[supertrope]

https://www.nytimes.com/2009/07/19/magazine/19healthcare-t.h...

"Why We Must Ration Health Care" by Peter Singer. New York Times Opinion Section.

Unfortunately this is a very difficult conversation to have between people and their physicians, between family members, and with ourselves. It ties into another very difficult discussion of facing death. In a democracy the lowest common denominator argument wins out with catchy slogans, in-group signaling, burying uncomfortable facts, avoiding short term sacrifice, and/or wielding anecdotes instead of rational analysis. Thus the rationing happens when it is least effective - during a crisis when significant human, monetary, and time resources are drained. And not much earlier when some planning and hard work could greatly ease the burden.

[refurb]

When people always ask "how come healthcare is so much more affordable in countries outside the US?", the correct answer is rationing.

If you need joint replacement surgery in Canada, you can expect a wait of many months to years. Canada has made the call that they will put a certain dollar amount into joint replacement and if the demand is higher, then people will just have to wait.

Same thing with the latest and greatest drugs. Some countries just say "no".

If you want an affordable healthcare system in the US, then rationing has to be a part of the equation. As others have pointed out, we already ration in the US, but trustfully, if you have good insurance, you'll get very good care in the US. The question is whether all that extra care is actually producing better outcomes.

[tdeck]

It's not only rationing care. In these other countries doctors earn a lot less than they do in the US, particularly specialists. They still make a good living though (excepting perhaps Cuba). Also administrative costs are lower and when insurance companies exist they're generally not allowed to make a profit on basic coverage, or they're not allowed to deny claims and must pay on a price schedule fixed by the government. Some of these policies can lead to shortages (i.e. if you pay doctors too little, you'll get fewer doctors), but there seems to be a middle ground that other countries have gotten closer to than the U.S.

[nine_k]

Rationing also makes some outcomes summarily worse.

If you have a relatively minor problem, you're put in a line. For months (or years) of waiting, your problem becomes worse, and when you finally get to be treated, the treatment is much costlier and less effective.

This is to say nothing about your actual suffering from the problem, and from knowing that it's deliberately not being treated.

[thatoneuser]

Joint replacement waiting a few months likely won't cause that much harm. I mean it can but it's statistical probably justified. And in fact it's guaranteed that these systems are trying to balance that.

[shkkmo]

I don't think that is true at all, it is very clear that identical procedures and materials cost less in other countries.

[refurb]

Price caps play a role, but rationing plays an even bigger role. Google search for the McKinsey paper on US healthcare costs. The volume of outpatient procedures in the US is quite shocking compared to other countries.

Yes, things cost more in the US, but the volume is also quite a lot higher.

[DanBC]

In your parent post you mention outcomes, and that's a really important thing you're missing when you talk about "rationing".

If a scan is more likely to cause harm than to treat illness is it really being rationed, or do single payer systems have an easier time not providing harmful over-testing and over-treatment options?

[thatoneuser]

Interesting about the volume being higher. In most logistical systems that would drive avg price down.

[ljcn]

Perhaps the total volume is higher, but this doesn't lead to downwards price pressure since there are many small(ish) buyers.

The opposite is often said for the NHS in the UK - certainly a smaller buyer than the US aggregate, but maybe a larger player than any one of them?

[testpostpls]

Blue Cross Blue Shield buys for 100 million patients. How much bigger does it need to get to save money?

[drewrv]

The dystopian angle to healthcare rationing is the realization that we already do ration care. We do it with dollars rather than by need or outcome.