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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?"

Answer:
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 (61 Responses)
  1. Dawn

    Why is it that the Obama Admin has to take on an issue that only affects approximately 10-15 percent of the population. Based upon population numbers in the Unites States, the uninsured account for only a small portion. I am not one of the people who would have to pay the "million dollar" tax, I sure do not make enough, but I do make enough to know that the health care I receive is both adequate and affordable. I will bet my life that once the government takes on being a health care provider, the company I am with will not be able to compete with the rates the goverment has and will go out of business, forcing me to join the government program. I sure do not want that to happen, especially seeing how they have managed Medicare, unsuccessfully trying to keep costs down, forcing doctors to not give quality care- perfect example is my grandfather: he had a problem and the doctor trying to keep costs down caused him to get an infection- which the doctor said was not a big deal and some cream would heal it- after 2-3 weeks of constant pain the infection turned into gang green, causing him to have to cut out a 3 square inch section of his bottom, in an emergency surgery, just so he could stay alive- all of this could have been avoided if the doctor was not concerned about the costs he would incur and have to absorb because Medicare does not cover costs 100%. And their there is the excellent management skills of the government to take care of Social Security. Another issue all together. My questions is this; Why does the government feel it has to get involved in every aspect of every persons life and in private business dealings? Shouldn't they be dealing with the issues they have the ability to control now- not take on more than they can chew. The cost projections they give are unreasonable as well as not funded adequately. I am not a democrat or a republican, just a concerned American that does not want my rights and benefits infringed on.

    July 30, 2009 at 13:51 | Report abuse | Reply
  2. GF, Los Angeles, CA

    "“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."

    As a child I recall a fictional story about a village that had a problem nobody could solve. The senior citizens were regarded as worthless and essentially past their prime so they weren't consulted and were largely ignored. After no resolution someone finally approached an elder who solved the problem. Moral of the story – our elders hold knowledge and experience that those before them do not. No one is disposable.

    The idea that a teenager's life is worth more than an 85 year old's is ridiculous. At what age does Mr. Singer view it to be ok to be left to die with no medical care?

    July 30, 2009 at 14:27 | Report abuse | Reply
  3. Rick DeBay

    Health care is rationed already, like anything else in a market based economy. There is so much money chasing so many resources; if you have the money you get the care, if you don't you miss out. When people worry about health care being rationed, the worry is that access will be granted based on something other than ability to pay.

    In this case, end-of-life care accounts for a sizable portion of national health care costs. If the family has their own resources to pay for the extraordinary care, then it's up to them. The best use of common resources would be hospice once the battle became hopeless.

    July 30, 2009 at 14:37 | Report abuse | Reply
  4. Carnita Wall

    I want govenment health care in this country and at the very least an option so there is at least some hope that what has happened in the last years to people may not happen again. Losing jobs, insurance companies taking advantage, so-called non-profit organizations [hospitals, nursing homes, doctors groups and etc] not being able to change jobs or move because someone is ill and on and on would make this much easier for Americans. Countries that have gov't programs the people do not have to worry about losing their homes because of health care costs.

    If you take a look at the Social Security and Medicare that seems very efficient to me although it needs to be supported by both parties rather than taking the money brought in and spent for wars and other pet projects. The one thing I saw in 30 years of working in health care was that there has always been a wedge between the' have's' and the the 'have nots'. This last 10 years or so the bubble on top got larger as more has been taken from the average American worker. In our case insurance premiums larger and covered less and always worrying about whether they would pay I always felt one door step away from homeless. [WHICH IS VERY STRESSFUL] Now that I am retired and my home is paid for it is all I have left if Medicare fails us as we watched our 401-k turn to 101-k's. I think American's deserve to have some security like the scandanavian countries do. I am paying taxes like they are. Just start adding all of the hidden taxes on utilities, licenses, state,municipal plus the federal and I would bet it is way over what they pay and they have health insurance and their families get wonderful education opportunities for all.

    The only argument I see is the have's want more and do not give a damn about those of us that pay taxes and have worked all of our lives. If those on top paid the same percentage of tax I did on their earnings all of these years we all could have the same wonderful health care the policians get which we all pay for.

    Support health care and education with conscience and better the country. It is time this country sets a better example for the rest of the world. I hear CNN say the polls show support for healthcare is down well, who gets the opportunity to be polled? Everyone I know that wanted it still does and wants the PPO dropped from Medicare as well as a decent RX plan so we are covered!

    Please consider these thoughts.

    July 30, 2009 at 18:10 | Report abuse | Reply
  5. Gladys

    This is to GF. Unfortunatelly is not about experience of wisdom. It is about who is producing and paying taxes. A 15 year old is just a few years away of being a tax payer individual and if he stays healthy will be for the next 65 years. Get it!

    July 30, 2009 at 18:18 | Report abuse | Reply
  6. Stan, Canada

    My feeling on the health care debate as I have watched all the way back into the Clinton years is that the media has evolved into an almost purely editorial based system. Reporters, 'news' anchors, hosts, etc. need to gather people with differing and usually opposing views (opinions) and talk from their particular pulpit. The problem with this approach to presenting the public with information is that facts, unbiased facts, are filtered through purposefully biased positions. This way of delivering information flies in the face of how 'we' as people learned in school, at least back when I was in school.

    We used to learn by reading facts based, peer reviewed martial in university, or text books which were written by learned leaders in the field within which they were writing. News which presents unbiased facts to the audience allows the reader/viewer to form an opinion of their own, not something spoon fed by someone who can craft a compelling 'story', as is far too often the case with 'news' today.

    Why this rant... well this directly relates tot he health care debate. Take into account how different biased 'news' organizations both on the left and the right are twisting facts to suite 'their' view of reality, passing it off as facts, when everyone is delivering a biased filtered, incomplete picture of the health care direction the president wants to go in, since as yet their is NO written down complete plan.

    Sorry for the long rant, but I wanted to say my peace, from the 'Great White North'...

    Stan, Canada

    July 30, 2009 at 18:59 | Report abuse | Reply
  7. Pete Marchesi

    They are talking about health care. The way you care for your health. It has become more than eating right and keeping clean. It is all very scientific now, and you have to adhere to what they say. They… That is the issue. Do we want… there to be a they? I think that is the question here. It has been decided for us for a long time what is best for our health.

    Now we live in a nation that wants it’s government to have a hand in our health care. Of course, I am against it. Where is it going to lead? I like my body, but not that much. I like it even less when somebody else is going over it. It is not really a privacy issue. It is a personal issue.

    But the government does not care about that. Lines are being wiped out. Boundaries are no longer clear. Suicide is a moral issue, not a social issue. Just one of the things… we should think about. We have corporations that will not be penalized in competition. They are supported and being bought by the government. We all know the danger of a totalitarian government. We are seeing it develop before our eyes. You know what it is like to deal with the government. They do not do… e-mails. They do not… stay up with what is going on. They are going to sink… into some strange conservatism, and we are all going to cheer.

    It is not funny. People do not understand what is going on. They soon will. I am just worried about all the people that are going to suffer before it comes to the populace… that this is not what we want.

    It is all about power. There are those of us, who want to tell others what it is they are to do. Corporations want power. That brings them money. And their investors want them to do that, despite any kind of personal value. So, corporations will go with the government to put together this health care deal. I just want to be left alone.

    I do not want to go to the doctor. And if I needed to, I don’t want anyone ordering me there. It is my choice. It is my choice to die. Just wait till they legalize all this. And the people have to toe the line. There is no line! It has all been rubbed out. This is what happens in totalitarian regimes… This is becoming a regime! Can you believe it? Free America. It is all going wrong folks. And I can’t wait… for the laws to start coming out over the next few years, that we are in this new health care… whatever you want to call it! Nobody will listen to me. Wait till your children start suffering. Wait for the new types of divorces based on whatever the powers that be want! Wait till the influences reach us.

    It is quite forbidding. And there is not a thing that we can do about it. We have to cooperate, because they… want to get the job done. They… want us to be there for them. They…

    I take a knife and strip my body of it’s skin. This is poetry, I say to myself. I am no fool. I am not going to live here. I am not going to live in a world like this, where it is arbitrary.

    Merriam’s…
    “Not restrained or limited in the exercise of power: Ruling by absolute authority (an arbitrary government). Marked by or resulting from the unrestrained and often tyrannical exercise of power. Existing or coming about seemingly at random or by chance or as a capricious and unreasonable act of will.”

    When a task is not seen in a meaningful context it is experienced as being arbitrary. There is nothing religious or meaningful about it. You go to the Doctor. He says you need this or that. Beware, you had better listen to him. You may think him unreasonable. You may think whatever you want about him. He has people… He has friends. And there is just the act of will, when it comes to power. This is what we face. A bunch of people that want to impose their will on us. You say… nothing to me. You say this is not happening. Sure… It is time to say something. I prefer a witch doctor. You give me one good reason why not.

    Hope to hear from you…

    July 30, 2009 at 19:29 | Report abuse | Reply
  8. John

    GF,

    The cost of caring for the elderly in the last 2 weeks of life through intensive care and monitoring can be very expensive. Why prolong an 85 year olds life for 2 weeks if they are going to die anyways? You could take that money and use if for a younger patient that has a good chance of survival following a procedure, or for treating many younger patients with less severe conditions. I don't think any patient should be made to suffer, but there are times where rationing of care needs to be implemented.

    Another example. An 85 year old man with chronic osteoarthritis of the knee wishes to have an elective surgery to repair his joint. Now obviously every scenario is unique, but in most cases, this gentleman could be managed medically (without surgical intervention) and still maintain a pretty good lifestyle with minimal pain. The money saved could be used to treat a trauma patient or to pay for a day of neonatal intensive care treatment for a child born with complications.

    The idea of rationing isn't an all or none concept. However, it is based on statistical outcomes and the hope of ethically providing the greatest possible good for populations as a whole through medical treatment. It is a logical way to approach care.

    July 30, 2009 at 21:53 | Report abuse | Reply
  9. Sue Johnson

    If Obama truly cared about the USA he would not be trying to bring us down this road. I haven't been impressed with anything he has done (think wall street, bailing out general motors, etc) and I don't see his health care 'plan' as anything different. Yes, I agree we should make improvements to health care in the USA but I don't believe Obama's drastic plans should even be considered. We simply don't have the money to have insurance for everyone - especially illegal immigrants!! Creating another government agency to be in charge of a public plan is NOT even a logical idea. This is not the time to be expanding government and have the government between us and our doctors! The idea of a government agency to run a public option is extremely scarey -– think of the effective and efficient service you get at the DMV and Post Office.

    One other point... Obama claims he is not creating government run health insurance. However, if there is a public option run by government I know big business will love it. They will gladly pay a measly $750 a year per employee and dump him/her into the public plan as soon as possible. Why aren't Americans out picketing against this plan?? I encourage everyone to call and/or write to the politicians and tell them to say "no" to any health care 'reform' bill with such awful ideas.

    July 31, 2009 at 01:44 | Report abuse | Reply
  10. R.E. Fitzgerald

    Dr Gupta,

    Many members of Congress, especially people like Senators McConnell and Hatch, are warning the public that the proposed "public option" in the Health Care Bill would be disastrous !!

    Can you comment on the following?

    (1) Re Congress.... What kind of health care insurance do the memembers of Congress have and does contain a public option? And who is eligible and for how long and how much does it cost the members? Also, are their immediate families covered under this as well ?

    (2) Re the Military...Does the health insurance received by active duty and retired military personnel include a public option ?

    (3) Re Veterans ...Who provides health insurance to military veterans through the Veterans Administration? Is it a public option?

    (4) Under what program are members of Congress authorized to receive treatment at military hospital such as Bethesda Naval Hospital and Walter Reed Army Hospitals in Washington DC?

    When weighing comments from our representatives re a public option, it would be helpful to have answers to the above questions.

    I can't recall reading or seeing much about any of the above on CNN, MSNBC or the other networks.

    RE Fitzgerald

    July 31, 2009 at 10:10 | Report abuse | Reply
  11. Skip

    Rationed: You have to do the math. As what has already been stated health care today is kind of being rationed. There are only so many doctors for those that have insurance or the money to pay for it. Adding to the roles of people access the system a couple of things will happen. 1. Since Doctors fees could be cut many may leave the profession. 2. With the added people getting coverage there simply will not be enough Doctors to meet the need. Finally, what really burns my hide is that many of these people are not legal citizens.

    July 31, 2009 at 10:40 | Report abuse | Reply
  12. GF, Los Angeles

    @ Gladys when you're no longer working and paying income taxes – make sure you put yourself out to pasture according to your theory.

    Everybody pays taxes in some form everyday – sales, gas, utilities, etc. so just because a senior citizen is no longer paying income taxes does not make them irrelevant.

    @ John healthcare period is expensive. My question to you then is why was Terri Schiavo kept alive all those years? Was she not expensive to take care of? A woman who was in a vegetative state who clearly could not contribute to society yet her life was still valued – why not a senior citizen? I would think we as a society should have the option to choose if we want to have the medical care or not. It shouldn't be offered based on age or the amount of money or insurance a person has – everyone's life is valuable. I would hope that each person considers their choices carefully. My father had terminal cancer and opted not to have chemo/radiation because all it would do was possibly prolong his life another year. The physical, emotional and monetary costs were too great so he chose not to do it. Shouldn't we all have the right to choose our healthcare?

    July 31, 2009 at 14:12 | Report abuse | Reply
  13. Jane

    CAPITALISM is the problem. As long as everything is given some monetary value above what folks can "earn", there will be so many who will be unable to receive. Healthcare needs to be a right, but then again under capitalism RIGHTS get bestowed by money. This is a fundamentally fatally flawed system.

    July 31, 2009 at 15:54 | Report abuse | Reply
  14. Pat McCullor

    Would it not be probable that Medicare style standard of care would have to be adjusted for coverage of a generally younger population?
    I would think Medicare generally covers people over 65 or disabled. The new universal health care program would have to cover from birth to grave and would need to be vastly different from Medicare.

    August 1, 2009 at 07:40 | Report abuse | Reply
  15. Bill Jones

    Why doesn't Dr. Gupta address Medicare and Medicaid fraud by physicians-yes, physicians- who basically have a license to steal? This is a major cause of the drain on health insurance for the poor.

    August 2, 2009 at 22:54 | Report abuse | Reply
  16. citizenjournalistreview

    The current health care discussions scare the daylights out of me. I can see it having the effect of the government determining who and when we should die. In other words, only the fittest and least expensive survive. This is an awful state of affairs for our country especially since we now have a group of adults who don't seem to care about the sick and elderly either.

    I have recently been diagnosed with very early Pulmonary Fibrosis and not only do I have to come to terms with my condition, I now have to worry that my government may determine that my life isn't worth saving and isn't a cost effective investment. That is really depresssing.

    August 3, 2009 at 07:40 | Report abuse | Reply
  17. shilpa clott

    I have worked as an employee for different hospitals to help the uninsured. I guess I am having a hard time understanding why the uninsured need to be insured. Currently, the uninsured can register for local clinics to receive primary care/preventitive care and women can go to ob/gyn clinics. These clinics are run by our tax dollars. There is a mentality for many of these pts to go to the ER because they portray their illnesses differently.

    Illegal immigrants should not have the right to our health care without payment.

    Also, to fund the proposed health care reform should not be placed on the "rich". The rich are the ones who keep the economy going. If we are going for equality and everyone receiving equal care, the tax should also be distributed equally. We are talking about the rich paying for the ones who cannot afford, but we are asking the rich for a decrease in their own healthcare. Am I the only one who sees a problem with the people who keep our economy running?

    August 3, 2009 at 10:08 | Report abuse | Reply
  18. mitch

    I dont think we should have health care.You can easily afford insurance you just got to give the Starbucks and use netflix not the theater and stuff like that.And if you cant afford to go the gym each day don't buy the signed Jordan shoes get some running shoes next thing you know your not an obese diabetic who doesn't need to go the hospital every week. And for less visits be careful in the kitchen with all the knifes.

    August 3, 2009 at 12:20 | Report abuse | Reply
  19. Dan

    Why are they not discussing a ramping up of improving our medical Infrastructure. We are lacking in GP doctors, nurses and facilities...and adding more poeple in...

    August 4, 2009 at 03:29 | Report abuse | Reply
  20. Miro Uhrik

    A simple solution for the public health care would be – to have exactly the health care insurance as te Congress has. That's what president Obama promised while campaining. He said: " why shouldn't American people have such good health insurance as Congress has?"
    It is already a good working plan and the Congress would not have to deal with reading 1013 some pages of new and so far not workable plan.

    August 5, 2009 at 23:27 | Report abuse | Reply
  21. Michael

    What I don't understand is this... Why can't the government provide a baseline level of care for the people and allow us to buy more insurance if we need it? If you want extended/better healthcare, then you will be able to buy extra insurance to cover it, or pay for it out of pocket.

    It is impossible to put a value on human life, at any age. But people must realize that healthcare, like any other resource is has its limitations. Should we spend a million dollars on extending an 85 y/o person's life by 6 or 12 months, when those same funds could be used to give several 10 y/o's 60 years of life? That's a question that will never have a clear cut anwere, but it is a question that must be dealt with.

    August 6, 2009 at 13:38 | Report abuse | Reply
  22. citizenjournalistreview

    The question of 'whether' or not one at any age should have health care or not, is an ethical question. It is also a question that has a way of discriminating against those above 'whatever' age. Our country overall has lost most of its ethics today and the aged and sick have born the brunt of much of the shifting values. The question is very different if it is you that is in the 'danger zone'. Who's to say that anyone younger, regardless of how much younger, deserves health care more than someone of any age. Even those 115 should get the health care they need and deserve. I would never agree that a 21 year old who has burned up their brain with drugs is of more value than a 65 year old who volunteers and helps make the lives of others better. No way! But, in our socieity, the 21 year old with dead brain cells would generally be chosen as the more sacred.

    I do agree with the baseline health care strainght across the board. Then, there must be a requirement that insurance will be made available with no 'pre-existing condition' clause.

    August 6, 2009 at 13:54 | Report abuse | Reply
  23. citizenjournalistreview

    I agree with shilpa clott the illegals should not have free health care. In fact, they shouldn't even be here, but that is a different issue. I'm not against legal immigration, just the illegal status. That is a large portion of our budget problems in government today. If it weren't for them, we wouldn't need so many more schools, medicaid and food stamp dollars.

    August 6, 2009 at 13:57 | Report abuse | Reply
  24. Pat

    Wow, some really uninformed people here.

    Carnita Wall – the top 1% in this country pay 40% of the taxes (IRS 2007 Stats). Sure those in Europe and Canada keep their insurance and don't have to go broke getting treatment. They also wait 2-3 times longer than us. They might get treatment, if the rationing body hasn't decided those treatments are "too expensive".

    Social security and medicare are doing good? You really need to get off CNN and check your facts. These programs are all about $43 trillion unfunded. Do you think we are $10 Trillion in the hole because of wars? I guess it's people like you who elect politicians like President Obama. You just don't have any real facts and actually beleive politicians when they say they can fix everything.

    We are guarenteed, Life, Liberty and the pursuit of Happiness. Why? Because our founding fathers knew, government is too corrupt and wasteful to ever provide citizens what they could work for themselves. Lower taxes and watch our economy thrive. Keep creating new social programs and debt, watch us all be dragged down into utopian misery.

    August 6, 2009 at 16:10 | Report abuse | Reply
  25. Diane

    When my grandmother, at the age of 85, was found to have pancreatic cancer, Medicare paid over $250,000 for surgery to "save" her life; she had several strokes and died in a nursing home a year later, at age 86.

    When my mother, age 52, was found to have pancreatic cancer, she was unable to continue working and pay for health insurance, so without treatment or surgery, she died at age 52.

    If I had to choose, I would have paid the $250,000 to save my mother instead of my grandmother; I loved them both, but grandma had a long wonderful life, while mom died before I was married and never had the opportunity to meet her grandsons.

    I support the current administrations quest to provide health care for all Americans.

    August 6, 2009 at 16:15 | Report abuse | Reply
  26. Pat

    Jane July 31st, 2009 3:54 pm ET

    CAPITALISM is the problem. As long as everything is given some monetary value above what folks can “earn”, there will be so many who will be unable to receive. Healthcare needs to be a right, but then again under capitalism RIGHTS get bestowed by money. This is a fundamentally fatally flawed system.

    Wow.. Really, Well give up your house, car, cell phone and every other thing you can afford and have because capitalism provided it. It is people like you who do not understand free markets. Thanks to capitalism we can afford much more than any previous generation. Quit sipping starbucks with your liberal freinds, if our system is so bad, I think they have room in Iran or North Korea.

    August 6, 2009 at 16:17 | Report abuse | Reply
  27. citizenjournalistreview

    The system is flawed. Ethically, we should not be making decisions to unequally fund something that will favor any group. It should be an across the board funding. No one should have to feel or know that someone else is 'chosen' because they are younger or for any other reason. If we allow our freedome to be eroded simply because they done presently apply to you or your family, they will eventually get around to you. None of us are free until all of us are free. When we stop protecting those less able to fight their own battles we as a society will go down the tubes. After all, with respect to the elderly, they are the ones who worked 30-40-50 years to make this a great country and they should be treated equally. Suppose we discriminated against everyone who was bald or overweight or pregnant or any other 'condition' we wanted to use. People would then be shouting about it. We simply need to insure that everything is equal. That is all I'm saying... equality for all regardless of affliction or age.

    August 6, 2009 at 17:21 | Report abuse | Reply
  28. cassandrayp

    We need health care reform. I have insurance but it keeps going up faster than my pay. We need to control the cost of health care for indiviuals and small businesses. I am willing to be taxed for a better system. My doctor is very good but even she becomes frustrated with the insurance company and their decisions about my care. We are paying for the uninsured one way or another. Let's just have them in the system. Many uninsured are hard working people who can not afford the care. Some of the untrue statements about what a possible bill will include needs to stop. I just want the facts not political posturing. Congress needs to finalize a bill and let's see how it benefits us. We need protections even if we like what we got right now. There is no guarentee that it will remain so. If a better health care system was not needed we would have stopped discussing this idea long ago. It is obviously a necessity, let's just get it right. Tthanks President Obama for putting it on your agenda.

    August 6, 2009 at 17:28 | Report abuse | Reply
  29. ms

    The cost of the medicare program – $25 billion; the avg cost of healthcare inflation was/is 6% over that period.

    $6 billion adjusted for 25 years of inflation $24,293,607,847.60 (pretty close)

    August 6, 2009 at 18:43 | Report abuse | Reply
  30. Aaron

    Jason must understand that we are already rationing healthcare in this country and have done so for many years. Heathcare services are scarce goods. Every day, decisions are made by health providers, insurance companies and policy makers concerning what treatments will be provided and financed and to what extent. All insurance institutions, whether private or public, make these decisions and in doing so, determine what type of medical services to provide and finance and which ones not to. Our economy and budget programs ration scarce goods. The price system of our economy rations scarce goods. No matter what political or economic system exists here or anywhere else, scarce goods will always be rationed. Medical services are no exception and will never be.

    August 6, 2009 at 20:23 | Report abuse | Reply
  31. A.B.

    Rationing is not a bad thing as it is portrayed in the media or American public opinion. Our economy is a system of rationing scarce resources and goods. All private and public insurers ration access to healthcare services. Decisions are made every day as to what services will be provided and which will be financed. Rationing makes it possible to provide goods to everyone on an equitable basis. There is enough for everyone's need, not for everyone's greed!!

    August 6, 2009 at 22:20 | Report abuse | Reply
  32. Mike

    Skyrocketing health care costs are increasingly putting a financial drag on our businesses. Insurance companies decide what they will cover and seek to deny/cap care. The recordkeeping and billing systems are extremely inefficient. Many doctors order large numbers of procedures and tests for financial gain and legal protection, without statistical benefits to patients. The cost increases of the status quo are unsustainable. We need constructive ideas about resolving these situations and providing a sustainable system for the long term. Distortion of the facts and scare tactics are counterproductive. I want conservative people at the table to make sure that we come up with a plan that is level headed...but I am concerned that so many seem to be boycotting the discussion by trying to focus on sabotaging the reform efforts altogether.

    What we need:
    • A system that coordinates medical records and streamlines/commonizes billing practices
    • A system that incentivizes & enables doctors to collaborate and make decisions in the best interest of patients
    • Better coordinated research into best practices that minimize cost while maximizing benefit, and sharing of these methods
    • A mechanism to protect doctors from unfounded lawsuits
    • A mechanism for cost feedback in the system – the current insurance format and billing system gives many patients little opportunity or incentive to reduce cost.
    • A law against rescission to prohibit insurance companies from denying care after accepting insurance payments
    • A way for people with pre-existing conditions to maintain medical coverage

    Anybody else have some constructive ideas?

    August 6, 2009 at 23:52 | Report abuse | Reply
  33. Mary King

    lived in England and I was not a citizen there. I was just a resident. I received health care coverage from the government without any cost. I was able to see any doctor I wanted and as many times I needed. My medications were like fifty cents here. I have exams at a hospital and did not pay a penney. Part of our taxes went to pay for the coverage and the taxes were a lot less than in USA. Of course England was not expending billions of dollars in unnecessary wars like we do here. We should stop the wars and save all that money to pay for medical coverage and control the healthcare providers fees. I have doctors in USA who told me to stop telling them my symptons as they only will listen to one complaint and if I have more pains or problems, I should make other appointments as they only have five minutes to see me. I just cry and felt helpless and depressed. Many doctors are pushing antidepressant tablets when patients are upset because they feel sick, The solution is to push tablets regardles of the root of the problem. Quality of care is none.

    August 8, 2009 at 15:18 | Report abuse | Reply
  34. Derek Kieta

    Dear Dr. Gupta,

    My name is Derek. I am a cardiac anesthesiologist that works in Dallas, TX at a underpriviledged hospital on an extremely sick patient population. I worked 70+ hours a week, and over 12% of the care I provide is gratis and another 50% is Medicare/Medicaid. Under HB3200, my income will become 30% of my current income. I understand that this is worse than the majority of specialists because anesthesia is billed differently than ever other specialty. The majority of my partners will not be able to pay the mortgages and will be unable to sell their homes in the current market without incurring debt that they will not be able to repay. Their maids, nannies, gardeners, etc. will have to be fired. Thus spreading, this countries economic woes.

    I thought I remembered something pertinent to physicians and the current proposals for the healthcare system in one of my favorite books of all time. Please consider Ayn Rand's words from "Atlas Shrugged" published in 1957. The quote is long, but it's absolutely creepy how current her arguments are!!

    This comes from a neurosurgeon explaining why he quit medicine and left the country:

    " 'I quit when medicine was placed under State control, some years ago,' said Dr. Hendricks. 'Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything – except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only 'to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards – never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind – yet what is it that they expect to depend on when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it – and still less safe, if he's is the sort who doesn't.' " (pg 744) [author's italics, highlighting mine]

    One more, if you don't mind, from the great Ayn Rand:
    " 'Let me give you a tip on a clue to men's characters: the man who damns money has obtained it dishonorably; the man who respects it has earned it ... Money is the barometer of a society's virtue ... when you see that men get richer by graft and by pull than by work, and your laws don't protect you against them, but protect them against you – when you see corruption being rewarded and honesty becoming a self-sacrifice – you may know that your society is doomed.' " (pg 412-413)

    Food for thought if nothing else.
    Derek Kieta, MD

    August 8, 2009 at 17:25 | Report abuse | Reply
  35. Paige

    The fact that you even mentioned Peter Singer is telling. He also advocates killing children who are born obviously disabled and feels that animals should be spared over humans. If this administration is listening to singer then we are in more trouble than I suspected.

    August 9, 2009 at 17:01 | Report abuse | Reply
  36. teinby

    thank you! I really liked this post!

    August 10, 2009 at 04:57 | Report abuse | Reply
  37. JOHN BOLEGOH

    I am a 65 year old Canadian who has lived in four out of ten provinces in Canada and can therefore comment on my direct experience with our health care system. Canada's federal government requires that its provinces (states) deliver total health care to its residents. Some Provinces simply require residency to have full access to health care while others require a premium to be paid by the employer or the individual. In my case, while I lived in British Columbia I paid $125.00 per month for family of five coverage of all health care costs. This fee covered all costs related to family doctor visits, hospitalization and if necessary any surgery that one can think of (including organ transplants, cancer treatment and even birth of children.
    Our health care system may not be perfect, but all Canadians have access to physicians or hospitals of their choice and the costs are fully covered by the plan.
    The prescribed treatment is not vetted by some government agency and the doctor determines, with the patient, the best approach to treating any medical problems.
    The misinformation being broadcast to Americans by the press, lobbying groups and even politicians does a disservice to rational approaches to resolving a problem that directly affects all Americans.
    I even heard President Obama state that his push for a health care solution will not be along the lines of the Canadian or British systems. I have not seen or heard any factual report done by the American press that have identified any major faults with the Canadian approach, a health care system that provides all Canadians with access to any medical treatment determined necessary by the patient's doctor.
    Is this because Canada's health care system was not invented in America. Our system is not a state secret, yet I have not heard of any congressional group taking a close look at our system that is currently working, funded and allowing Canadians to sleep soundly without the threat of financial ruin if one of our children or ourselves becomes ill.
    Is there just too much money available to lobbyists or politicians to maintain the American status quo at the expense of the average working American.
    Best of luck with your project and sorry that we Canadians cannot be of more help.
    Regards,

    August 10, 2009 at 21:55 | Report abuse | Reply
  38. Davis Liu, MD

    Healthcare doesn't need to be rationed if the healthcare system is changed to focus on providing the right care at the right time and not the excess of testing, medication, and imaging that occurs in our country without added benefit or improved healthcare outcomes. It is already demonstrated in our country by various groups including Mayo Clinic. Learn more at http://tinyurl.com/q8ymzz. Incidentally, healthcare is already being rationed – by the ability to pay or not to pay.

    Davis Liu, MD
    Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System
    Website: http://www.davisliumd.com
    Blog: http://www.davisliumd.blogspot.com
    Twitter: davisliumd

    August 11, 2009 at 10:11 | Report abuse | Reply
  39. Barry Douglas

    I have been trying to understand section 123 and related sections of HR3200. I can find nothing which would prohibit the Health Benefits Advisory Committee from determining priority of access to specific medical procedures, dialysis for example, based on age. Can anyone help me understand section 123?

    August 11, 2009 at 21:05 | Report abuse | Reply
  40. Ed

    By what authority in our Constitution does the government enter into a non-government activity like health care? Just asking.

    August 13, 2009 at 01:35 | Report abuse | Reply
  41. Gwen Levine

    Read what Obama's medical ethicist adviser - Rahm Emanuel's brother, Ezekiel wrote about rationing. Then decide if this is what health care reform really means.

    The Lancet, Volume 373, Issue 9661, Pages 423 – 431, 31 January 2009 Principles for allocation of scarce medical interventions by
    Ezekiel J Emanuel MD

    Summary: Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favoring the worst-off, maximizing total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritizes younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.

    My 2 cents worth: The people afraid of what health care reform really means are justified in their concerns. Obama’s administration is truly starting generational warfare.

    August 13, 2009 at 12:29 | Report abuse | Reply
  42. Steffani

    The hard fact is health care is already rationed. Those who have the ability to pay receive healthcare; those who do not, do not receive healthcare. This is nothing new.

    Insurance companies are the ones actually doing the rationing. They may mandate that certain procedures, or certain equipment, is "not medically necessary," despite the common sense analysis that it is medically necessary. Equipment which could not only improve the user's quality of life, but which could actually prevent predictable secondary complications and reduce constant re-hospitalizations, is frequently denied.

    The insurance company tells the patient , and the medical provider, what will be covered, and what will not. The medical provider may then refuse to do procedures which will not be reimbursed to them. The insurance company stays in business by making money...not by covering claims. They stand to benefit from denying access to health care; by rationing care. Remember, it's a business. Thus, the patient is effectively foreclosed from obtaining care they need....no matter what their age.

    The real problem, then, is to provide real coverage for all people; insured or not. Personally, I was forced to terminate my private insurance because of exhorbitantly escalating monthly costs. Paying for insurance became a gamble; what is the liklihood I will need some critical care, this year? Can I take the risk?

    I work in the medical industry. I have clients call all the time who need the product my company manufacturers; but their insurance refuses to purchase this type of equipment for them. Medicare is especially problematic. Despite the fact that some of those on Medicare have a heightened need for certain types of equipment (such as equipment which would safely assist them in re-gaining the ability to stand and walk), Medicare will not cover this equipment. People are not getting the medical services, and the medical products, they need for healthy functioning.

    August 15, 2009 at 13:18 | Report abuse | Reply
  43. h sutherland md (retired)

    Where are we going to get the 15,000+ doctors in primary care to take care tof the 50,000,000 new patients? When you subtract the doctors that retire or die during the year and those who are will not work for 55 cents on the dollar, the deficit in doctors comes even more severe. The number of graduates today barely replaces those who retire or die and most of these do not enter primary care. Since it takes a minimum of 10 years for a student to finish college, medical school, and training, Where are we going to find those extra doctors? Foreign trained doctors come to USA to excape socalized medicine and certainly won't come now. Yes, medical care will be rationed, but not by denial of care. Inability to see a doctor will be the cause of rationing.

    August 17, 2009 at 13:56 | Report abuse | Reply
  44. Martha Macy

    I have a question/suggestion about the health care problems.

    Why are the present ideas SO complicated?? It is totally mired in convoluted, twisted plans that no one wants or understands.

    Why is no one talking about keeping Medicare, and Medicaid in place ....... enrolling everyone who wants and needs it .... on a sliding scale! That, plus raising taxes a little is a much better idea.

    Both systems work quite well after years of tweaking. Just let everyone who wants it use it. I think the combination of sliding scale payments and a little tax hike would be much easier for people to swallow.

    Another thing.....most intelligent people realize we can't have this for nothing. We have no problem with everyone paying a little more in taxes for this. That's exactly what we want our taxes to be used for!!! The politicians should stop saying that we can have the moon without raising taxes!

    I think that is why people are so afraid of these changes. Go with a system that we already know and love...and make it available to all who want it. The wealthy can keep their private insurance if they want it. I really don't understand why we must scrap good programs that are already in place.

    I'm just askin'.

    PLEASE address these thoughts on the air. I've never heard anyone talk about this simple obvious solution.

    Martha Macy
    Highgate Center, VT

    August 18, 2009 at 08:14 | Report abuse | Reply
  45. Sibylle Johnson

    It is so ironic that so many Americans are so easily misled into fighting what may be so crucial to their own wellbeing sometimes in the future.

    I have lived in 3 countries (France, Germany, England) with socialized medicine and having lived in the USA for 20 years I still miss the sense of security I used to have when I was able to go to the doctor without financial worries.

    In France and Germany (maybe England) private insurance companies thrive as they cover those who like additional perks (private rooms in hospitals, expedited treatments with shorter waits, etc.). IT WORKS! Everybody is covered, and those who wish to buy additional / alternative coverage CAN and DO.

    Nowadays, I am amongst the lucky ones who have a great health insurance, and yet I don't even go to the doctor since I am concerned about being diagnosed with a preexisting condition, which would prevent me from getting insurance when my husband retires and I have to buy my own. This being said, I am a very health conscious and live an exceptionally healthy lifestyle, but still nobody can predict the future. Frankly, I do believe in personal responsibility and I would favor increased costs for those who are resisting a healthy lifestyle and are, therefore, suffering from lifestyle-related illnesses. If they cannot afford it, this cost could be covered by volunteering / public service.

    I am at a loss to see how gullible so many Americans are. How can ANYONE believe the nonsense the right-wings, backed by insurance and Big Pharma lobbyists, are putting out.

    Anyone who is now resisting the public option health insurance because they themselves have good insurance and don't give a second thought to those who don't – beware, because if you or a loved one are unlucky enough to be diagnosed with a serious disease later on (which is likely), you will be experiencing the pain and hardship so many people are currently suffering as they are being dropped by their health insurance and are losing their homes and retirement funds to pay for medical care.

    Sibylle Faye

    August 18, 2009 at 11:31 | Report abuse | Reply
  46. RSaunders

    Today's tagline is "Facts vs Fears – Care will not be rationed".

    When I read that I think; Yes Dr Gupta, you have identified my fear. I am afraid that the proponents of health care are telling folks that care will not be rationed. If true, that really scares me.

    As Rick Debay mentioned, we currently have health care rationing. Part of our health care dollars go to provide adequate care for most people. Part of our health care dollars go to providing excessive care, usually diagnostic testing, for most people. We don't spend the money to prove adequate care to some people. That's the current rationing plan.

    Obama has taken malpractice reform off the table, so the excess care for folks with insurance is going to remain. Obama has said that the plan won't run a deficit, so spending a lot more to increase overall health care spending is off the table. That only leaves one thing we can change, who gets adequate care. Today, we give inadequate care to poor people. With the goal of including everyone in the plan, are we going to give inadequate care to old people, as Mr Singer may suggest? If not them, then who??

    To give everybody adequate care, the total care delivered in the country is going to have to go up. That means more hospitals, doctors, nurses, medical machines, drugs, hospital administrators, etc. That means that either all these things/folks have to become less expensive (which they seem to be against) or we will need a lot more money.

    Medicare cost a lot more than folks said it would cost, the Massachusetts plan cost a lot more than people said it would cost, and I can't escape the notion that this is going to cost a lot more than Obama's folks say it will cost. I'm afraid. Afraid it is going to cost a great deal because we can't make the hard choices needed to ration care. We need health care rationing, or we're all going to go broke paying for it.

    Dr Gupta's reports need to get to the bottom of the cost issue. Fact checking the silly Palen stuff is fine for starters, but in the end somebody has to get all the facts on the table. It would be nice to pay for whatever medical care people want, but we can't afford it.

    August 18, 2009 at 13:12 | Report abuse | Reply
  47. Kimberly O'Connor

    We currently ration health care based on economics-if someone has the money or the insurance coverage, they get both required and optional treatments; if not, they get minimal care. Would I rather have a government entity making the rules about what is covered and what is not or an insurance company representative who is under significant pressure to keep costs down and ensure a positive bottom line for the company? Not a contest, the government! Fear government intervention in your health care? Don't accept your Medicaid, Medicare, VA, EPSDT, and other government medical care. Not only do you get to stand by your principles, but you help reduce the cost of these programs for the government.

    I was involved in the 1995 effort to reform health care and am dismayed that once again, the opposition (regardless of political party) is picking apart each comma and semi-colon.

    August 19, 2009 at 09:47 | Report abuse | Reply
  48. Joel

    I just saw a piece on CNN regarding the health insurance co-op in Minnesota called HealthPartners. I was under health partners for a number of years in MN and I saw no difference from any other insurance company (I've had several over the years) for myself as the insured. The cost was high, except the co-pays were good for ppo at 10% instead usual 20 or 30%. But what they insured, how they disqualify by conditions, the overall cost of the insurance, plus others is about the same, and nothing special. Their HMO option was not any better at all then anywhere else. The electronic record keeping was very good, but that saving must have gone back to the employer or somewhere but not to me. The overall major issues in this health care/insurance reform is in the level of overall costs and access and these issues still remain in this co-op. One would not know that it was a co-op unless told in some way.

    I really don't see that a co-op is the answer to access and cost and other problems unless the co-op is the federal government ... really it is only the intentions, size, and power of the feds that can make it pervasive enough and with resolve to bring down costs, allow access for all, allow quality to be the main choices over profit. Private insurance never considers quality and access over profits but rather profit is always king with them ... no doubt ... that's a no brainer to anyone looking and thinking. So it is plainly obvious once one cuts through all the smoke that the government is the ONLY organization with the publics interests in mind while also being powerful enough to do something about it. The government in this country has gotten a bad wrap when it comes to the millions of dedicated government workers and 100's of working programs that do what they say they are doing and do plenty of good. Anything short of a viable public option will be cheating the public. Please let's do the right thing.

    August 19, 2009 at 17:50 | Report abuse | Reply
  49. Dr. Stephanie Frame

    Hi Dr Gupta. I think you are great and really enjoy hearing you on CNN. I am a Board Ceritified Family Practice Physician, acting Medical Director, practicing in a rural FQHC health clinic in Mill Creek, WV. There is high unemployment and poverty in this area. Most people are uneducated. There is a huge addiction problem in this area. This is a federal clinic that is kept running by federal dollars. It is a big job. I enjoy that I do not have to worry about treating or not, because we treat everyone reguardless of ability to pay. I feel that as long as insurance companies are involved with insurance for profit, the American public will not have good care. Currently, the insurance companies tell me what test I can get or not get and what medications that I can use. Actually, the people that I see having the most freedom of choice are Medicare and Medicaid patients. I feel that a government based plan is a better option at this point. However, I have many concerns about the government option. The government option must put the Physician back in the picture. This clinic is run by individuals with MBA's but no health care experience before this job. If Physicians are not part of the plan it will be difficult for a govenment plan to work. For example, at my current job I make alot less money than I could in a private situation. My employer does not provide raises, retirement or increasing benefits over time. I get one week of CME and it has been difficult for me to get them to pay for that. The one week, out here in the middle of nowhere is not enough for me to keep myself educated and I am planning to take time off without pay this year so I can continue to learn. Health insurance is provided, but is so expensive that many of the employees can not afford it. The plan here is to hire more people, to provide jobs, but most of them are not educated or trained in the health care field and this makes for chaos in how the office runs. Also, in the chain of command here, Physicians and other providers are on the bottom of the chain. I have heard the office manager being told to ingnore the nurse practicioner that works here because she is just a nurse. I feel I have very little influence in what happens here. There is a community board over the clinic, but employees are not allowed to talk to them and are not allowed to attend board meetings, so, this board does not really know what happens here. Currently, the office mangager above me worked at a wood plant and has one year of college and no prior health care experience and is above me on chain of command. Most of the employees here have no clue how a medical office should be run. We have many employees, yet it is difficult to get the patients put into a room. Because I have no real power here, the employees do not try to do things that I suggest. I am not respected by employees or administration and feel that most of the time I get lip service for my comments, complaints and concerns. So, if the government plan runs like this all over the country, that will be a big problem. It is difficult to work under these conditions and I could tell you many stories that you would not believe. So, while I do believe a government plan is the best, I feel the Physician must be put back into an administrative postition in order to have these government clinics run smoothly. As it is, turnover here is high. I would like to stay for a number of years, but I am not sure I can. I do plan to apply for the money for student loans that you mentioned on the news recently. Again, I heard about that on my own. My CEO told me that he knew about it when I mentioned it, but had not gotten around to telling me about that. I still have alot of loans and the decision to stay here is a finacial burden for me. Also, I had to pay my own insurance tail when I came here and I am still paying that off. So, there are many problems for me here. The good part is that my patients are my neighbors and I really enjoy being part of this community. If you have any ideas for me, please let me know, but please do not put may name on TV or anything. I do not want to lose my job for speaking out. Thank you for your time. Dr. Stephanie Frame.

    August 20, 2009 at 09:20 | Report abuse | Reply
  50. Richard McDermott, MD

    I was listening to a panel on health care which included yourself on Anderson Cooper 360 and you commented that a patient could go to the ER and be turned away even with a life threatening condition because they did not not have health insurance. You cannot be turned away from an ER under these circumstances and you cannot be sent to another hospital until you are stabilized. There are federal regulations on ER care.
    I hear the words quality. inefficient care, evidence based medicine being bandied about and articles being written about the USA being low in infant survival but no in depth data showing how the conclusions are being reached. You mentioned that it was more expensive to be treated in urgent care which for some people is not true as it is less expensive than ER treatment. Medicare is among the lowest payers( on the program a figure of 20-30% lower was mentioned) causing many providers to drop them, if the Medicare payment levels extend to a national health care plan some offices will not be able to stay open. Private insurance is subsidizing the cost of Medicare and TRICARE for hospitals which is a problem that needs to be addressed in the current debate over a national program.

    August 23, 2009 at 15:11 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.