Rationing Health Care: The US does it a lot

In conversations with friends about health care in Canada I often hear, "Well in Canada you have to wait months to get a hip replacement. Right?" No one in my family has had a hip replacement, but I can say when we needed primary care we got it. When my Dad injured his elbow he had an MRI, and the appropriate surgery within a week (and then afterwards got months of physical therapy). And for all this health care we have never had to worry about getting a bill in the mail. Ya, it is pretty awesome!

And before you say we pay for it in taxes, I just want to remind you of a post I had written a long time ago that argued Canadians actually pay quite similar tax percentages. Here's the proof again! These are all taken from Canadian and American federal websites (please click and make the pictures larger).

First Canada, the above numbers the federal tax rates. The second set is the provincial tax rates:


Second, the United States. Here are the Federal Income tax brackets:


And here are the State income tax rates (roughly, since we only see the bottom and top tax bracket. It also shows deductions, but please know that Canadians claim thousands in deductions and credits every year as well):


So there you have it. Tax wise, we are really not much different. However, with what the average middle-class US citizen gets out... don't you feel a little cut short. I mean, no universal form of health care. An essential right, is sold much like any other form of insurance. You mean, there is a company placing bets that you won't or will get sick and charge you the appropriate fees per month.

I'm going to be bold and just say it. Health insurance in America is sickening. Detestable. Gross. Abhorrent.

So back to my original point about rationing. You think this is only a Canadian phenomena. Read THIS.

The NY Times article I linked above talks about health care rationing in United States. Here are some highlights:

Today, I want to try to explain why the case against rationing isn’t really a substantive argument. It’s a clever set of buzzwords that tries to hide the fact that societies must make choices.

In truth, rationing is an inescapable part of economic life. It is the process of allocating scarce resources. Even in the United States, the richest society in human history, we are constantly rationing. We ration spots in good public high schools. We ration lakefront homes. We ration the best cuts of steak and wild-caught salmon.

Health care, I realize, seems as if it should be different. But it isn’t. Already, we cannot afford every form of medical care that we might like. So we ration.

We spend billions of dollars on operations, tests and drugs that haven’t been proved to make people healthier. Yet we have not spent the money to install computerized medical records — and we suffer more medical errors than many other countries.

We underpay primary care doctors, relative to specialists, and they keep us stewing in waiting rooms while they try to see as many patients as possible. We don’t reimburse different specialists for time spent collaborating with one another, and many hard-to-diagnose conditions go untreated. We don’t pay nurses to counsel people on how to improve their diets or remember to take their pills, and manageable cases of diabetes and heart disease become fatal...

Milton Friedman’s beloved line is a good way to frame the issue: There is no such thing as a free lunch. The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally.

The article contains itemized reasons as to why America actually does ration health care. The author is much more balanced then I am on the health care issue, so don't be scared.

Obama & Health Care

The New York times ran an interesting editorial on health care that got me thinking about health care reform again.

First of all, Obama spoke to the AMA today. The reaction was chilly. Obama's proposed changes to malpractice, electronic health records, and anti-smoking legistlation were met warmly. However, the push for health cost savings was met with ice cold stares. So why the resistance from the AMA?

Fortunately, the NY Times expanded on this and provided an explanation. Essentially, health cuts really hurt physician salaries because they get less money for doing the same thing. Does this idea need to be expanded? Probably not.

So what is the solution? I think we need to simplify the system. I think materials and procedures should have a consistent cost and a clear system of billing. Is this possible? If so, it would provide a clearer picture as to how Obama's plan would change things. Because I think right now, everything is just speculation. We don't know how physician compensation would change. We don't know how our costs will change. Everything is a step in the dark.

Hopefully, President Obama will continue to make more steps to inform us about his proposed changes. I will be listening carefully for any numbers that he reports. So if you're interested tune in June 24th for Obama's "Health Care Town Hall" on ABC.