Comparative Effectiveness: Is Obama Really Calling for Rationing?

Rationing will come. Either it will be done by people deciding to allow some government worker to ration based on some sort of QALY indicator, or it will come by closure of hospitals and clinics. At present, in the US, if you are a child with a serious illness who lives outside a major metropolitan area, you most likely will not be able to be treated for your cancer, seizure disorder or cancer whatever locally. They'll fly you 3 hours away to whatever lone treatment center is supported by the state. That's because nearly all kids with a serious chronic illness (diabetes) or major acute illness (skull fracture) qualify for Medicaid. That doesn't pay the overhead costs of their care. Understandably, pediatric beds were closed down a long time ago, and the pediatricians went back to general practice and did their best to avoid seeing kids again. (Sad, really.) That's coming down the line for Medicare (which was a break-even proposition before, and will be an underwater proposition now.) Trust me, you will BEG for sensible government rationing within a few years.

Shirin of MO 6:06PM March 18, 2009

Rationing is the allocation of a limited resource. Rationing should not be a problem in the United States if we were to enact a universal health program. We already have enough funds ($2.5 trillion) and enough capacity in our system to provide all necessary health care for everyone, though we will need to improve the distribution of that capacity.

Research (comparative effectiveness) that provides better information about the benefits and deficiencies of treatment options improves both the quality and value of health care, and may sometimes actually reduce costs.

Whether government or private insurance, we all pay into the pools. The stewards of our public and private health funds have a responsibility to see that those funds are spent wisely. If the studies show that the interventions don't help and may harm, then we shouldn't allow our funds to be wasted that way. If the interventions are of benefit, then they should remain available for all of us.

If expensive technological advances increase to the point where we decide that health care is consuming too large of a percentage of our GDP, we can start making rationing decisions at that time. But we'll want to make those decisions based on best practices, and common sense spending.

Don McCanne, M.D. of CA 3:28PM March 18, 2009

Keep employers out of the records.

Keep insurance underwriting out of the records.

Make sure you NEVER have to sign anything that indemnifies any corporations for actually relying on your record, or for putting false information into your record.

It's okay to like Obama. I do. But the above matters have to be non-negotiable.

As for the pop-ups, if medicine is going to mostly become a computer prompted matter, then you DO NOT need a quarter-million-a-year doctor, now do you.

Muser of NM 2:35PM March 18, 2009