Scientocracy

Why psychological science is relevant to policy debates—and what policies might look like if they were better aligned with human nature

by Peter Ubel

Avoiding the “R” Word in Health Policy Debates

By Peter A. Ubel on April 17, 2012 in Scientocracy

A couple of years ago I was invited to speak at the annual meeting of the American Medical Association in Chicago, to discuss the morality of whether physicians should ration care from their patients. Read More

Rationing As A Half Filled Balloon

Submitted by SteveM on April 17, 2012 - 7:14am.

Doc, you're ignoring the other huge element of health care costs which is physician reimbursement. The "PC" phrase that is anathema to you guys is "Price Controls". So you fixate on rationing care outright to cut costs rather than cutting compensation for doctors. When in actuality, it will probably require a combination of both.

Here's the thing, physicians largely supported Obamacare because there was no real cost containment element, (the Medicare reimbursement caps are regularly waived). From their PoV, Obamacare simply represents a larger population of patients implying increases in physician compensation based on the normative fee-for-service model. Too bad that model is unsustainable.

The standard physician response to fee capping is, "Doctors will leave the profession" Well in a tanked economy in long term decline, they'll leave medicine to do exactly what?

Nope, at the end of the day, patients will indeed have to do with less. And physicians will have to do with less. I don't begrudge doctors making a decent buck, but everybody will have to do with less, (except of course for the Crony Political and Bankster Elites and the Leviathan National Security State.)

End of life rationing is one thing. But how about all of the elective procedures that cost an arm and a leg, like joint replacement? Should those be rationed too? Or should physicians fees be crammed down instead to maintain accessibility?

Pricing life is easy compared to pricing pain and misery. You guys have to start looking at the bigger cost picture beyond end of life rationing.

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I agree

Submitted by Peter A. Ubel on April 17, 2012 - 1:42pm.

I agree with your point. Ask any of the undergraduates taking my health policy class at Duke!!

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Sticking to your principles

Submitted by Mark, MSSI on April 17, 2012 - 9:25am.

Dr. Ubel,

So you still believe in rationing care for patients but don't say that directly because you're afraid people will get angry or disagree with your point of view? Wow. Pretty brave of you...

If you believe in rationing care for patients, then say so. Don't hide behind some veil of secrecy just because it is not a popular topic and is not at all popular with the general population. Changing people's minds by morphing your argument into something that it is not is dishonest and disingenuous.

People can see through your arguments and see them for what they are. We are not as stupid as you think we are.

Cheers

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An Honest Discussion of What Rationing Means to People

Submitted by Peter A. Ubel on April 17, 2012 - 1:41pm.

I think we can discuss this issue without anyone calling anyone "stupid", which I never suggested anyone was, or "cowardly", which I hope no one would accuse me of being.

Here is the point I was trying to make.

I wrote a book about rationing. Whether or not that was "brave" is a matter of opinion, but I was honestly trying to convince people to change the way they think about the health care system.

Over time, I realized that a subset of folks, a large subset, were so against the word "rationing" that they wouldn't listen to my argument. The word distracted people from the issue. The word, for one thing, carries many connotations that don't fit with how it is used in health care contexts. In addition, it is used as a pejorative so often that, even when one carefully defines its meaning (which I did in one chapter of my book), people still come back to their initial feelings about the idea.

So the best way to have honest discussions, some times, is to find words that convey the same meaning but do not distract people with other connotations.

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Peter Ubel, M.D., author of Critical Decisionsand Free Market Madness, is a physician, behavioral scientist, and Professor of Business and Public Policy at Duke University. more...