Talk:Healthcare rationing in the United States

Untitled
This page was nominated for deletion. Considering how important healthcare rationing is to the present debate, I think this article should have time to develop. I would propose revisiting this article in September once a variety of editors have been able to work on it.Farcaster (talk) 04:01, 17 August 2009 (UTC)

Based on discussion on my talk page, the person including the template did not understand the definition of healthcare rationing. I have added citations from Peter Singer and David Leonhardt of the NYT, plus David Axelrod, that indicate there is rationing under the present system.Farcaster (talk) 04:48, 17 August 2009 (UTC)

UK kidney dialysis claim incorrect
The claim in the article that the UK has an "age-based policy that prevents the use of kidney dialysis as treatment for older patients with renal problems" is incorrect, so I will remove it. Evidence: 1) "The median age of those starting dialysis is 65 years." 2) "There is no upper age limit for renal transplantation" 3) Private medicine is available to all as well as the UK NHS system. Rwendland (talk) 02:38, 6 September 2009 (UTC)


 * That information was true. The policy has since been changed. The Squicks (talk) 03:27, 6 September 2009 (UTC)


 * Yes, the source was describing the situation in the early 1980s, when NHS resources were significantly restricted and kidney dialysis more medically problematic, rather than now - the original source is "Aaron HJ, Schwartz WB. The painful prescription. Washington, DC:The Brookings Institutions, 1984". But even in 1984 the situation was more complex than generally portrayed. There is a rather interesting and blanced 1984 short paper on the Aaron and Schwartz book here, but you need a free BMJ registration to see it. A couple of snips, from 1984 but still interesting, are:
 * Its persuasiveness derives from the fact that the dynamics of American society, and its medical system, are incompatible with the organising principle of the NHS, which is-to return to an earlier point-that health care should be rationed according to medically defined needs, not distributed in response to consumer demands. ... health care activity should not be confused with health care outcomes.


 * Aaron and Schwartz rightly warn their American readers that the United States faces the "painful prescription" of rationing if it wishes to put a ceiling on total health care expenditure. But they fail to point out that the United States already rations health care somewhat brutally, although in passing they note that "several million Americans lack adequate insurance or personal means and therefore face obstacles to obtaining hospital care." The issue, in other words, is not whether to ration but how to ration; how best to devise a system which allocates what will always be inadequate resources-in the sense of falling short of permitting the medical providers to do everything technically feasible for all their patients-in the fairest and socially most acceptable way.


 * Rwendland (talk) 12:16, 6 September 2009 (UTC)


 * Partial correction - No about the "even to those who can privately afford the costs" bit which was and is incorrect. The UK has never prevented private medicine or private insurance, and there have always been private hospitals for those that want to pay. Rwendland (talk) 14:13, 6 September 2009 (UTC)


 * If the information was clearly true (except for the brief error that you noted), than what is wrong with including it? It's relevant to the discussion. The Squicks (talk) 00:43, 7 September 2009 (UTC)


 * That "brief error" is actually crucial to the context: "rationing involves restricting health care goods and services from even those who can afford to pay" - the UK always allowed people to pay and bypass the NHS. Secondly, if you look at the BMJ paper, you can see that using kidney dialysis was rather cherry-picking the data to back an argument - most other life-threatening medical areas were similar. I think 25 years ago UK medicine wasn't that hot with dialysis for a while for some reason, and that was corrected a while back. Rwendland (talk) 01:18, 7 September 2009 (UTC)


 * But it still is rationing. While the statement "rationing involves restricting health care goods and services from even those who can afford to pay" is false as regards NHS kidneys, the statement "rationing involves restricting health care goods and services" is still true in this context. After all, those people really needed those kidneys and the NHS- at the time- could have funded that with time and resources from another thing. The Squicks (talk) 02:40, 7 September 2009 (UTC)

Sections and Related articles on Current Debate in desperate need of overhaul
I have added this note to all major articles related to the current healthcare reform debate. The related sections in this article and all related articles on the current healthcare debate desperately need to be overhauled and expanded. There is practically nothing in this article about the ongoing major events around the current debate, a subject area that is absolutely required.

The main discussion around generating an overhaul effort is on the talk page on the main article: Health care reform debate in the United States

For now, for this overhaul effort, please discuss anything not pertaining specifically to this article on that talk page.

NittyG (talk) 05:07, 27 October 2009 (UTC)

Medicare "Rationing"
Something that was inadequately and touched on only in a biased manner was the HCR proposal cutting Medicare. It is true that Medicare Part D will be cut, only in such a way that would overhaul it and make it more efficient. When Part D was made law, it was a big fat wet kiss to pharmaceutical companies, and so what HCR would do is make that go away. The "government controlled" rationing section which portrays Republicans as being heros and great crusaders against rationing and against cuts to Medicare is really done poorly. Thoughts? GnarlyLikeWhoa (talk) 03:39, 16 March 2010 (UTC)

Is this article really about "rationing?"
This article uses the pejorative "rationing" in a tortured way. Two essential features of a "rationing" scheme, as understood by the common man, might be(in my own words):
 * 1) An essential good/service in short, or potentially short, supply.
 * 2) A defined maximum allotment to all individuals (their ration) for the purpose of constraining consumption to match the limited supply, and to assure everyone has appropriate access to the good/service.

Consider wartime rationing of gasoline as a typical example. Gasoline was allegedly in short supply. (some say that tires were the real issue) Various groups were given different allotments. The military, doctors, clergy, (and some congressmen) were granted unlimited amounts. Others were allowed a gasoline ration based on their specific needs as determined by a local volunteer board.

Now let's consider this article: Among the topics covered in the article, I find only two that resemble "rationing":

1. The practice of defining what will not be covered by an insurance policy, either in terms of specific procedures/drugs or caps on annual or lifetime payouts. (defining the maximum ration) This practice is not driven by "short supply". Whether done by the government of by private insurance companies it is meant to limit the cost to the taxpayer, either in the form of taxes or premiums. (This was the origin of the infamous "rationing = Death panel = Obamacare" canard, a perfect example of the misapplication of the word "rationing", and evidence of its pejorative nature.)

2. The ACA levies a 50% excise tax on "Cadillac" private insurance policies. This will have the effect of reducing the demand for policies providing very thorough coverage with minimal out-of-pocket cost to the consumer.(defining the desired maximum ration) Once again, this is not driven by short-supply. This will raise revenue to help pay for the ACA while appealing to the sense of "justice" that the wealthy and union members won't get a "fairer shot" than the common man. (excepting of course those on Medicaid)

I suggest this article could be named "The Healthcare Equity Debate in the United States", as most of the content seems aimed at the justification for the ACA. The word "rationing" can then be given a well deserved rest.

P S If you think my definition of rationing is too narrow, then consider the current lead which says Health care is "rationed" because some people can't afford health insurance. Using that rationale, everything sold in commerce is rationed, and people can't get healthcare unless through an insurance policy...Thomas Pain 67 (talk) 18:15, 16 July 2012 (UTC)

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