"The discussions about the new health care law are endless.
To the person on the street, everything seems to be changing on an almost daily basis. How can the ordinary person begin to understand all the ramifications of the Affordable Care Act? What is a person to do when, even though they have health insurance, they are potentially facing high medical bills that are not addressed by their plan?
Some people with a high deductible plan end up having to pay thousands of dollars in co-pays and deductibles. Are there other options for them or ways they can get discounted services? Or maybe they have seen a doctor out-of-network, or for some reason their condition is not addressed by their health insurance. What are they to do?
"When the government takes over health care and bans private health insurance, what can we expect? We can expect rationing of medical care.
In fact, in the New York Times article below, leftist utilitarian philosopher Peter Singer openly advocates rationing. He does it by arguing that health care is already "rationed" in the free market, it is just "rationing by price."
This is an inexcusable abuse of the language. "Rationing by price" is a contradiction in terms, because prices are the opposite of rationing.
The essence of a price is voluntary exchange. A price is the result of a negotiation between a willing buyer and a willing seller, with each party acting on his own judgment about his best interests.
So if you decide to pay lower premiums for less extensive insurance coverage, or to forgo an extremely expensive treatment that will only extend your life by a few months, so that you can leave more of your savings to your loved ones, these vital decisions are under your control and are directed according to your judgment of the risks and of the relative values involved.
You are never denied care-if you are actually willing to do what is necessary to obtain it.
Prices are implicitly based on an ethics of individualism-the idea that it is the individual's right to make his own decisions and his responsibility to support himself.
Rationing, by contrast, is an artificial shortage created by coercion.
It consists of the government telling you that you cannot have certain kinds of medical care because some board of bureaucrats has decided that it is not "cost-effective."
Rationing is implicitly-and explicitly-based on an ethics of collectivism.
I don't recommend reading the whole article below, because reading a contemporary philosopher is like sticking your head in a cotton candy machine. But if you do choose to read it, you may notice that it never looks at medical care from the perspective of the individual making rational decisions about costs and benefits for his own life.
It always implicitly looks at health care from a collectivist perspective: the perspective of bureaucrats making decisions about the cost of your medical care "to society."
The term that sums up this collectivist outlook is the "quality adjusted life year"-the pseudo-mathematical term for a government bureaucrat's decision concerning whether your life is worth continuing or not, based upon your age, your prognosis, and some bureaucratic formula that quantifies your "quality of life."
"Quality adjusted life year" is the term that tells you that the most profound decisions concerning your own life have been taken out of your hands. Get ready to hear it a lot- and to live and die by it- if Obama and the Democratic leaders in Congress get their way.
"Why We Must Ration Health Care," Peter Singer, New York Times, July 15
"You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much? If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn't going to be good. But suppose it's not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man-and everyone else like him-with Sutent, your premiums will increase.
Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone's life?
If there is any point at which you say, "No, an extra six months isn't worth that much," then you think that health care should be rationed.
In the current US debate over health care reform, "rationing" has become a dirty word .
Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for.
But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.
The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it. Health-insurance premiums have more than doubled in a decade, rising four times faster than wages.
In May, Medicare's trustees warned that the program's biggest fund is heading for insolvency in just eight years. Health care now absorbs about one dollar in every six the nation spends, a figure that far exceeds the share spent by any other nation .
Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. 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. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money.
The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?...
This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care.
The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money.
If a reformed US health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the US.. The Tracinski Letter
““Medicare’s release of data on physician payments serves no purpose except to further the federal government’s war on doctors. Doctors are the scapegoats for the program’s bankruptcy.... What Medicare does not tell the public is that hospitals are paid much more than physicians for the very same drugs or treatments. This is driving independent doctors out of practice, and patients into hospitals that are likely to care much more about their bottom line than about giving the best treatment to individual patients." Medicare Data Release Counterproductive, Misleading
NYC Debate:Is ObamaCare Beyond Rescue? On Wednesday 1/15/2015, Intelligence Squared will host a debate on the topic, "Obamacare Is Now Beyond Rescue": With the disastrous launch of the HealthCare.gov website, critics of the Affordable Care Act, or “Obamacare,” were given more fuel for the fire. Is this political hot potato's inevitability once again at stake? And is the medical community really on board with the law, or resisting (rewriting?) it from the sidelines? Panelists taking the "For" side include: Dr. Scott Gottlieb, Practicing Physician & Former Deputy Commissioner, FDA Megan McArdle, Writer and Columnist, Bloomberg View On the "Against" side: JonathanChait, Political Commentator and Columnist, New York Magazine Dr. Douglas Kamerow, Family Physician & Former Assistant Surgeon General The debate starts at 6:45 PM and will be moderated by John Donvan, Author & Correspondent for ABC News The website includes a "LiveStreaming" tab for folks to watch online. We are organizing a Tweet chat on Twitter at UPenn in the hopes of making it more interactive and engaging. We are promoting it on twitter to the general public and to radiology groups, other doctors groups and health policy groups... The hashtag will be : #IQChat. http://blog.westandfirm.org/2014/01/nyc-debate-is-obamacare-beyond-rescue.html
Short answer: A lot. Many valuable tips provided in the below essay. "What Can One Do?" by Ayn Rand "This question is frequently asked by people who are concerned about
the state of < today's health care system > and want to correct it...
More often than not, it is asked in a form that indicates the cause
of their helplessness: "How can an individual propagate < the correct ideas
> on a scale large enough to effect the immense changes which must be
made in order to create the kind of ideal social system
< or health care system > which you picture?" If this is the way the question is posed, the answer is: he can't.
No one can change a country single-handed. So the first question to
ask is: why do people approach the problem this way? Suppose you were a doctor in the midst of an epidemic. You would not
ask: "How can one doctor treat millions of patients and restore the
whole country to perfect health?"
You would know, whether you were alone or part of an organized
medical campaign, that you have to treat as many people as you can
reach, according to the best of your ability, and that nothing else
is possible. People approach intellectual issues in a manner they would not use to
deal with physical problems.
They would not seek to stop an epidemic overnight, or to build a
skyscraper single-handed. Nor would they refrain from renovating
their own crumbling house, on the grounds that they are unable to
rebuild the entire city. But in the realm of ideas, they still tend to regard knowledge as
irrelevant, and they expect to perform instantaneous miracles,
somehow or they paralyze themselves into inaction by projecting an
If you are seriously interested in fighting for a better < health
care system >, begin by identifying the nature of the problems.
The battle is primarily intellectual (philosophical), not political. Politics is the *last consequence*, the practical implementation, of
the fundamental philosophical ideas that dominate a given nation's
You cannot fight or change the consequences without fighting and
changing the cause; nor can you attempt any practical implementation
without knowing what you want to implement.
In an intellectual battle, you do not need to convert everyone. History is made by minorities or, more precisely, history is made by
intellectual movements, which are created by minorities.
Who belongs to these minorities? Anyone who is able and willing
actively to concern himself with intellectual issues. Here, it is not
quantity, but quality that counts (the quality and consistency of the
ideas one is advocating). An intellectual movement does not start with organized action. Whom
would one organize? A philosophical battle is a battle for men's minds,
not an attempt to enlist blind followers. Ideas can be propagated only by
the men and women who understand them...
Today, most people are acutely aware of our cultural-ideological
they are anxious, confused, and groping for answers. Are you able to
Can you answer their questions? Can you offer them a consistent case?
Do you know how to correct their errors? Are you immune from the
fallout of the constant barrage aimed at the destruction of reason
? Can you provide others with
antimissile missiles? * A political battle is merely a skirmish fought with muskets; a
philosophical battle is a nuclear war.* If you want to influence a country's intellectual trend , the first step is to
bring order to your own ideas and integrate them into a consistent
case, to the best of your knowledge and ability.
This does not mean memorizing and reciting slogans and principles;
knowledge necessarily includes the ability to apply abstract
principles to concrete problems, to recognize the principles in
specific issues, to demonstrate them, and to advocate a consistent
course of action...
If you like condensations (provided you bear in mind their full
meaning), I will say: when you ask "What can one do?" the answer
is "SPEAK" (provided you know what you are saying). A few suggestions: do not wait for a national audience. Speak on any
scale open to you, large or small, to your friends, your associates,
, your professional organizations, or any legitimate
public forum. You can never tell when your words will reach the right mind at the
right time. You will see no immediate results, but it is of such
activities that public opinion is made... The opportunities to speak are all around you...Most particularly, do not
keep silent when your own ideas and values are being attacked... It is a mistake to think that an intellectual movement requires some
special duty or self-sacrificial effort on your part. It requires
something much more difficult: a profound conviction that ideas are important to you and to your own life.If you integrate that
conviction to every aspect of your life, you will find many
opportunities to enlighten others.... If a dictatorship ever comes
to this country, it will be by the default of those who keep silent.
We are still free enough to speak. Do we have time? No one can tell.
But time is on our side because we have an indestructible weapon and
an invincible ally (if we learn how to use them): reason and reality. "What Can One Do?" by Ayn Rand < with personal editorial modifications in
brackets > Entire essay here. Additional similar articles here.
"Bam! Bam goes the hammer. People receive cancellation notices from their insurance companies. Bam! Obama is exposed as a liar. Bam! Reid and Pelosi were in on it. Bam! When times are bleak for conservatives, we have one inalienable tool--the hammer of reality."
Another great article by Dr. Hal Scherz, founder of Docs4PatientCare
"In the three years since the law passed, it is becoming increasingly clear to everyone that centralizing control of the healthcare economy in Washington is increasing costs, causing confusion and making the bureaucracy more difficult to navigate. With each passing month, new surprises are revealed, just as Nancy Pelosi predicted.
The newest revelation coming from Washington is the need for Obamacare Navigators. These individuals are “necessary” to assist people signing up for health insurance under the new state exchange systems. The “simple” 21 page application for federal insurance subsidies, along with the 61 page addendum, is apparently not quite as straightforward as promised. It has been suggested that these positions would be “awarded” to deserving individuals - supporters of this administration- union members, former ACORN employees, and other political cronies. The fact that voter registration has been included in the application suggests that only the “right people” will be hired as navigators.
The truth is that the ACA is not and never was intended to “fix” American health care. Its purpose is to place control of American’s health care in the hands of Washington bureaucrats giving them enormous power and control of the electorate. If there was any doubt about this reality, it is quickly evaporating as the details of the law become clearer with each new healthcare revelation, now happening almost daily.
The only possible way to accomplish the overly ambitious goal of providing health care for all, is with the creation of a massive and expensive new bureaucracy. The paradox should not be overlooked- healthcare spending is bankrupting our country, yet we are primed to spend far more money to create a massive bureaucracy in order to put it under government oversight.
How everyone could not predict what we are currently witnessing is amazing. The ACA created 159 new commissions, boards and departments. This translates into a huge, new and expensive bureaucracy. It has been predicted that in California alone, 20,000 navigators will be necessary, which means that nationally, hundreds of thousands will be needed. The number of new government employees needed to staff all of these new agencies is incalculable. Currently, 1/3 of Americans are covered by government financed healthcare, which accounts for 1/5 of our GDP. If some in Washington have their way, and healthcare is eventually totally financed by the federal government, the costs of running the bureaucracy will consume such a large part of our budget, that we will be able to afford little else...."
Full article here