Would you support any rationing of healthcare

[newinnm]

We all know the RW talking points about this topic but Im curious to whatthe folks on DU might think.
If it were necessary to bring about single payer, would you support any rationing of heathcare?


-nnnm

[RufusTFirefly]

1. The question itself is a right-wing talking point.

Our health care is already rationed. Rich people get it. Poor people don't.

[SammyWinstonJack]

30. Rich people get it. Poor people don't.

:thumbsup: And it seems that the PTB want to keep it that way. x(

[ejpoeta]

2. this is ridiculous. we ALREADY HAVE IT!! insurance companies are already

doing everything that the rw are trying to scare people with. So the argument is ridiculous.

[wryter2000]

14. My point exactly

We'll always have some form of rationing. Right now, it's based on how much money you have, not on any rational assessment of the person's need.

[Fire1]

21. Thankyou! n/t

[John Q. Citizen]

3. There is no such thing as unlimitied resources. Everything is rationed.

[Cleita]

4. We already have it. It's known as deny any claim you can on a technicality. n/t

[FiveGoodMen]

5. Healthcare is always rationed

Always.

Right now in America it's rationed on the basis of your insurance and/or ability to pay out of your own pocket.

But elsewhere ... face it: we won't be giving heart transplants to 90-year-olds. There aren't enough hearts to go around.

That is rationing, but it's inevitable.

[ColbertWatcher]

15. THIS THIS THIS THIS THIS THIS. n/t

[stray cat]

6. Of course - it is already rationed and will have to be rationed differently

[Selatius]

7. We already have rationing. We ration according to ability to pay. If you can't pay, you're fucked.

[haele]

8. Health Care is already rationed - by the insurance companies -

We have to ask permission to see a specialist. Our doctors have to ask permission for procedures and to see what medications or therapies are covered. We have a cost limit; if we go over we have to dig up the funds ourselves.

How is this not rationing? We're just rationed by the what the corporations want to let us have and what we are able to pay for.

Haele

[billyoc]

9. Yes, of course I would.

Everything is rationed.

[bluestateguy]

10. No.

But we already have it under private insurance. When they refuse to pay, or only pay so much, then that has the same effect as rationing.

[dorkulon]

11. HMOs already ration health care.

http://patients.about.com/od/patientempowermentissues/a/rationing.htm

Health insurers ration care, but they don't call it rationing, and they don't even want you to realize that it is rationing. Dr. Rich Fogoros, the About.com Guide to Heart Disease gave this its own term. He calls it "covert rationing."

When insurance companies ration care, it's a money-saving measure, in part for the greater good, but also to preserve profits or raise salaries or other reasons that their customers disdain.

Rather than dwell on the reasons that frustrate us, suffice it to know that some of their rationing does keep premiums from getting any higher than they do, and does allow insurers to stay in business.

Health insurers ration your care by limiting the doctors you may visit because they negotiate fees with those doctors. They will only pay for you to visit the ones they have negotiated the lowest fees with.

Health insurers ration care through co-pays, deductibles and caps. In fact, what they are really doing is encouraging you to self-ration. Knowing that a certain amount of your care will have to be paid from your pocket, you may choose not to get the care or drug you need.

Health insurers deny services or reimbursements for services. Denial of care is perhaps the most understood form of rationing, because it causes outrage and frustration. What most patients don't understand is that this is also the aspect of rationing that is most affected by laws and regulations, too.

[Brigid]

12. As the others have already said . . .

We already ration health care. We have for many years.

[bemildred]

13. What the heck do you think we have now?

Lot's of people just do not have health care, does that count as "rationing" with you? Is anyone at all suggesting that people with the money ought not be able to spend as much as they want on health care? No, nobody is suggesting that. The question is whether people who cannot afford to pay whatever is demanded will be able to get some basic tax-funded health care too. When the government attempts to interfere with your rights to have botox injections whenever you like, let me know.

[nosmokes]

16. Of course I would. No Matter what happens some sort of triage for available

resources is inevitable at some point. How to to do it ethically and fairly is going to be the $64Billion question and the longer we put off facing the dilemma the thornier that thicket is gonna get.

[MannyGoldstein]

17. Health Care Has To Be Rationed

Suppose that we could prevent a single case of the flu, but it would cost $1 Trillion. I think that all would agree that this wouldn't work out.

We always have to make cost/benefit decisions.

[scubadude]

22. You are confusing Health Care with R&D.

Two totally different animals. R&D would end up being one of the sole profit centers in a universal health care scenario. And it would be kept in check by mass purchasing power.

Scuba

[scubadude]

18. No I wouldn't and that's why we must abandon our current system.

Health care is rationed already. If you think the insurance companies pay 80% of an 80/20 plan I've got news, I've been told by professionals they don't even come close. So in effect your 20% of the bill may be 50% of payments received. So we pay a high price for health care that cheats us.

We need single payer and must demand it!

Scuba

[Ms. Toad]

36. That depends on how the 20% is calculated.

In my plan on Tier 1 the amount billed is capped at the UCR (usual, customary, and reasonable). I pay 20% of that, the insurance company pays 80%, and the doctor eats the rest.

On Tier III, The amount the insurance company pays is 80% of the UCR. I pay whatever is left over of the bill - which may be closer to 90% in some cases.

On Tier II I haven't gotten a clear answer because the language of the certificate of coverage seems closer to Tier III, but processing of payments appears to be the same as Tier I (but with a higher deductible and copay)

Example (close to real from our experiences a couple of years ago):

Jaw surgery - billed cost $10,000
Tier I - UCR is $2000. I would have paid $400, the insurance company would have paid $1600, the doctor would have "lost" $8000.

Unfortunately, between the time the surgery was approved and the time it was scheduled our doctor dropped the plan forcing payment into the Tier III schedule:

The insurance company is still only willing to pay $1600. They consider my share $400 - and the rest overcharging by the doc. The doctor (who no longer has a contract with the insurance company because it paid him too little, in his assessment) is unwilling to accept the UCR as full payment - so I am stuck for the rest, making my total bill $8400 (84% of the bill).

We found another doctor on the plan - the cost difference was worth the inconvenience of the doctor search (and as an added bonus, the only one we could find turned out to be much more competent than the original doc - based on a comparison between experiences with a friend having the same surgery and reports of the hospital staff who worked with the new doc)

Bottom line - it pays to understand how your insurance company calculates the bill and how the UCR fits in(it sometimes goes by different names - but it is part of virtually every insurance plan). It makes all the difference in how much you pay - and if you just pay the bills and don't double check against what you should have to pay you WILL be overbilled.

[scubadude]

40. You have touched upon a sore subject with me. .

The insurance companies trick people with complex language and intentionally formulate their policies to do so. There is no understanding possible in my opinion, because the language and meanings used in these contracts shift fluidly, and are written the way they are to promote profitability. We would all have to be Contract Lawyers to understand their contracts fully.

I was directly told by a hospital employee over the weekend that it is rare that insurance companies pay the full amount they are supposed to pay. They consistently underpay, forcing the hospital to look elsewhere for funding.

I was also recently told by an insurance rep that it was their intention that the customer is never surprised by a request for payment prior to treatement. Not 2 weeks later I was totally floored when asked for full payment for a common test that was arranged ahead of time at my local hospital. The insurance company in their writing claimed to cover fully to my eye, yet I ended up paying way more than my 20% anyway to get the test done and it stunk totally! I feel I was cheated, but the insurance company claims everything was 100% correct. What should I do, sue to get my $300?. It's just not worth it, and they know it.

Scuba

[Ms. Toad]

43. First thing to do is appeal.

They count on people accepting what is paid and not appealing. The vast majority of the time they are right - so it is in their interest to deny first and answer questions later if anyone bothers to ask them. Every appeal I have made that I fought to the end I have won - most at the first step.

If it was only two weeks later, that sounds like just the hospital bill not yet adjusted for write-downs and insurance payments. I never pay hospital bills until I get the matching insurance statement (typically at least 30 days later), and a second hospital bill showing their write-down (they call if different things, but if you are limited to which hospitals you can go to each hospital will have a contract with the insurance company to accept a lower amount than billed as full payment.)

The most important thing in winning a fight is not to give them their money until after any appeals you are going to make are resolved - once they have their money they don't have motivation to work with you any longer.

One thing that is common is a covered hospital sends something to an uncovered entity for work (anesthesiologists, radiologists, and pathologists are the three most common). Sounds like that may be what happened here. The key to winning is to make sure you can document that you had a referral (if it was necessary), that it was approved by the insurance company (again, if necessary), that the primary work was done by the approved entity, and that the bill they are rejecting was from an entity chosen by the approved entity that you had no ability to influence.

If, by "supposed to pay" you mean the billed amount - the hospital employee is correct. But hospitals bill insurance companies far more than they have agreed to accept as full payment from the insurance company - so it is not that the insurance company "underpaying" unless paying what the hospital has agreed to accept from them is "underpaying."

Hospitals have contracts with insurance companies for amounts that barely cover the cost of the work. In order to be financially stable, hospitals then have to overbill everyone else in order to cover the losses (or near losses) on insured patients.

If a procedure actually costs $4000, and the hospital has agreed to accept $2000 as payment in full from the insurance company, it has to make up the difference somehow. The bill you actually get for that procedure would likely be something like $5000 - the amount they expect to collect from uninsured individuals. $4000 goes to pay for the uninsured individuals' procedure, and the extra $1000 goes to make up part of the loss on the insurance contract. After the dust settles (1-3 months after the procedure) Your bill (and insurance statement) should show a $5000 bill, a $3000 write-down, and $2000 shared between you and the insurance company as being owed to the hospital.

But - you're right about the language being hard to read. Right now, on my Tier II they could legitimately calculate it like they do Tier III based on the language. Fortunately for me they don't seem to realize that - and I'm not complaining...but if they can't read their own contract it is amazing they expect people to be able to read it and understand what they have to do to get full coverage - and what full coverage really is even if you do jump through all their hoops.

[scubadude]

44. Thanks for your explanation. My head is spinning!

The events I described as separated by 2 weeks were 2 different sets of players. One was 2 salespeople making a spiel on what would change for renewal, with me looking at the wording on my policy thinking I understood it knowing I had this procedure coming up. The other was 2 or 3 weeks later actually standing in front of the billing office at the hospital being told they couldn't do my colonoscopy because the insurance company wouldn't approve it, and I would have to pay cash upfront. That is exactly what the salespeople said would never happen. There would never be any surprise billing... Imagine that, going through all the pre-procedure crap, literally, then being told it was a no go unless I paid on the spot. I was able to cover about 1/3 or so of it there and set up a payment plan for the rest. Some of the rest was eventually covered by the insurance company, but not enough to nearly satisfy the 80/20 in my recollection. I questioned them on it and later they came back with an explanation that I didn't agree with, and your right, it took months to all settle out. It had to do with preventive screening, which I would think they would want to do. That's as much as I can remember. It's over.

Needless to say many would be more than willing to pitch in the combined fees their employers and they pay for a public non profit system. At least everyone would be treated the same and there would be no trickery.

Thank you again.

Scuba

[Ms. Toad]

48. Similar thing happened to me with that procedure

Everything was cleared up front. Got the referral from my doc. Checked with the colonoscopy doctor's office and they told me they had approval from the insurance company. Did the whole nasty prep. Got there early in the morning and somehow the colonoscopy doc's office couldn't find the approval they had assured me they had - and of course because it was early in the morning for a non-emergency procedure, they couldn't get anyone from the insurance company with access to the non-emergency files on the phone.

I ended up signing away my first born child (more or less) rather than do the prep again. Fortunately, they didn't require cash on the spot - and fortunately they had just misplaced the approved referral - but I went into the procedure expecting to have a massive fight on my hands with the insurance company once it was done - because I relied on the colonoscopy doc's verification of the insurance approval rather than call the insurance company myself and documenting the call (name, person I spoke with, time, approval number).

That piece of the process drives me nuts (and where I most often have to appeal because I'm passive/aggressive about it). I can number crunch the bills and beat them up on that pretty well - But when my daughter has a chronic illness she has had since she was 4 which requires specialists' visits every six months - why on earth does she have to get a new specialist referral every six months to see the same specialist she's been seeing for 14 years? It isn't like her illness (or need to be treated for it) is gonna vanish. You'd think (like the colonoscopy) they would want to avoid putting barriers to care for folks with chronic illnesses who need care more regularly than the rest of us.

Not so bad as it used to be, at least - I had a primary doc who insisted my daughter see her first (every six months) before she would give us a referral to the specialist, which turned one day off work into to and then required two visits and two co-pays. Fired that doc.

Cold or warm water diver? (I'm a crazy mixed up kid - if there's water, I'm game.)

[rurallib]

19. to emphasize the point others have made: 1/3 of America already rationed

I am not sure how much worse rationing can get. Perhaps some rich fucker may have to wait an extra month to get a new knee? I can handle that, since I would most likely never have a chance for such a surgery without universal health care.

[moobu2]

20. It’s already rationed by insurance companies and exorbitant costs

[NYC_SKP]

23. Health Care will have to be closely regulated, it can't be "whatever you want"...

And I don't mean cosmetic surgery.

There are unscrupulous doctors and medical providers now and there will continue to be.

There are patients who will want more than they need.

I will not use the word "rationing" because it's too loaded and nobody agrees on it's meaning.

Health care will have to be dispensed rationally and economically.

eom

[Mayberry Machiavelli]

24. So, uh, what is your reaction to people pointing out our care is already rationed? LOL

Come back, come back!

:rofl:

[backscatter712]

25. Health care is already rationed by the insurance companies...

based on your ability to pay and their willingness to pay.

[safeinOhio]

26. I can't see any reason for anyone my age

to get a heart transplant. Save em for the young. I have no problem with that type of rationing.

[tabbycat31]

27. it's already rationed

there are 46 million other people like me who don't have access to it AT ALL because of our system. I've had back pain for the last month and can't see a doc about it. And besides, the insurance companies are rationing healthcare anyways.

[sarcasmo]

28. Where you just watching Billo? and listening to Rush today?

[newinnm]

29. uhm no...

I have to work for a living

[jpak]

46. LOL!!!11 Rush and Billo are proof that the Goddess rations brains

Got insurance at your job? - or do they ration that too...

:rofl:

[newinnm]

49. WTF r u talkin about?

[Chisox08]

31. Health Care is already rationed by insurance companies

They tell you what docters you can see, they can deny you life saving procedures because it will cut into their profit margines, they deny people coverage and they price people out.

[havocmom]

32. I support recognizing healthcare IS ALREADY RATIONED

Some get way more than they need, some barely get any and pay too dearly, too many get lip service and overpriced aspirin from the ER

[Edith Ann]

33. Rationed Health Care

It's already rationed. Depends on the money you have or the insurance you have. Some people get all they need or want, some, even with insurance, can't get what they need. When profit is the motive people are expendable.

[Still Sensible]

34. Another dishonest RW talking point

the truth is SOMEBODY will be calling the shots, making the decisions, etc., regardless of whether it's single payer, public option or private insurance. There will be rules and standards no matter which way we go. The issue IMO is whether the bureaucrats/administrators will be making those calls based on the need to generate profit or not. Make no mistake, the people making those calls today are doing so to maximize their company's profit... but also, make no mistake, there will be a cost-containment motive with a public option or single payer as well.

[RufusTFirefly]

35. End Rationed Health Care. Support Single-Payer!

(Now if that isn't a T-shirt!)

[Juche]

37. yes. But we already have rationing

I would support rationing based on finding the most cost effective treatments for serious diseases. Doing that could cut healthcare costs down dramatically.

Our current rationing system is based on insurance companies trying not to pay for anything/everything no matter how effective the treatment is.

Like others have said, every system has rationing. The only difference is 'those' countries ration based on which treatments are most effective and use the least resources so that everyone can be covered for a reasonable price. our country rations with no interest in health or quality of care, the only goal is to make money for private companies that spend part of it trying to manipulate the public into submission with misleading Harry & Louise ads. As a result we spend 200-300% more per person on healthcare for lower quality and less reliable care.

Rationing to provide high quality care to everyone vs. rationing to make money and people's health be damned in the process. I know which I'd pick.

[harun]

38. How is it not rationed now?

[Karmadillo]

39. Sure. I'd start with no health care for elected representatives until we have single-payer.

nt

[nadinbrzezinski]

41. It is called TRIAGE and it is done ALL THE FREAKING TIME.

so the talking point is a scare tactic that has no basis in reality

[Vinca]

42. 2 points -

1: We already have rationing when 1 out of 6 Americans are uninsured and when those who are insured have their insurance companies turn them down for some treatments.

2: A whole lot of tests are completely unnecessary and often done to pad the pockets of the provider. Take, for example, the little strips they routinely have you pee on and then charge $20.00. If they charged somewhere near the actual cost of the strip for this test, it might be worthwhile to screen you each and every time you darken their door. But they don't. And it doesn't take a rocket scientist to interpret the results, either. Usually the office assistant does it. Years ago I was having intestinal problems and the doctor ordered a sigmoidoscopy. It didn't show anything, so he ordered a colonoscopy. Helloooooooo. No point in inspecting the sigmoid colon twice, is there? He should have just ordered a colonoscopy in the first place. The ordering of tests solely for diagnosing a patient and not for turning a buck would make any kind of rationing unnecessary. That said, if I've got terminal cancer I don't expect a knee replacement.

[alarimer]

45. I think that there will have to be some discussions about what is appropriate care.

Doctors will have to stop ordering every single test they can think of in order to cover their asses. There are places in this country where there is overuse of health care. That article in the New Yorker made it clear that there is overuse in some places, but it is the doctors' fault, primarily. They own the hospitals and the clinics and the more tests they order, the more money they make.

But ending that kind of abuse is not rationing.

We might have to decide that it might not be the best use of funds to give a 90 year old a hip replacement, for example.

[mmonk]

47. Healthcare is already being rationed.