Digging deeply into death panels and rationing

April 27, 2012 | By | 5 Replies More

At at website called Respectful Insolence, Orac takes on the misconceptions and lies regarding the PPACA (“Obamacare”), focusing on “death panels” and “rationing.” It’s a fact-filled article sprinkled with excellent links. This brand new article is called “No, Virginia, cancer care in Europe doesn’t suck, contrary to what a recent paper implies.” Here’s an excerpt:

Indeed, most of the resistance to the Patient Protection and Affordable Care Act (PPACA), otherwise known in popular parlance as “Obamacare,” has been fueled by two things: (1) resistance to the mandate that everyone has to buy health insurance, and (2) the parts of the law designed to control the rise in health care costs. This later aspect of the PPACA has inspired cries of “Rationing!” and “Death panels!” Whenever science-based recommendations are made that suggest ways to decrease costs by reevaluating screening tests or decreasing various tests and interventions in situations where their use is not supported by scientific and clinical evidence, whether by the government or professional societies, you can count on its not being long before these cries go up, sometimes eve from doctors themselves in the form of Ayn Rand-worshiping libertarian doctors who think that Medicare is unconstitutional, that doctors’ autonomy should be virtually unlimited, and that there should be in essence no constraints on them.

My perspective on this issue is that we already “ration” care. It’s just that government-controlled single payer plans and hybrid private-public universal health care plans use different criteria to ration care than our current system does. In the case of government-run health care systems, what will and will not be reimbursed is generally chosen based on evidence, politics, and cost, while in a system like the U.S. system what will and will not be reimbursed tends to be decided by insurance companies based on evidence leavened heavily with business considerations that involve appealing to the largest number of employers (who, let’s face it, are the primary customers of health insurance companies, not individuals insured by their health insurance plans). So what the debate is really about is, when boiled down to its essence, how to ration care and by how much, not whether care will be rationed. Ideally, how funding allocations are decided would be based on the best scientific and clinical evidence in a transparent fashion.

This article punctures the flawed methodology of another recent study that slams all government health care based on prostrate and breast cancer outcomes without taking into account the “lead-time bias.”  Here’s the issue with LTB: “aggressive screening can lead to more patients having a diagnosis of cancer for a longer period of time even without any real improvement in survival [this leads to] more overdiagnosis, which will inflate the apparent survival time after a cancer diagnosis in the population.”

The article links to a stunning set of graphs At Incidental Economist showing that the U.S. isn’t getting anything for all of that early diagnosis and high tech cancer treatment.   And this is the health care system that we tout as the world’s best.  Another case where evidence is inconvenient.   If you really want to get pissed off at the insanity of our lawmakers, check out this article at Incidental Economist(“Public health prevention fund: On the chopping block once again“), which points out that fact that our preventative health system is atrophying and the reasons for this horrific development.


Category: Health, Health Care Reform

About the Author ()

Erich Vieth is an attorney focusing on consumer law litigation and appellate practice. He is also a working musician and a writer, having founded Dangerous Intersection in 2006. Erich lives in the Shaw Neighborhood of St. Louis, Missouri, where he lives half-time with his two extraordinary daughters.

Comments (5)

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  1. Adam Herman says:

    Incidental Economist is using a tired, flawed argument. The reason cancer survival rates are such a good stat for cross-country comparisons is because they are the only stat that measures health care system outcomes. Things like mortality from all causes and how many people get cancer is a function of many other things besides the health care system. Americans are notoriously unhealthy in our lifestyles. I’ve never heard of anything in health care that can prevent you from getting cancer. Or any disease whatsoever, unless there’s a vaccination. It’s such an obvious thing that I can’t believe he actually trotted it out. How does measuring how many people GET cancer or respiratory disease say anything about our health care system?

  2. Niklaus Pfirsig says:

    Adam, There are several cancers that are treatable, if detected early. There are also some cancers that a healthy immune system can handle.

    Health insurers prefer the term “managed care” when they determine, based solely on cost of paying for treatment vs the revenue generated by the patient.

    Back in February, I had a colonoscopy to screen for colonorectal cancer. Under the currently active provisions of the affordable health care act, the insurance was supposed to pay 100 percent of the cost.

    Instead I received a bill from the hospital for nearly $800, which the hospital demanded payment in full. According to the insurance company (CIGNA) if the examination finds anything, as it does in 35 percent of the cases, the screening morphs into a diagnostic and if a biopsy is performed, it may also be considered surgery, so the full coverage no longer applies.

    Apparently all other health insurers are doing the same. They are following a strategy to increase the costs of health care on the consumer, while maximizing their revenues and at the same time sabotaging the affordable health care act. No doubt the repugnant Republicans will be quoting stats to prove the affordable health care act made health care more expensive.

    But wait, there’s more! CIGNA has restructured their formulary. The most common insulin used by diabetics has been reclassified as a specialty drug with a $90 copay, up from $20, and the premiums have increased, so CIGNA’s CEO could claim a $4M bonus with enough left over to declare $1.2M in profits.(please note that salaries and bonuses are payroll expenses, so if the gold-plated @$$ could have declare bigger profits by simply forgoing his bonus.

  3. Adam Herman says:

    Since they now have to spend 80% of their revenue on health care, it’s not possible for them to profiteer anymore. Did you hear that the FDA is considering putting a lot of prescription drugs OTC so that Medicare and Medicaid won’t have to cover them anymore? Do you think the government is immune from bottom line considerations? Every dollar spent on health care is a dollar that can’t be spent on a local project that actually gets Congressmen votes and campaign donations.

  4. Niklaus Pfirsig says:


    The government has always had strict accounting standards, but since 2010 with a large influx of a large number of innumerate idiots like Boehner and Cantor, who believe it is their manifest destiny to destroy government from within, to defund and shrink it to a size small enough to be “drowned in a bathub”, to weaken the government to the point that is becomes unable to govern, and who actually believe that corporations are benevolent gods which must be appeased at any and all cost.

    Poor Dave Cordani needs that money to buy a new McMansion and a private island to keep it on. Most of the large million dollar corporations have over 100 execs with salaries over a half million. They are not hurting. In fact, many of them use the excess to buy out smaller regional competing companies.

  5. Adam Herman says:

    Wouldn’t have had a large influx of people you don’t like had Democrats listened to the public in the first place.

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