You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much? If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn't going to be good. But suppose it's not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man -- and everyone else like him -- with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone's life? If there is any point at which you say, "No, an extra six months isn't worth that much," then you think that health care should be rationed. <...> Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. "So," he says, "would you have sex with me for $50?" Indignantly, she exclaims, "What kind of a woman do you think I am?" He replies: "We've already established that. Now we're just haggling about the price." The man's response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it's immoral to apply monetary considerations to saving lives -- but is that stance tenable? <...> Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won't be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. 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. Then we can ask, What is the best way to do it? ...
If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn't going to be good. But suppose it's not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man -- and everyone else like him -- with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone's life? If there is any point at which you say, "No, an extra six months isn't worth that much," then you think that health care should be rationed. <...>
Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. "So," he says, "would you have sex with me for $50?" Indignantly, she exclaims, "What kind of a woman do you think I am?" He replies: "We've already established that. Now we're just haggling about the price." The man's response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it's immoral to apply monetary considerations to saving lives -- but is that stance tenable? <...>
Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won't be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. 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. Then we can ask, What is the best way to do it? ...
While the Senate continues to struggle over its approach to health care reform, House Democratic leaders have unveiled a bill that would go a long way toward solving the nation's health insurance problems without driving up the deficit. It is already drawing fierce opposition from business groups and many Republicans. This is a bill worth fighting for. The bill would require virtually all Americans to carry health insurance or pay a penalty. And it would require all but the smallest businesses to provide health insurance for their workers or pay a substantial fee. It would also expand Medicaid to cover many more poor people, and it would create new exchanges through which millions of middle-class Americans could buy health insurance with the help of government subsidies. The result would be near-universal coverage at a surprisingly manageable cost to the federal government. The nonpartisan Congressional Budget Office estimates that by 2015, 97 percent of all residents, excluding illegal immigrants, would have health insurance. <...> The bill makes a mockery of Republican claims that the Democrats are pushing a hugely costly government takeover of medicine. This bill is clearly not hugely costly. It would expand the government's role in financing and regulating coverage but would also bolster private coverage. It would increase employer-based coverage, mostly by requiring employers to participate. And it would send more clients to the private insurance industry. The Congressional Budget Office estimates that perhaps 10 million people might enroll in a new public plan, while twice that number might enroll in competing private policies. ...
The bill would require virtually all Americans to carry health insurance or pay a penalty. And it would require all but the smallest businesses to provide health insurance for their workers or pay a substantial fee. It would also expand Medicaid to cover many more poor people, and it would create new exchanges through which millions of middle-class Americans could buy health insurance with the help of government subsidies. The result would be near-universal coverage at a surprisingly manageable cost to the federal government.
The nonpartisan Congressional Budget Office estimates that by 2015, 97 percent of all residents, excluding illegal immigrants, would have health insurance. <...>
The bill makes a mockery of Republican claims that the Democrats are pushing a hugely costly government takeover of medicine.
This bill is clearly not hugely costly. It would expand the government's role in financing and regulating coverage but would also bolster private coverage. It would increase employer-based coverage, mostly by requiring employers to participate. And it would send more clients to the private insurance industry. The Congressional Budget Office estimates that perhaps 10 million people might enroll in a new public plan, while twice that number might enroll in competing private policies. ...
It's s different thing if it's a cure. But simply delaying the inevitable for a couple of months or so is less justifiable.
It's difficult. None of us get out of here alive. I thik we should accept that there must be a level of reasonableness about efforts to sustain us. keep to the Fen Causeway
