Category Archive 'Rationing'
21 Sep 2014
Dan Greenfield explains how Progressivism has changed the fundamental nature of American society.
There are two types of societies, production societies and rationing societies. The production society is concerned with taking more territory, exploiting that territory to the best of its ability and then discovering new techniques for producing even more. The rationing society is concerned with consolidating control over all existing resources and rationing them out to the people.
The production society values innovation because it is the only means of sustaining its forward momentum. If the production society ceases to be innovative, it will collapse and default to a rationing society. The rationing society however is threatened by innovation because innovation threatens its control over production.
Socialist or capitalist monopolies lead to rationing societies where production is restrained and innovation is discouraged. The difference between the two is that a capitalist monopoly can be overcome. A socialist monopoly however is insurmountable because it carries with it the full weight of the authorities and the ideology that is inculcated into every man, woman and child in the country.
We have become a rationing society. Our industries and our people are literally starving in the midst of plenty. Farmers are kept from farming, factories are kept from producing and businessmen are kept from creating new companies and jobs. This is done in the name of a variety of moral arguments, ranging from caring for the less fortunate to saving the planet. But rhetoric is only the lubricant of power. The real goal of power is always power. Consolidating production allows for total control through the moral argument of rationing, whether through resource redistribution or cap and trade.
The politicians of a rationing society may blather on endlessly about increasing production, but it’s so much noise, whether it’s a Soviet Five Year Plan or an Obama State of the Union Address. When they talk about innovation and production, what they mean is the planned production and innovation that they have decided should happen on their schedule. And that never works.
You can ration production, but that’s just another word for poverty. You can’t ration innovation, which is why the aggressive attempts to put low mileage cars on the road have failed. As the Soviet Union discovered, you can have rationing or innovation, but you can’t have both at the same time. The total control exerted by a monolithic entity, whether governmental or commercial, does not mix well with innovation.
The rationing society is a poverty generator because not only does it discourage growth, its rationing mechanisms impoverish existing production with massive overhead. The process of rationing existing production requires a bureaucracy for planning, collecting and distributing that production that begins at a ratio of the production and then increases without regard to the limitations of that production.
Read the whole thing.
21 Oct 2013
Adam Garfinkle, writing at The American Interest, debunks the egalitarian rhetoric used to promote federalizing health care.
[N]o one seems willing to call what is going on by its real name: class-based triage, or rationing, of medical care.
We can see this more clearly if we put these two data points together: We are slowly (or not-so-slowly) but surely moving toward a much more finely gradated class-based system of healthcare. Compared to where we were before Obamacare passed, the top is moving up and the bottom is moving down faster than ever, leaving a thinner middle where most Americans with employer-provided health insurance have typically beenâ€”somewhere in the murk between HMOs and PPOs of various descriptions. Now, those who can afford it will increasingly pay more and get more. Those who cannot afford it will pay less and get less.
Now, there is nothing surprising about this, and itâ€™s what happens in most countries with some form of government-mandated universal health care. There are always private healthcare options in those countries, for people who can afford it, to detour around the public option. But it is not what Obamacare advertised.
Daniel Greenfield (author of the widely-admired Sultan Knish blog, responds:
Actually they will pay more and get less. When they do pay less, they will be paying more for less services. It may not be obvious to them, but the insurers will have done the math.
The problem is that triage of this sort is inevitable.
The market naturally rations products and services. Thereâ€™s no way to get around that. Even in a totalitarian state with a planned economy, national health care and price controls, professionals will just go to the most rewarding fields.
And thereâ€™s always a class structure. Soviet academics lived much better than their colleagues lower down on the ladder. Meanwhile Soviet medicine was pretty terrible. The smart people were going into research and then not doing any research because the entire system was too far behind to catch up.
The more the system is tampered with, the more the middle, which is a product of the free market collapses, reverting everything back to the 99 percent and 1 percent model that the left pretends we have now. Except itâ€™s really more like a 67%, 9% and 24% model.
ObamaCare forces more doctors to become completely inaccessible to anyone other than the wealthy. The process began with HMOs, that original ingenious plan to solve the health care problem, which instead made it more expensive and less rewarding for doctors to do business. Costs kept going up and so did health care.
This is just one of the final steps on the rung before we end up with no middle ground. This wonâ€™t just have an impact on the people in the middle, it will eventually destroy the quality of medicine in general.
Thereâ€™s only so much room at the top. If the only way to really make money is by treating the rich, that requires far fewer doctors and that means thereâ€™s much less room in medicine.
Medical schools will turn out more mediocrities, Third World students who excel at rote memorization but have no interest in patient care, and the top tier of medicine will continue shrinking down. There will be some good people at the top, but their numbers will diminish with each generation.
And then American medicine will die. But youâ€™ll always be able to go and see a Nurse Practitioner for some obesity counseling.
23 Jan 2011
Harvard researcher Mike Stopa, in the Boston Globe, argues that American’s concerns about bureaucratic rationing in a socialized heath system and the conflict of interest in end of life counseling sponsored by the government provider are entirely rational and legitimate.
Supporters of President Obamaâ€™s health care reform law have relentlessly derided Sarah Palinâ€™s notion of â€œdeath panelsâ€™â€™ as a vulgar rhetorical technique, with no basis in reality, devised merely to scare a gullible, uneducated citizenry into rallying to repeal the law. The death panel notion persists, however, because it denotes, in a pithy way, the economic realities of scarcity inherent in nationalizing a rapidly developing, high-technology industry on which peopleâ€™s lives depend in a rather immediate way. G.K. Chesterton once wrote that vulgar notions (and jokes) invariably contain a â€œsubtle and spiritual idea.â€™â€™ The subtle and spiritual idea behind â€œdeath panelsâ€™â€™ is that life-prolonging medical technology is an expensive, limited commodity and if the market doesnâ€™t determine who gets it, someone else will. …
The resistance to incorporating end-of-life planning into Medicare is based on the rational fear that such planning will be used to coax patients into forgoing life-extending technologies that Medicare administrators may deem risky, of marginal benefit, or unlikely to succeed â€” an estimation that could be based in part on the cost of the technology.
Moreover, the suspicion that such programmed advance planning conceals ulterior motives is exacerbated by the fact that relatively few patients will ultimately benefit from it. It is mainly of value for those who do not die suddenly, who have no trustworthy relations to maintain their power of decision, and who lose their wits a potentially long time before their death.
Opposition to government-funded end-of-life planning does not imply ignorance of the indignity or discomfort of having one more tube placed into oneâ€™s body to buy an extra few days of painful life. (Although one can imagine concluding that dignity is a highly overrated virtue when the alternative is death). But when a massive government bureaucracy, tasked with determining medical â€œbest practicesâ€™â€™ and controlling costs, announces a policy that â€œwellness visitsâ€™â€™ should have us chatting with our doctors about what technologically invasive, life-extending procedures we would just as happily do without, we are not supposed to be suspicious?
Read the whole thing.
15 Jul 2010
Daniel Henniger, in the Wall Street Journal, argues that Obama’s appointment of Daniel Berwick, aptly headlined by Gregory as: Obama Appoints Marxist to Lead Death Panel, is decidedly worse than the Kagan appointment.
Barack Obama’s incredible “recess appointment” of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services (CMS) is probably the most significant domestic-policy personnel decision in a generation. It is more important to the direction of the country than Elena Kagan’s nomination to the Supreme Court.
The court’s decisions are subject to the tempering influence of nine competing minds. Dr. Berwick would direct an agency that has a budget bigger than the Pentagon. Decisions by the CMS shape American medicine.
Dr. Berwick’s ideas on the design and purpose of the U.S. system of medicine aren’t merely about “change.” They would be revolutionary.
One may agree with these views or not, but for the president to tell the American people they have to simply accept this through anything so flaccid as a recess appointment is beyond outrageous. It isn’t acceptable. …
These excerpts are from past speeches and articles by Dr. Berwick:
“I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”
“You cap your health care budget, and you make the political and economic choices you need to make to keep affordability within reach.”
“Please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can.”
“Indeed, the Holy Grail of universal coverage in the United States may remain out of reach unless, through rational collective action overriding some individual self-interest, we can reduce per capita costs.”
“It may therefore be necessary to set a legislative target for the growth of spending at 1.5 percentage points below currently projected increases and to grant the federal government the authority to reduce updates in Medicare fees if the target is exceeded.”
“About 8% of GDP is plenty for ‘best known’ care.”
“A progressive policy regime will control and rationalize financingâ€”control supply.”
“The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property.”
“Health care is a common goodâ€”single payer, speaking and buying for the common good.”
“And it’s important also to make health a human right because the main health determinants are not health care but sanitation, nutrition, housing, social justice, employment, and the like.” …
“Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy.”
Previous Berwick posting.
30 Nov 2009
William A. Jacobsen notes that we have five times the population, so…. would our death rate produced by service rationing limits and delays really be merely linear, or would it be exponential?
Another day, another exposÃ© by a British newspaper about the failure of nationalized health care. This time, it’s the left-wing The Guardian reflecting on how delays in cancer care cause 10,000 unnecessary deaths each year compared to other European countries:
Up to 10,000 people die needlessly of cancer every year because their condition is diagnosed too late, according to research by the government’s director of cancer services. The figure is twice the previous estimate for preventable deaths….
Richards found that “late diagnosis was almost certainly a major contributor to poor survival in England for all three cancers”, but also identified low rates of surgical intervention being received by cancer patients as another key reason for poor survival rates.
Research by academics at Durham University led by Prof Greg Rubin has identified five types of delay in NHS cancer care: “patient delay”, “doctor delay”, “delay in primary care [at GPs’ surgeries]”, “system delay” and “delay in secondary care [at hospitals]”….
Since Britain’s population is less than one-fifth that of the U.S., the equivalent number of unnecessary deaths in the U.S. would exceed 50,000. The U.S. has cancer survival rates which exceed even the better European countries, so that number may be higher.
Keep that in mind the next time you hear Alan Grayson (D-Fla.) and others throw around fictitious numbers about how many people die in the U.S. from lack of insurance. And this week as Harry Reid and the Democrats tout how Reid’s plan will save families in the “non-group” market $500 on private insurance.
15 Jul 2009
Dick Morris observes that, in return for that tremendous tax increase and resulting economic stagnation and unemployment, older people, the principal current users of health care, can look forward to rationing at their expense.
Obamaâ€™s health care proposal is, in effect, the repeal of the Medicare program as we know it. The elderly will go from being the group with the most access to free medical care to the one with the least access. Indeed, the principal impact of the Obama health care program will be to reduce sharply the medical services the elderly can use. No longer will their every medical need be met, their every medication prescribed, their every need to improve their quality of life answered.
It is so ironic that the elderly – who were so vigilant when Bush proposed to change Social Security – are so relaxed about the Obama health care proposals. Bushâ€™s Social Security plan, which did not cut their benefits at all, aroused the strongest opposition among the elderly. But Obamaâ€™s plan, which will totally gut Medicare and replace it with government-managed care and rationing, has elicited little more than a yawn from most senior citizens.
Itâ€™s time for the elderly to wake up before it is too late! …
Today, 800,000 doctors struggle to treat adequately the 250 million Americans who have insurance. Obama will add 50 million more to their caseload with no expansion in the number of doctors or nurses. Indeed, his plan will likely reduce their number by lowering reimbursement rates and imposing bureaucrats above them who will force medical decisions down their throats. Fewer doctors will have to treat more patients. The inevitable result will be rationing.
And it is the elderly who rationing will most effect. Who should get a knee replacement a 40 year old or a 70 year old? Who should get a new hip, a young person or an old person? Who should have priority in the operating room a seventy year old diabetic who needs bypass surgery or a younger person? Obviously, it is the elderly who will get short shrift under his proposal.
Read the whole thing.
Skeptical? Just read between the lines of this New York Times article by radical leftwing ethicist Peter Singer, no less, hailing government rationing of heath care as inevitable and a fine thing, too. Says Singer:
The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable.