Talking Back to the Talking Heads
On Fox News Sunday this morning, Chris Wallace asked Peter Orszag about whether a public health care option would not involve rationing. Says Steve Benen, “Orszag set the record straight.”
Fox News’ Chris Wallace asked OMB Director Peter Orszag this morning if the administration will be “rationing” health care by establishing a commission of doctors and medical experts to oversee medical practices. Orszag, thankfully, called this a “canard” and pointed to the status quo.
“The fact of the matter is, right now, politicians and insurance companies are making decisions,” Orszag explained. “We’re saying, we want doctors to be making decisions.”
Wallace said once these physicians start “making decisions,” they’ll be in the business of telling consumers which medical treatments they can and cannot have. So, Orszag turned the question around: “Do you think that politicians are currently rationing care? Or insurance companies are currently rationing care? There are no set of decisions that this commission would have that is not currently resting with either members of Congress or insurance companies.”
Matthew Yglesias gives us a new way to think about rationing:
Thinking about the “rationing” question in health care it’s worth trying to get clear. Sometimes there are shortages of something relative to demand—think of a huge oil shock—and the government decides it wants to impose price controls. That, in turn, leads to shortages. So you can attempt to ameliorate the shortages by rationing. Everyone is only allowed to buy so much gas. During World War II, Great Britain had comprehensive rationing for lots of staple food products—you were only allowed so much sugar, so much tea, so much bacon, etc. That’s rationing.
Now consider something else. If you’re a parent in Montgomery County Maryland, you pay taxes to the county and you get to send your kids to very good public schools. But even though the schools are good, they won’t just do anything you want. Your kid can learn Spanish at government expense, but the taxpayers won’t foot the bill for your kid to learn Burmese. But you don’t normally hear anyone say that the presence of a “public option” for elementary and secondary education involves “rationing” of foreign language instruction. If people have the means and want to arrange private lessons for their children of various kinds nobody is stopping them. And certain forms of this sort of supplemental instruction—Hebrew school in synagogues, Sunday school in churches, piano lessons or Kaplan test prep—are quite common.
Think of it as a shift in consciousness. Shake up the gray matter a bit.
5 Responses to “Talking Back to the Talking Heads”
Kathy, it doesn't sound like a shift in anything. In fact it sounds just like the deal private insurance provides: you can have any treatment you like…though you may have to pay for it yourself.
Call it rationing or whatever word you prefer, the bottom line is the same: government sponsored care will be generous to the patient and affordable to the taxpayer in inverse proportion.
So no matter which way you're hoping it will come down, the specifics are what matter. Will government pay for eyeglasses? Podiatry? Experimental treatments? Major surgery for 95-year-olds?
It's really just semantics. Orszag is right we already have rationing but the government won't and shouldn't let physicians order unlimited tests and perform procedures that don't make sense. There has to be some sort of rationing (or resource management, call it what you like) for the plan to work.
A better question would have been how government panels will be different from insurance companies. Most insurance companies guidelines are already set up by panels of physicians and experts. I would think the goal of controlling costs would be as strong in a government plan as with insurance companies.
Another good question would have been if physicians follow the government's guidelines will they be held harmless from lawsuits. Currently the insurance companies set the guidelines but the doctors have the malpractice risk. So far Obama has almost ignored tort reform as an element of health care reform, gee I wonder why that could be.
Since “rationing” was mentioned, let me repost a comment I posted for DJ at my post “Universal Health Care is debatable, Children's Health Care Is not”:
This weekend's New York Times Magazine has an article (“Why we must ration health care”) that those with an eye on cold, cost/benefit analyses of health care might like to read.
While it does not address CHIP specifically, just imagine–in the excerpt below–the patient ( the “you”, or the “stranger”) to be your child, instead of someone who has already lived a relatively good, long life:
“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?
The costs of the current health care system are becoming increasingly clear, and public sentiment for a more systematic approach may be growing. We’d like to know what you think about the prospect of rationing.
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.”
To read the entire article go here:
http://www.nytimes.com/2009/07/19/magazine/19he…
I'll sidestep Kathy's latest remarks and simply note that at least Orszag is less annoying to hear than Geithner.
(Though Kathy might not want to admit it, with the current Dem idiocy, people like Geithner and perhaps someday Orszag are well positioned as public-rejection-to-outrage “lightning” rods that keep Obama and his image nicer and cleaner than they otherwise would be. [It is already commonplace that the Dems in Congress with their lunacy already are lightning rods.])
“There has to be some sort of rationing (or resource management, call it what you like) for the plan to work.”
In the early-mid 1990s, at least that part was obvious: “Managed care, under a cap.”
It seems now we're back to full-bore lib-Democratic magical something-for-nothing gimmickry.