July 30th, 2009
12:00 PM ET

Will health care be rationed?

As a regular feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From iReporter Jason in San Antonio:
"Four years ago my father was diagnosed with terminal brain cancer.  [For] 18 months we fought that disease with everything we had because we felt like every day was precious, every day we kept him alive we were one day closer to a cure for that disease. I guess my question is, under a public option or government run health care system, would that type of care be possible? Is it something that 10 years from now we're going to have to sacrifice or come up with a tremendous amount of cash to pay for it because it would be rationed under our government run health care system?"

First, Jason thanks for sharing that personal story. Our best wishes are with you and your family. The idea of rationing really strikes at the core of all that we are talking about with regard to health care - this idea of lowering costs, trying to increase access. The question is, will we have to ration health care as a result?

There was a New York Times editorial a couple of weeks ago by Peter Singer, a bioethicist at Princeton University, where it was put like this: "The death of a teenager is a greater tragedy than the death of an 85-year-old and this should be reflected in our priorities."  Think about that for a second. He's saying we should assign value of life differently in certain situations.

Jason, we took your story specifically to the White House and asked them to respond. They said, "Our heart goes out to Jason and his family. We know families across America are dealing with issues like this every day. There are a number of different bills making their way through Congress right now but we do know this: The reform bill that the President signs will not lead to rationing. It will be fully paid for and bring down costs over the long term." They went on to say, that the President won't sign a bill that doesn't guarantee coverage to all people of all ages regardless of  specific health conditions.

But as you're saying, Jason,  it may come down to numbers and whether estimates of the cost of  health care reform are accurate. When Medicare hospital insurance was conceived in 1965, the House Ways and Means Committee projected that in 25 years it would cost 6 billion dollars. The actual cost? 67 billion, according to the Centers for Medicare and Medicaid Services. You can see how far off costs for Medicare were, based on initial projections –much, much higher. Now the president says they'll add prevention programs and wellness programs, creating a healthier population and that will be a cheaper population with regard to health care costs. But who knows? You've got more people that you're trying to cover; more people, more tests, more screening. How that all adds up, we're just not sure.

soundoff (62 Responses)
  1. David Kaye

    I am 71 yrs old. Three yrs ago I went to the hospital with chest pains and learned I was 6 hrs away from a major heart attack – 95% blockage of the right artery. I underwent angioplasty that day & my life was saved.
    Under Obama care I understand it would take up to 6 months to see a cardiologist...even if they agreed to see me because of my age. Is this correct? If so this Plan is a death sentence for tens of thousands of people with heart disease in this country.

    August 23, 2009 at 15:24 | Report abuse | Reply
  2. abetterviewoftomarrow

    in the past I have been silent on this issue I have read some of the bills being passed arround easy enough to search google and only click on the gov issued pdfs and read , some I found apauling yes , and yes I am disabled and I will tell you one plan cause for the gov not actualy run it , but to dish out funds to cigna health america and the like to handle them , this will also eliminate medicaid and medicare , these programs will be moved into the pot and looking at it there , this same plan only has co pay above people making 2% of fed pov so a family of 2 can make 30k and pay nothing 33k would pay what my fiance pays 1.20 for generic larger copays would go up as you up above 50 100 and 200 K so I dont see a problem with it , it would also equalize cost rises because drs would still be getting paid the same and those on welfare such as kids on chip like my daughter who is almost 2 would get even better health care. I have friends in canada and britain and even in norway all have the same style system almost , they pay for it through flat taxing and fat taxing , honestly being in the system it would make everyone better off , ever wonder why medicaid people get more severe illnesses , well to be honest those of you with regular insurance take precidents over us and I have seen it in hospitals . so please look at ALL sides Fair is Fair if you lead a horse to water and it does not drink , you cant force it

    September 1, 2009 at 22:43 | Report abuse | Reply
  3. Don

    If a person has insurance, they are already rationed. Rationed due to the total allowed by the policy. Rationed, based upon the profits that are to be given to the multi million s of dollars paid to the upper echelons in those companies.

    More rationed, based upon the medicines that that company allows and upon the procedures that the insurance company deems worthy of low cost!

    None of this rationing is based upon medical needs. So, who is getting in between the patient and their doctor ?

    One of the BIG problems that insurance companies are afraid of, is that if national insurance is adopted then laws will follow. Laws that protect the people of the United States !

    September 8, 2009 at 13:31 | Report abuse | Reply
  4. David C. Murray

    Health care has always been rationed and it always will be. Anytime an third party payer, public or private, declares that some drug or treatment isn't covered, health care is rationed. Anytime an insurer says that you've met your annual or lifetime limit of payment, health care is rationed. Anytime your deductible or copay goes up or becomes unaffordable, health care is rationed. Anytime an insurer refuses to cover a pre-existing condition or drops your policy when you become too costly, health care is rationed. 'Twas ever thus; 'twill ever be thus.

    And it should be.

    Neither public nor private payers should be required to pay for needless, unproven, or pointless treatment. An eighty-five year old person with a terminal condition should not be eligible for heroic care unless and until the needs of the rest of the community are already met. There are too many undelivered health care services that could provide a virtual lifetime of benefit for the rest of us to buy a person in such straits a few more days of suffering. Relieve pain and anxiety? Sure! But not extensive and expensive care that will do virtually no good.

    September 17, 2009 at 10:06 | Report abuse | Reply
  5. citizenjournalistreview

    David C Murry. That is a ridiculous assertion! Everyone MUST be treated equally with regard to healthcare. A drug using 25 year old is no more important and no more worthy of the best medical care than that 85 year old who worked her/his entire life to make ends meet. Only an uncaring person would cast out people as trash when they age. Everyone will grow old at some point and those who are now saying they should be given preferential treatment will soon find out that their life is the only one they have. Respect humanity. Everyone is worthy of the very best medical treatment with no preferential treatment given.

    September 17, 2009 at 11:35 | Report abuse | Reply
  6. Don

    Do some people have some thing about 80 year olds?

    As to undelivered health care services, they are limited with coupons.
    Other limits are also imposed by states.

    If health care is provided for all, then the 80 year olds won't be considered last after every one else. Sounds like prejudice against old people, who next people Of color and the infirmed ?

    My experience:

    Coops aren't any better as they limit who you see and often the geographical area covered ! Their cost often is not appreciably better than commercial providers . They have other limitations, such as medicines and medical diagnostic equipment.

    September 17, 2009 at 11:50 | Report abuse | Reply
  7. citizenjournalistreview

    I agree, Don. Thanks for the comments.

    Just this week I visited Auschwitz and it was an awesome and moving experience. The thing that bothers me is that when people start talking about essentially exterminating the elderly, they are infact promoting Nazi concepts. When the prisoners arrived at the concentration camps, there was a doctor there who using strictly an 'eyeball' exam, determined who was worthy of being kept and who should be exterminated. Only 15% were considered worthy and that was only until they could work them to death. So, I think we need to think long and hard about the concepts that we promote before we stand for something that is so far from our American ideals. While we appreciate our doctors, everyone should be given equal healthcare treatment without having to allow or require the doctors to play god.

    September 18, 2009 at 16:22 | Report abuse | Reply
  8. LJ

    READ THE BILL! 1000 pages but skim it and you will learn a LOT,

    If you spend a couple hours on it and take some notes you can consider yourself informed. It is an absolute and complete takeover of the entire health care industry (Not system) and no there will not be any private insurers left, as they are not allowed to make a profit. there will be a multitude of new government agencies, thousands of new "Public Health Workforce Corps" employees, that will work beside "civilian" health care workers. Read it, its all in there.

    September 21, 2009 at 16:17 | Report abuse | Reply
  9. Brenda

    Hi Dr. Gupta ,
    This is an emergency question and I need you help asap. My son has a hernia in his belly button and two not at the groin but the bottom one on each side. He's had this for several years . He now is getting pain going down his right leg. He is worried because a friend of his almost died because of the allergic reaction to the mesh that is used in the surgery.
    What was done in the past for this? So many men are suffering from this surgery. Please help us ? We have no one to turn too!

    November 18, 2011 at 05:13 | Report abuse | Reply
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