Politics

Rationing Debate

The case for and against President Obama's newest health care administrator.

|

If government-run health care is such a bad thing—at once too expensive, too impersonal, and too ineffective—shouldn't those who oppose it want to see the government's major health care payment systems run by someone who has single-mindedly devoted himself to cutting costs, focusing on patients, and improving health outcomes?

Dr. Donald Berwick, President Obama's appointee to run the Centers for Medicare and Medicaid Services (CMS), is, judging by his record, just such an individual. And yet his appointment generated enough early opposition, mainly from those who favor a limited role for the government in health care, that the White House took the controversial step of nominating him during a congressional recess. That means Berwick gets to serve for a year without the Senate's vote of approval—and, perhaps more importantly, without a public hearing. Yes, there are legitimate reasons to be concerned about Berwick's appointment and the signals sent by the White House's decision to avoid public debate. But within the bounds of political possibility, there are also reasons to think that he might be just the man for the job.

A Harvard triple-graduate, Berwick helped pioneer the study of health care delivery system reforms and has earned a reputation as a driven, outspoken wonk. Since the 1980s, he has made cutting waste from health care systems—and in particular, cutting costs without diminishing quality of care—a central goal in his professional life. In a July 2008 speech about Britain's National Health Service (NHS), he declared that health providers should make it a priority to "[customize] care literally to the level of the individual." In an op-ed for The Boston Globe, he rejected the idea of reducing expenditures through mindless cuts to service, writing that "[making] care less expensive and worse at the same time…is neither necessary nor worthy of us."

Berwick, though, has run into trouble largely because he's spoken highly of the National Health Service, Britain's socialized medical system. But it's to be expected that a Democratic president would pick a fan of government health care to oversee the nation's biggest government health care programs. As head of CMS, it will be Berwick's responsibility to prepare Medicare and Medicaid for the massive changes called for by the recent federal health care overhaul, including more than $400 billion in cuts to the former and the addition of an estimated 16 million new enrollees to the latter. Given the fiscal stakes riding on the future of these programs—according to the Congressional Budget Office, health care costs are the chief contributor to our fiscal woes—isn't it preferable to have them led by someone whose stated goal is to keep them running efficiently, and for less money?

Like it or not, Medicare and Medicaid aren't going anywhere. As long as that's true, we may as well have a devoted cost-cutter and health optimizer like Berwick at the reins. Far better that than the alternative—a political panderer with little actual interest in containing the health system's bloat or addressing its inadequate health outcomes.

No, if there's a reason to worry about Berwick, it's that although he's expressed a preference for limiting the resources consumed by government health care systems, he's also stated a strong desire to expand their reach and scope. A professed single-payer advocate, he's also a foe of markets and private decision-making. In his speech to the NHS, he declared that he finds "little evidence anywhere that market forces, bluntly used, that is, consumer choice among an array of products with competitors' fighting it out, leads to the health care system you want and need."  And in 1996, as The Wall Street Journal pointed out in a recent editorial, he and Troyenn A. Brennan wrote that health policy should seek "to constrain decentralized, individual decision making" and "to weigh public welfare against the choices of private consumers." Berwick is not merely an advocate of publicly funded health care systems; he believes that it is the purpose of those systems to exercise a controlling influence on private markets.

Still, arguably the most worrying thing about Berwick's nomination is not the philosophy he professes, but the method by which he was installed. The White House argued that a recess appointment was necessary to avoid partisan sniping, and to make for a speedy appointment. But the real effect was to stifle debate. Berwick's belief in the power of benevolent bureaucrats to cure our health system's woes represents a significant strain of thinking in American health policy circles. It is not, however, the only strain. Yet, as happened so often throughout last year's health care debate, President Obama has decided not only to ignore opposing ideas about health care, but to effectively pretend that they do not exist. Like Berwick, he has decided that the best way to govern is to make people's choices for them.

Will the American public eventually come to agree with Berwick's ideas about rationing care? Maybe, maybe not. But either way, they ought to be given the opportunity to hear about them first.

Peter Suderman is an associate editor at Reason magazine.

NEXT: "Chu has lost his ticket to ride"

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. We’ve found just the man for rationing healthcare. Hooray!

  2. FIRST COMMENT!!

  3. FUCK!!!

    1. Welcome to my world.

      1. If only you’d locked the soundstage door.

  4. “If government-run health care is such a bad thing?at once too expensive, too impersonal, and too ineffective?shouldn’t those who oppose it want to see the government’s major health care payment systems run by someone who has single-mindedly devoted himself to cutting costs, focusing on patients, and increasing health outcomes?”

    The guy is a socialist twit.

    Why in the world would anyone who opposes socialized medicine think it’s a good thing to appoint him?

    1. Because he’s super super smart.

      1. No one that is a fan of British healh care can be considered “smart”.

        1. “No one that is a fan of British healh care can be considered “smart”.”

          Yeah, like that dummy Stephen Hawking. What would he know about health care or the NHS?

          1. He’s a physicist with a debilitating disease for which there is no current cure (although those EVIL PHARMA COMPANIES are working on it)…so…about the same as anyone else?

  5. I’m in the biz, so I can tell you there is a lot of angst out here in the Real World about this guy.

    Here’s the problem:

    He made his reputation, and its a good one, on health care quality and the value of bringing doctors and hospitals into integrated and consistent care protocols.

    Unfortunately, what he’s good at isn’t what he will be doing at CMS. At CMS, he won’t be in the quality business, he’ll be in the resource allocation business. And on that front, he is horrifying.

    1. I made the same point to my sister who is on the faculty at Harvard Med. She raves about Berwick – and she is a person who rarely has nice words for most of the faculty there.

      Berwick really needs to speak to only one issue to show his competence or incompetence: SUDAFED.

  6. Still, arguably the most worrying thing about Berwick’s nomination is not the philosophy he professes, but the method by which he was installed.

    That’s a losing argument. There are very few things as personal as health decisions, and any man who believes the state must take preemptive control of those decisions is perhaps better suited to administrate medical research but should definitely stay the hell away from policy decisions about medical practice.

    1. But when you have tax payer funded medical services, it’s investiable that you will end up with some type of rationing eventually.

      After all, resources are limited, but demand is almost unlimited.

      Up to this point they’ve tried to ration through the back door (reimubursing less than cost) but now it’s time to get serious about the rationing !

      1. +1 if the government is indeed going to continue paying for health care–and we all know that is not going to stop–I don’t see the problem in trying to get the most cost-efficient results. As someone said in another thread, it is unreasonable to expect taxpayers to spend hundreds of thousands of dollars to keep a 90 year old alive for a few more weeks or months. Yes it is cold but that is reality. Again if we are stuck with government meddling in health care I’d rather see resources spent according to cost effectiveness, as opposed to political favoritism (though Im not sure that is even possible).

        Of course if someone wants to pay out of pocket for care that is not very cost efficient they have every right to do so.

        1. Two problems with that. First, if you think that government efforts to increase efficiency are going to begin and end with taking old ladies off of life support, I have a bridge to sell you. I have yet to see a legit statistic that shows how much end of life care is actually not needed when judged at the time. We think it wasn’t needed in hind sight because the person died. But, we didn’t know the outcome at the time. How do you tell what treatment isn’t going to work and what is actually needed? It is pretty damned hard. Also, the whole “90% of all medical expenses are incurred right before death” statistic is the most misunderstood and misused statistic known to man. Of course most of your medical expenses occur in the last few days of life. That is when you are sick. If I got hit by a bus tonight and died tomorrow as a result, all of those expenses would count as ‘expenses in the last days of life’. But that hardly justifies leaving me on the street to die. So the savings are not going come from 90 year old ladies in a coma. They are going to come by cutting and rationing treatment to people who need the care.

          Second, the whole “you can pay for it if you want” theory is great except that government health care will come with huge mandatory taxes and regulations. Telling me that I can pay for what I want and then taxing the hell out of me and regulating so that insurance or pay for service health care is impossibly expensive is a pretty empty assurance.

          1. It’s not too difficult to compare survival and recovery rates for individual treatments, based on age. We know a lot of treatments work and a lot are a waste of money (substance abuse treatment and statins fall into the latter category for example).

            I do agree with your second point. It’s one reason Im against nationalized health care to begin with. I’m just afraid it’s inevitable.

            1. “It’s not too difficult to compare survival and recovery rates for individual treatments, based on age. We know a lot of treatments work and a lot are a waste of money (substance abuse treatment and statins fall into the latter category for example).”

              There is no reason why insurance companies and doctors can’t and don’t do that now. I am unconvinced that we are spending money keeping already dead people alive.

              1. Insurance companies and doctors can and do, do that. But in this case we are talking about the government PAYING for it. So when it’s someone else’s money, often times skies the limit. Which is the problem of course.

                Also
                “Second, the whole “you can pay for it if you want” theory is great except that government health care will come with huge mandatory taxes and regulations”

                Umm, government already has plenty of taxes and regulation, and more is coming. Medicare/Medicaid is the majority of the unfunded liablities (40 trillion out of 56 trillion or so).

                So really the two choices are either 1 get government to stop paying for healthcare (not a bad idea, but I don’t see it happening) or two there will be some type of rationing.

                Hopefully you’ve read
                http://www.newyorker.com/repor…..ande?yrail

                Which shows that a LOT of cost savings are there to be had without a reduction in quality.

                1. “Which shows that a LOT of cost savings are there to be had without a reduction in quality.”

                  Yeah and I am sure the government will do just that. They won’t fuck it up and totally destroy the quality of care in the name of cost savings or anything. And we are all getting unicorns for Christmas to.

                  Getting government out of health care, beyond providing people vouchers to buy private insurance is the only solution.

                  1. I LOVE unicorns!

                  2. “Yeah and I am sure the government will do just that. They won’t fuck it up and totally destroy the quality of care in the name of cost savings or anything. And we are all getting unicorns for Christmas to.

                    Getting government out of health care, beyond providing people vouchers to buy private insurance is the only solution.

                    I’m sure government will probably mess it up a bit just like they mess up most things. That doesn’t mean it’s not going to happen though. Nor does it mean government is likely to get out of healthcare (not matter how much we might like it). Look at the stink about “cutting our Medicare).

              2. Uhm, yes, we do, every day. Extrapolating nationwide from what goes on in just the OR of my 300-bed community hospital every day—I’m an anesthesiologist—we are pouring enormous resources into treatments that we all know will return little in improved survival or quality of life.

                Feeding tubes for demented 90-year-olds? Really?a demented 90 yr old should get oxygen and morphine, and little else. Why do we do this? Mainly because ignorant families demand that “everything” be done for Granny. Easy for them to say, when the cost appears to be covered by someone else. My colleagues are either too lazy, greedy, or gutless to educate the families about “futility”; or afraid of being sued for failing to “treat”.

                I loathe the idea of govt run healthcare as much as anyone here. But we need to figure out just how much we’re willing to spend as a nation to indulge our collective fantasy that everyone lives forever, at no out-of-pocket cost.

                1. “We” don’t need to figure out anything as a “nation”.

                  I can pull the plug on myself (and maybe someone who specifically gave me power of attorney), but if you touch the cord it’s called murder.

                  There is no “we” here.

                  1. There is when someone else is paying the bill. When you pay, it’s your business. When “WE” pay, it’s our business.

                    1. Precisely. Which is why everyone’s health related decisions are also our business. Which is pretty much everything.

                      You there! Quit smoking! And you, fattie, put down the Freedom Fries! And all you lazy bastards commenting on Reason.com, go get some exercise! I demand it in the name of Fiscally Responsible Health Care!

                  2. +1…BILLION

                    1. that was to Sean MAck btw. I don’t want none of you other chilluns stealing his points.

          2. I agree with you, and I would point out that it is not simple cost/benefit decision. It is a values decision that can never be simply decided. Spend hundreds of thousands on a premie, with only a 25% chance of survivial, or more funds for AIDS education? Breast cancer screening at 40 or at 50? What happens when genetic tests become much more common? Publically or privately funded abortion?
            And because these values differ, there will always be a great deal of debate. That is why I always feel these decisions should be made in the private sector as much as possible.

        2. Of course if someone wants to pay out of pocket for care that is not very cost efficient they have every right to do so.

          I’m guessing in a government-rationed world those luxury options are going to dry up pretty quickly, but I hope I’m wrong.

  7. “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.” – Donald Berwick

    If Suderman really believes in free markets, he might have parsed the inexaustible supply of statist comments Dr. Berwick has made, only one of the most egregious being the one above. Maybe if Dr. Berwick had gotten his PhD in Economics he would realize that it is in COMPLEX systems that the “invisible hand” of consumer choice works for the greatest efficiency… but what the fuck do I know, I am not a Harvard Triple-peater…

  8. The profession of shaman has many advantages. It offers high status with a safe livelihood free of work in the dreary, sweaty sense. In most societies it offers legal privileges and immunities not granted to other men. But it is hard to see how a man who has been given a mandate from on High to spread tidings of joy to all mankind can be seriously interested in taking up a collection to pay his salary; it causes one to suspect that the shaman is on the moral level of any other con man.
    But it’s lovely work if you can stomach it.

    1. But it’s lovely work if you can stomach it.

      You got that right!

  9. Here is a list of choice Berwick quotes.

    “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”

    “You cap your health care budget, and you make the political and economic choices you need to make to keep affordability within reach.”

    “Please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can.”

    “Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs.”

    “It may therefore be necessary to set a legislative target for the growth of spending at 1.5 percentage points below currently projected increases and to grant the federal government the authority to reduce updates in Medicare fees if the target is exceeded.”

    “About 8% of GDP is plenty for ‘best known’ care.”

    “A progressive policy regime will control and rationalize financing?control supply.”

    “The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property.”

    “Health care is a common good?single payer, speaking and buying for the common good.”

    “And it’s important also to make health a human right because the main health determinants are not health care but sanitation, nutrition, housing, social justice, employment, and the like.”

    “Hence, those working in health care delivery may be faced with situations in which it seems that the best course is to manipulate the flawed system for the benefit of a specific patient or segment of the population, rather than to work to improve the delivery of care for all. Such manipulation produces more flaws, and the downward spiral continues.”

    “For-profit, entrepreneurial providers of medical imaging, renal dialysis, and outpatient surgery, for example, may find their business opportunities constrained.”

    “One over-demanded service is prevention: annual physicals, screening tests, and other measures that supposedly help catch diseases early.”

    “I would place a commitment to excellence?standardization to the best-known method?above clinician autonomy as a rule for care.”

    “Health care has taken a century to learn how badly we need the best of Frederick Taylor [the father of scientific management]. If we can’t standardize appropriate parts of our processes to absolute reliability, we cannot approach perfection.”

    “Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy.”

    “Political leaders in the Labour Government have become more enamored of the use of market forces and choice as an engine for change, rather than planned, centrally coordinated technical support.”

    “The U.K has people in charge of its health care?people with the clear duty and much of the authority to take on the challenge of changing the system as a whole. The U.S. does not.”

    http://online.wsj.com/article/…..on_LEADTop

    Only a liberal bootlicking nitwit like Suderman could think there is any case for this guy to be anywhere near positions of authority. Shame on you Suderman.

    1. “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as [INSERT INDUSTRY HERE]. That is for leaders to do.”

      Seriously, did I wake up in the 1930s? Does command economics never go out of style?

      1. no…

    2. I assume that the ever-circumspect John got this list from the Dan Henninger article that appeared in the Journal today and I wonder if this part of a certain quote troubles anyone else: “And it’s important also to make health a human right because the main health determinants are not health care but sanitation, nutrition, housing, SOCIAL JUSTICE, employment, and the like.”(emphasis added)

      Is this just boilerplate code that all statists insert into otherwise innocuous lists of rational variables to cover their plans to run all our lives for us, from cradle to death panel?

      1. Yes I did. And the link is in my original post above.

        1. Thanks – should’ve noticed in my haste to post….

      2. Social justice is to liberals as the commerce clause is to Congress.

      3. “”And it’s important also to make health a human right because the main health determinants are not health care but sanitation, nutrition, housing, SOCIAL JUSTICE, employment, and the like.”(emphasis added)

        Finally free hookers!!!!

    3. I predict, based on the quotes from John, that this guy will fuck things up, at least at the margins. You can’t think like this, be this opposed to market processes, and get good results.

      1. And when he does fuck things up, it will be everyone else’s fault. And the solution will be to give him more power to fix things.

        1. And when he does fuck things up, it will be everyone else’s the Republican’s fault.

          1. No, it’s obviously going to be Bush’s fault.

      2. Don’t worry, we’ll get it right this time.

    4. Here is another gem from Berwick:

      “any health-care funding plan that is just, equitable, civilized and humane must?must?redistribute wealth from the richer among us to the poorer and less fortunate.”

    5. What annoys me is the all or nothing mentality that many seem to have. All government controlled/funded or all ‘free’ market. There are advantages and disadvantages to both, though I tend to be biased toward the latter. I’m more and more leaning toward the model of government funded (not controlled) catastrophic health care insurance and high ‘co-payments’ (or whatever they might be called). I’m not really thrilled with statist mentality toward this issue Berwick seems to exhibit (but what could be expected).

  10. As a British citizen currently navigating his way to America, I have to say that Berwick’s fondness for the NHS ought to trouble Reason far more than it appears to. The adverse effects of the NHS, of any publicly provided Health system, go beyond mere inefficiency, reduced care, and destructive political incentives. Reduced choice – rationing, which Berwick has spoken so fondly of – has conditioned British citizens to expect less from healthcare. Survey after survey indicates that Americans demand, and receive, faster service, more up-to-date treatments, and greater disclosure.

    The planning mentality that suffuses the NHS, and so animates Dr Berwick, not only stifles actual medical innovation, but encourages an attitude of not even looking for it. Rationed healthcare, disconnected from the individual patient in cost, produces xenophobia and suspicion of immigration far more direct, and perversely more insidious, than in the US.

    Overall, Berwick’s model encourages the worst sort of dependency: people do not merely refuse to consider their own healthcare their own responsibility, they lack any ambition to seek better care, feeling that what is offered is what there is. I can’t think of something more antithetical to American culture of principles.

    1. I have to say that Berwick’s fondness for the NHS ought to trouble Reason far more than it appears to

      It would, except that Reason writers have apparently gone completely off the rails in some bizarre effort to seem distant from teh krazy teabaggerz. Almost every article on some liberal or administration controversy is basically a hand-waving “nothing to see here” spin job.

  11. “Will the American public eventually come to agree with Berwick’s ideas about rationing care?”

    Does it matter? Does anyone really believe we will not eventually end up with a single payer system that people are unhappy with, but that they are afraid to get rid of?

    Or maybe I’m just too pessimistic.

    1. Good news and bad news on that front. The good news is that we will never have a UK style single payer system. The bad news is that we will never have one because the government will go bankrupt before the liberals can ever get such a system enacted.

      1. Watch as John transforms pessimism to optimism by injecting separate pessimistic prediction. Deft. And I like it.

        Seriously, though, I don’t share your optimism because I don’t see the public pushback on budget issues ultimately trumping demand for more government. Or do you mean an actual collapse of some kind?

        1. Not so much a collapse as the bond market preventing us from borrowing money. If that happens you can’t enact any big new spending policy. The threat of a collapse will prevent single payer from ever happening.

          1. agreed

          2. “Not so much a collapse as the bond market preventing us from borrowing money.”

            Didn’t stop Mugabe.

      2. Talk about Scylla and Christmas!

      3. I see your bankrupt gov’t, and raise you one that just imposes massive price controls.

        1. At least those ALWAYS work!

  12. He is, after all, an Alpha-plus, so we are in excellent hands. Rest easy, citizens.

  13. if the government is indeed going to continue paying for health care–and we all know that is not going to stop–I don’t see the problem in trying to get the most cost-efficient results.

    This assumes that government financial support of healthcare can only come in the form of a centralized payment system. There are other models.

    It also assumes that central planning can achieve cost-efficient use of government resources. History begs to differ.

    Appointing Berwick is bringing in somebody with a big shovel to dig the hole.

    1. It also assumes that central planning can achieve cost-efficient use of government resources. History begs to differ.

      But… but… healthcare is different! It’s, like, complex and stuff!

      1. “It also assumes that central planning can achieve cost-efficient use of government resources. History begs to differ.”

        No, it can’t be cost effective but it can contain costs.

        1. Like the toilet seats bought by the Defense Department?

        2. No, it can’t be cost effective but it can contain costs

          Medicare circa 1966 is on the phone. She’d like a word with you…

  14. So, a guy might do okay in a job that SHOULDN’T EVEN EXIST?

    Gosh, you’ve warmed the cockles of my cold libertarian heart with that one.

  15. Suderman’s either an expert at chumming the waters or headed straight for the Weigal bin.

    1. Let’s hope it’s not the latter.

      1. BTW, Weigel Bin has a nice ring to it and is really fun to say.

        Now if you will excuse me, I have to go push a giant stool out of the old Weigel Bin.

  16. “Reason” and “ration” come from the same root word, so this makes sense.

    1. Just like Stag and Stagliano.

  17. Fun fact about Berwick: he has guaranteed healthcare insurance coverage for life, courtesy of a retirement package from a nonprofit he started.

    1. No one will ever ration that bastard’s care. And he knows it. I can’t fully describe how much I hate people like him. He is only about two steps above Joseph Mengele. Seriously, he would gladly kill and leave to die thousands to see his policies put into place. What Mengele did to individuals, Berwick would do to the country; conduct sick experiments with real human subjects.

      1. He’ll be responsible for more deaths than Mengele could have caused in his sickest dreams, let alone his actual death count.

      2. Fun, uplifting TRIVIA!!! Know what Mengele did while on the lamb to South America and avoiding the Allies? Performed abortions!! (I am actually pro-choice, but that little tidbit always leaves me queasy…)

        1. Know what Mengele did while on the lamb to South America and avoiding the Allies?

          He towed the lion, I think.

        2. That’s reasonable. His mission in life was to cull the herd.

  18. Anyone who think that the UK’s health care system is one we should emulate when they have what is probably the worst in the first world should be kept as far away from the reins of power as possible.

    I mean, if you get cancer in Great Britain, your odds of surviving for any significant length of time are an abysmal 50%!

    1. “I mean, if you get cancer in Great Britain, your odds of surviving for any significant length of time are an abysmal 50%!”

      I don’t suppose it matters to you if this is true or not but, all the same, it’s not true. There’s a negligible difference between cancer mortality rates in the UK and US. According to OECD cancer mortality stats, the average Briton faces a .5% greater risk of dying of cancer than someone in the US. If the US is so much better at treating cancer that must mean that a great many more people get cancer here than in the UK. Or it means you’re being deceived by lead-time bias.

      1. No. It just means Britons die of something else before they have a chance to contract cancer. 🙂

        1. DLM, I know you’re kidding, but for anyone who reads this and doesn’t the avg. life expectancy at birth in the UK is 1.3 years more than in the US.

  19. “I mean, if you get cancer in Great Britain, your odds of surviving for any significant length of time are an abysmal 50%!”

    Well that’s OK as long as EVERYONE’S odds are EQUALLY abysmal.

    Socialits hate it when so much as one person (other than themselves of course) does better or has more than some other people do.

    So the real objective is to drag everyone down to the same miserable level in every aspect of life.

    Socialized medicine is merely one of the means to acheiving that end.

  20. I note that Berwick has done NOTHING to reduce the cost nor increase the accessibility of education at Harvard Med.

  21. “Still, arguably the most worrying thing about Berwick’s nomination is not the philosophy he professes, but the method by which he was installed.”

    Not to me. His preference to squash what little health care freedom I have left by putting even more decisions about my health in the hands of central planners is not just moronic economically, but more importantly, they are a direct assault on my life, liberty, and pursuit of happiness.

    Whether it is public schools or health care, how in the 21st century can there still be grownups arguing that central planning is a more effective way to deliver goods and services than a free market?

    Didn’t we answer that question with the better part of a century of real world research in the Cold War? In Reagan’s words – We win, they lose.

    And how can we even be asking the question of whether I should be able to make the choices directly effecting my life an health?

    1000 channels of shit on the tv to choose from – is that the only choice we’re supposed to have?

  22. He looks kind of old to me. Maybe we should take away his food and give it to someone younger.

  23. Seems like everyone is giving up on retracting health care, even though it was cheated through congress.

    I wonder how much a shack in New Zealand is going for these days.

  24. …someone whose stated goal is to keep them running efficiently, and for less money?

    I’m not sure why the ‘stated goal’ is all that relevant. What matters is the (real, not ‘stated’) agenda of the person appointing him. In the end, it will still be about politics.

  25. I am a physician who works in a moderate sized ER in the Upper Midwest. Although I think Medicare and Medicaid stink, I do agree we are stuck with it. The biggest waste and abuse of the system are from the consumers themselves who look at healthcare as an all you can eat buffet of free or heavily subsidized service. We need rationing of healthcare for those that get it off the backs of tax payers. It is mind boggling how many older folks demand “everything” to be done regardless of whether or not a particular treatment will help. We should stop doing heart bypasses, dialysis, ventilator care, chemotherapy, and endless MRI’s on octagenerians. It is a total waste. Yet, we do it all the time. For those on medicaid, they use the ER as a “lets go to the hospital to get checked out for the heck of it because it’s free” program. Since we are never going to get rid of these programs, we need someone who will have the guts to come in and limit how people use them. Certainly if one wants to pay for healthcare themselves, there should be no rationing. But as long as people want something for nothing, they should be forced to accept limitations. I actually agree with this appointment.

    1. I totally agree, cb. I work in medical equipment, and people get Medicare to pay for a power wheelchair, but then a few months later want a manual wheelchair because it is really hard to get out and about in a power chair. But ads like the ones from the Scooter Store convince these people they need a power chair, so they somehow get one. It requires loads of documentation, so I don’t know how they do it.(our company doesn’t supply them btw, we just get screwed when Medicare denies the manual wheelchair). I’ve had people request duplicate equipment for each floor of their home. Fine if you want to pay for it, but not if you want Medicare to pay. They get really angry when they find out that Medicare will not pay to install a stair glide in their homes. It is getting out of control, especially since we cannot bill the patient for what MAY be a covered item unless we spell out to them exactly why it may be denied. Otherwise, we’re SOL. Meanwhile, I get at least three e-mails a week from Medicare with changes to coverage rules and more hoops to jump through to get paid. I think we need to say, unless you have some catastrophic illness, here’s your allotment for the year. Spend it wisely.
      I really have no confidence in whomever they put in charge at CMS. The writing’s on the wall, and I don’t think it will be changed anytime soon.

  26. Customer Service – What is it worth to you? You can email us 24×7! Our represnetative. will reply you in 24 hours. You can check our tracking page, and see hundreds of orders which we have delivered.Now you can Google most of these other places and see they have histories of not providing products or having terrible customer service.

  27. health care rationing is inevitable. We just need to be fair and honest about it.

  28. Thank you, my dear on this important topic You can also browse my site and I am honored to do this site for songs
    http://www.a6rbna.com
    This website is for travel to Malaysia
    http://www.m-arabi.com

Please to post comments

Comments are closed.