Friday, July 09, 2004
Point-counterpoint on health care rationing
[Arthur Caplan, "Good health care should not be only for wealthy," The Wichita Eagle, 7 July 2004.
Ronald Bailey, "The Health Care They Want to Give You Is A Right," Reason, 7 July 2004.]
A column from University of Pennsylvania medical ethics professor Arthur Caplan ran in the Eagle earlier this week. In it, he expresses his profound distate for a health care system that differentiates between people based on willingness or ability to pay. Here's an excerpt:
Denver was the setting a few weeks ago when more than 100 physicians from around the United States attended the first meeting of the American Society of Concierge Medicine. Concierge medicine is a special, high-end form of medical care that guarantees that if you need treatment you will get it, without a hassle, seven days a week -- but only for an extra fee. If you can pay amounts that range from $20 to thousands of dollars a month, you can guarantee that your phone calls will be promptly returned by your doctor and that you'll get special attention whenever you're admitted to a hospital.
Meanwhile, Tennessee is making over its state Medicaid program, known as TennCare. If this program gets implemented, many of the poor, elderly, children and disabled in Tennessee who rely on Medicaid will be told simply to get over it. And other hard-pressed states may well follow suit.
No one wants to see any state dissolve in a sea of red ink. But how can any American stomach a public health-care system that is so unfair to people who aren't rich?
Reason columnist Ronald Bailey responds with a few questions of his own. Why, for instance, should health care be different than any other area of the market where the more you pay, the more you get?
In free markets most goods and services are differentiated by quality and customers get what they pay for. The more one pays, the better one expects to be treated. But many bioethicists think that medicine is different—that "health care is a right." But this mentality leads them to the position that we only have a right to the health care the state chooses to give us—and that we ought to be, or at least will be, denied anything better.
In his column Caplan decries recent reform proposals for Tennessee's state Medicaid program. The reforms, known as TennCare, were launched with much ballyhoo 10 years ago. They involve the state government taking its allocation of federal dollars for Medicaid and using it to cover not only those residents who met Medicaid poverty guidelines, but also other poor residents lacking health insurance. As with most any open-ended government entitlement, TennCare is heading for bankruptcy. So the Tennessee legislature passed a reform earlier this year under which medical necessity would be defined as the least costly "adequate care," instead of the traditional standard of "most effective" care.
So eager is Caplan to play class warfare by contrasting concierge care with adequate care that he actually misses the main lesson to be learned from TennCare—that any government-run national single payer system would inevitably run up against fiscal limits and impose rationing on everybody. Bureaucrats would then be making health care decisions for us all. But then at least we could share the "solidarity" of all having the same equally inadequate health care.
[Arthur Caplan, "Good health care should not be only for wealthy," The Wichita Eagle, 7 July 2004.
Ronald Bailey, "The Health Care They Want to Give You Is A Right," Reason, 7 July 2004.]
A column from University of Pennsylvania medical ethics professor Arthur Caplan ran in the Eagle earlier this week. In it, he expresses his profound distate for a health care system that differentiates between people based on willingness or ability to pay. Here's an excerpt:
Denver was the setting a few weeks ago when more than 100 physicians from around the United States attended the first meeting of the American Society of Concierge Medicine. Concierge medicine is a special, high-end form of medical care that guarantees that if you need treatment you will get it, without a hassle, seven days a week -- but only for an extra fee. If you can pay amounts that range from $20 to thousands of dollars a month, you can guarantee that your phone calls will be promptly returned by your doctor and that you'll get special attention whenever you're admitted to a hospital.
Meanwhile, Tennessee is making over its state Medicaid program, known as TennCare. If this program gets implemented, many of the poor, elderly, children and disabled in Tennessee who rely on Medicaid will be told simply to get over it. And other hard-pressed states may well follow suit.
No one wants to see any state dissolve in a sea of red ink. But how can any American stomach a public health-care system that is so unfair to people who aren't rich?
Reason columnist Ronald Bailey responds with a few questions of his own. Why, for instance, should health care be different than any other area of the market where the more you pay, the more you get?
In free markets most goods and services are differentiated by quality and customers get what they pay for. The more one pays, the better one expects to be treated. But many bioethicists think that medicine is different—that "health care is a right." But this mentality leads them to the position that we only have a right to the health care the state chooses to give us—and that we ought to be, or at least will be, denied anything better.
In his column Caplan decries recent reform proposals for Tennessee's state Medicaid program. The reforms, known as TennCare, were launched with much ballyhoo 10 years ago. They involve the state government taking its allocation of federal dollars for Medicaid and using it to cover not only those residents who met Medicaid poverty guidelines, but also other poor residents lacking health insurance. As with most any open-ended government entitlement, TennCare is heading for bankruptcy. So the Tennessee legislature passed a reform earlier this year under which medical necessity would be defined as the least costly "adequate care," instead of the traditional standard of "most effective" care.
So eager is Caplan to play class warfare by contrasting concierge care with adequate care that he actually misses the main lesson to be learned from TennCare—that any government-run national single payer system would inevitably run up against fiscal limits and impose rationing on everybody. Bureaucrats would then be making health care decisions for us all. But then at least we could share the "solidarity" of all having the same equally inadequate health care.
Comments:
Post a Comment
