Posts tagged with: rationing

lincThis is only one powerful and horrific story that highlights the severe problems with Veterans Affairs Medical Centers. Unfortunately, there are easily thousands of stories like the one experienced by this veteran. Kay Daly sums it up well in the article from the American Thinker,

Fighting a bureaucracy the size of the VA leviathan is not only physically exhausting, it is soul crushing as well. My brother was literally losing his will to live. That’s what I saw in the picture he sent to me — a man who was defeated.

The VA is a giant maze of a bureaucratic nightmare. Claims often go missing, unfairly denied, or simply lost. I worked on VA casework for a U.S. Congressman over a decade ago, and the extensive problems with the system predate my experiences.

The VA healthcare system does of course serve as a model for what the future for care looks like most Americans with more government involvement. In 2009, I wrote a commentary on VA healthcare and noted that since government can’t meet the obligation to its veterans, more government control of health care will only “increase the likelihood and scale of injustice.” The VA offers us on a smaller scale a perfect picture of healthcare rationing.

In 2013, I highlighted the killing of veterans at VA hospitals. In some instances, individuals waiting for their colonoscopy procedures had Stage 1 cancers go to Stage 4 before diagnoses.

Now, at least five VA treatment centers are being investigated for keeping a secret list of appointment waiting times for patients. Those secretive actions are facilitated so hospital administrators and healthcare providers can secure bonuses for scheduling appointments in 14 days. It would be more shocking if these incidents are only contained to five VA hospitals. Of course the cover up is more widespread.

The American Legion
has called for Veterans Affairs Secretary Eric Shinseki to resign. A necessary action perhaps, since one of the main short terms problems is lack of accountability. But the federal government continues to prove that it cannot handle socialized medicine on an even smaller scale. It may be prudent to focus on clearing up the massive backlogs of VA disability and medical claims and offering vouchers for care elsewhere. This is one bureaucracy that is becoming more notable for collecting body counts. That’s never a good image for a healthcare facility.

vetsBack in 2009, I wrote a commentary titled “Veterans First on Health Care.” I argued the government must prove it can handle existing obligations before proposing any further takeover of the health care industry. I interviewed former Congressman Gene Taylor (D-Miss), who I once worked for, and among other things, assisted with Veterans Affairs claims and other military constituent services. Taylor made the point then that “We [government] can’t pay for the promises we’ve already made on health care, and it only gets worse for the next fifty years.”

I posed the logical question, “If it cannot handle the challenge of caring for 8 million veterans, how will a government bureaucracy manage a system dealing with 300 million Americans?”

Unfortunately, according to CNN, things have become even worse for American veterans who use VA hospitals:

Military veterans are dying needlessly because of long waits and delayed care at U.S. veterans hospitals, a CNN investigation has found.

What’s worse, the U.S. Department of Veterans Affairs is aware of the problems and has done almost nothing to effectively prevent veterans dying from delays in care, according to documents obtained by CNN and interviews with numerous experts.

The problem has been especially dire at the Williams Jennings Bryan Dorn Veterans Medical Center in Columbia, South Carolina. There, veterans waiting months for simple gastrointestinal procedures — such as a colonoscopy or endoscopy — have been dying because their cancers aren’t caught in time.

The entire piece at CNN is worth reading. It’s a scary glimpse on a smaller scale of just how destructive single-payer health care is and how it leads to rationing of care and death.

Blog author: jballor
Wednesday, February 13, 2013
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Jerk StoreIn “The Moral Meanings of Markets,” in the latest issue of the Journal of Markets & Morality, Ryan Langrill and Virgil Henry Storr argue that markets ought to be understood and defended not simply as amoral, or merely moral, but as robustly moral spaces. In exploring the contention that markets reward virtues besides prudence, Langrill and Storr illustrate how market exchanges tend to promote civility and politeness. “It makes sense for profit-seeking businessmen to invest in goodwill and good customer service,” they write.

A recent piece in the Harvard Business Review, however, underscores the reverse phenomenon, the costs of rudeness. As Christine Porath and Christine Pearson write in “The Price of Incivility,” the virtues required for good business are not merely oriented towards customers. “Rudeness at work is rampant, and it’s on the rise,” they write: “Nearly everybody who experiences workplace incivility responds in a negative way, in some cases overtly retaliating. Employees are less creative when they feel disrespected, and many get fed up and leave. About half deliberately decrease their effort or lower the quality of their work.”

But Porath and Pearson also note that “incivility damages customer relationships. Our research shows that people are less likely to buy from a company with an employee they perceive as rude, whether the rudeness is directed at them or at other employees. Witnessing just a single unpleasant interaction leads customers to generalize about other employees, the organization, and even the brand.”

The costs of rudeness are illustrated even more clearly outside the context of “competitive market settings,” as Langrill and Storr relate. They note John Mueller’s observation that “since enterprises like these cannot ration by price, they are inclined to ration by rudeness.” And even outside the context of “non-price competition,” as we observe in our own experiences everyday, there are costs associated with rudeness. Customers can certainly use rudeness as a rationing mechanism.

How much would it be worth to you to be treated rudely the next time you stop in at a McDonald’s or buy something from the supermarket? How cheap would things have to be for you to shop at the jerk store? Just how good would the lobster bisque have to be for you to buy it from the Soup Nazi?

[UPDATE BELOW] I discussed the creepy side of President Obama’s “science czar” here. But there are more creepy things in the cabinet. The Wall Street Journal reports that the president’s health policy adviser, Dr. Ezekiel Emanuel, wants to implement an Orwellian-sounding “complete lives system,” which “produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”

The WSJ piece continues:

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change.”

True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care.

Now a freer healthcare market could take care of rationing much more simply, while providing increased incentives for healthcare providers to provide better value to choosey consumers. The problem is, a freer healthcare market wouldn’t route power through Washington.

And yes, it is more about power than about wanting to spread scarce healthcare services around more equally. Otherwise, the government would pursue something like healthcare tax credits for lower and middle income Americans. And they would pursue meaningful tort reform to curtail wasteful defensive medicine and the regressive transfer of wealth from consumers (who pay higher medical costs) to wealthy trial lawyers.

And no, I’m not proposing that these power-hungry politicians are monsters. Most are probably sincerely convinced that their increased power will help them pursue the greater good down the road. It’s just that others have been down this road before, and it isn’t pretty.

UPDATE: Longtime medical ethicist Wesley J. Smith has a nuanced look at Dr. Emanuel here. The post concludes:

[H]e explicitly advocates rationing based on what appears to be a quality of life measurement. From the piece [in the Hastings Center Report]:

This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.

A lot of people are frightened that someone who thinks like Emanuel is at the center of an administration seeking to remake the entire health care system. Having read these two articles, I think there is very real cause for concern.