future.
The government that has the power to provide everything to you also has the power to take everything away from you.

By: WhiteCoat

WhiteCoat — Wed, 27 May 2009 21:18:28 +0000

I see the logical conclusion you’re trying to draw, but I don’t think that Medicare follows logic. Unless EMTALA is changed, there will be a distinction drawn between “medical effectiveness” and “stabilizing an emergency”. Medicare may say that the care isn’t medically effective in the long term, but it will still enforce the “stabilizing treatment” required by EMTALA.
Will the paradigm shift so that patients get a shot of insulin, a few swigs of apple juice, and a kayexelate chaser? That remains to be seen.

By: WhiteCoat

WhiteCoat — Wed, 27 May 2009 21:13:33 +0000

If only …

By: k

Wed, 27 May 2009 20:52:23 +0000

How about reforming EMTALA in an effort to eliminate some of its unintended consequences, such as blatant user stupidity, sense of entitlement, etc.?

By: Oh Please

Oh Please — Wed, 27 May 2009 04:25:44 +0000

I am tired of the short sightedness of the legislators who think that everyone has access to health care, just go to your local ED and that solving a single problem will fix the global problem of health care reform without recognizing that the problem is multifactorial. Unless all the component parts are fixed there will be no solution.
Americans are too familiar with the concept of the best care at any cost right now, whether or not they can pay. Second, EMS providers need to empowered with respect to who really needs emergent care. The burden should be spread to primary care physicians, specialists etc.
Now ED’s are holding up the ceiling of the whole health care system. At some time that ceiling will collapse. We already see this in terms of overcrowded ED’s.
Importanly, unless health care reform includes malpractice reform and EP’s do not have to practice defense medicine and people are not allowed to bring frivolous lawsuits things will not change. Getting out of a frivolous lawsuit may cost thousands or even hundreds of thousand of dollars for a malpractice carrier company multiplied by how many defendents are named. This has to stop before the money is spent. The cost of medical care in this environment is too high and the solution not simple.

By: scalpel

scalpel — Wed, 27 May 2009 01:28:13 +0000

If Medicare (or any other government insurance plan) stopped paying for dialysis in certain populations, I suspect that hospitals would feel empowered to refuse that service. Passing the law that specifies rationing is the tricky part.