I'm glad to see how many people can see the future.I'm sad
to see how many people can see only doom in the future.Fortunately I
believe in the power of democracy and the democratic system, which definitely
invalidate all the doom sayers.
Their will be rationing simply due to LIMITED government funds.How
else will government control costs?
As a retired nurse with experience in government regulation of health care
systems, I chuckle at doctors "sometimes" do too much - who decides what
is too much? Much is possibly over done out of defensive medicine to ward off
litigation - check out malpractice costs.Care will be
"monitored" by who or is it whom? How, what reports, observations by a
third party will be necessary, and then there is the time involved for feedback.
I smell a really great bureaucracy in the making.Medication
management, see above. Time of delay in getting approval for a medication, cost
of medication are these factors to be considered in management.Oh,
who decides "when the time has come"? The author works in palliative
care, she is accustomed to assisting people, through surrogates who do the hands
one care, who are terminally ill to die. She is already used to forecasting a
death date (one of those pesky reports that are monitored and managed). ACA is
a bureaucratic nightmare in the making.As I see it, ACA is another
progression in the march by some people who have a pathological desire to
control other people, "for their own good". Beware Greeks bearing
This is looking a possible benefit of the ACA. The other side is a crushing debt
that is yet unpaid for. Mr. Obama said it will cost $980 billion and the
non-political Congressional Budget Office now says $2.5+ trillion along with
Medicaid criteria that each state will have to craft with no universal standard.
We are only looking at the glitzy tip of a very large iceberg.
What a bunch of gibberish.Of course health care will be limited...
especially for the elderly. Sarah Palin correctly identified it as 'death
panels.'Of course doctors will leave the profession in droves.
Those who stay will have to be satisfied with whatever fee the the Secretary of
Health and Human Services decides.Of course you will have to stand
in line for care because rationing is inevitable.This is what
Obamacare will give us.@ThatsSoUtah:"The author
never said or supported letting people die who want to keep fighting."The author doesn't make the rules. Obama has already described it,
"if you're elderly and need health care you might want to go home and
take an aspirin.""I really wish people would give up the
hysterics of healthcare reform and at least look at what it accomplishes and
what it's goals are."We know what the goals are... for the
government to control another segment of our lives.@atl134:"The only way the healthcare bill could lead to "rationing" is if
doctors suddenly have too many patients to handle."Doctors will
leave or chose another profession. That will be the cause of rationing.
I have had two persons in my immediate family (and we are insured by private
insurance) be denied medication that their doctors prescribed, by the insurance
company. Is this because of the ACA, or in spite of it, or is it unrelated, or
will the situation be corrected by an as-yet unmplimented provision of the act?
Thanks DN for printing another thoughful article on this complex and politically
ugottabekiddnI see you did not cite any of your "fact check"
sites. How do I know they are reliableBut what percentage would you
accept? 75%, 50%, 25%? how many have to leave the profession before you think
there's a problem.Are you saying there are no wait times
anywhere in any doctors' offices? Are you saying we havew such a plethora
of doctors we can afford to lose any?Are you HONESTLY saying you
ahve NEVER seen a sign in a doctor's office saying they are accepting NO
NEW medicare patients?If so, you don't get out much.Are you saying cost/benefit analyses are NOT just another form of rationing?
Let's see, we COULD give you, Mr. 87 year old, this procedure, but it would
be more cost effective to save the funds to treat 27 year-old cocaine overdose
@Lost in DC, the 83% you refer is sooo incorrect and has been "pants on
fired" by several fact check sites. It is false plain and simple.@Tulip, Lost in DC is correct that rationing has been done due to the ability
to pay. I am sure your experience with healthcare has been good but I cannot
believe people don't find in immoral to profit on others misfortune,
especially when it comes to life and death. Can you imagine 911 requesting a
credit card or insurance contacts before sending aid? Think its far fetched? Or
when you are in a hospital bed with tubes in you and an employee hounding you
for payment? Think that's and exageration? Think again because its not.
I totally support a single payer health care (not insurance) system. However I
also believe that people with money, or extra insurance, should be able to
obtain whatever treatment they see fit above and beyond the health care system.
Wonderful, informative article. So grateful to the DN for posting it.
Thank you Ira Byock and DN for a comprehensive essay written in simple terms for
all of us to understand.atl134 you stated very clearly. Medical
rationing has been taking care in the U.S. for a long time. Those of us who have
medical Insurance, have access, until the Insurance company decided we had
become too expensive. Others without insurance just have been deprived of any
preventive care and forced to the ER when may be too late.ThatsoUtah, Well put. ACA is not perfect, far from it. But we can as a country
start working with it, modify it and improve it. We needed to start somewhere.
Tulip, If ACA becomes a harmful system and "death panels "
show up. I will join you in the fight against the system. Until
then, I will support any idea to improve the lives of the citizens of this
country regardless their income.I understand how somebody can think
that affordable care for most Americans is wrong. Because "most" should
be changed for "ALL" Americans.
“In the prevailing fee-for-service financing system, insurers, including
Medicare and Medicaid, routinely reimburse hospitals and doctors for treatments
regardless of whether they have been proved to be effective”Obamacare does not change that despite her next sentenceObamacare
“…advances a new approach, called accountable care, that aligns
financial incentives with high-quality treatment. This key feature of the law
transforms health care by making local health systems - made up of doctors,
hospitals, clinics, laboratories and imaging facilities - responsible for the
outcomes of care and the costs for the population of people they predominantly
serve”Doctors make a cost/benefit analysis - still
rationingAtl134,83% of doctors surveyed are considering
quitting because of Obamacare, the shortage is a real possibility.Rationing based on ability to pay – My sister has a friend on medicaid.
Wrenched her knee. Since medicaid paid, she had no compunction calling an
ambulance to get to the hipsital, costing at least $300, rather than calling a
friend to take her. I have no problem with her getting treatment on
medicaid’s dime, but the ambulance for $300 when she could have called a
friend for free? That is waste.
The only way the healthcare bill could lead to "rationing" is if doctors
suddenly have too many patients to handle. Okay, so everyone having access to
care is a bad thing? Doesn't that mean if the ACA leads to more people
having access to care (to cause the system to overwhelm)... then the current
system is also rationing based on eliminating people from being able to afford
access to care in the first place?
You are either purposely deceiving people or fooling yourself if you actually
believe that rationing will not happen. Even a middle aged, uneducated person
like myself knows "spin" when I see it. Solutions exist for the problems
surrounding healthcare...turning it over to the government is not one of them!
@DavidWay to latch onto a minor part of the article and spin it into
something that wasn't said. The author never said or supported letting
people die who want to keep fighting. She said that sometimes doctor's try
to do too much. Given the context of the paragraph, she was talking about
doctors going for quantity over quality. "Sometimes they do too much."
Doctors seem to try to do everything, instead of trying to do the _right_ thing.
That's what I took away from that paragraph at least. You obviously leapt
to a different conclusion and tried to rekindle the notion that the healthcare
act kills the useless old people because they're not worth the time or
money. I really wish people would give up the hysterics of
healthcare reform and at least look at what it accomplishes and what it's
goals are. You may not think it's perfect. Neither do I and most likely
anyone else, including the ones who wrote it. It is a positive step though. The
free market has obviously not been able to control the health care industry and
it got out of hand. Something had to change.
Despite stating that the ACA does not utilize death panels, the author proceeds
to argue that the current medical system tries too hard to keep people alive.
In other words, she would have Americans lower their expectations for life &
death, & what options for healing are available through the science of
medicine because of the ACA law. Isn't that taking away
personal freedom & choice? If someone is dieing but wants to pursue options
of prolonging life, & elects to pay for it, shouldn't that be their
right? Instead, the author is setting up what sounds like denial for treatment,
or death panels.