Health care by the budget

Friday, November 12, 2010

Author's note: The views expressed in this column are the author's and do not represent the views of Southeast Missouri State University or any other organization.


We are told that the U.S. has a Medicare cost crisis. This "crisis" is at least a quarter-century old. The arrival of the baby boomer generation into Medicare is no surprise, but successive administrations have "kicked the can down the road" until today, when the boomers begin to retire. The solution offered by the current administration is to ration health care for seniors, with a reduction of $500 billion in Medicare over 10 years.

This rationing is worse than it appears for two major reasons:

1) Due to the large number of seniors, the dollars per person must decrease significantly.

2) This reduced coverage does not consider advances in medical care. New drugs, new procedures and advances in gene therapy will be discovered, and they usually cost more than the care they replace.

Since older people have worse health, they are the prime target of politicians and bureaucracies. The other target group is the very young. We physicians call these groups the "extremes of life." A physician member of the White House's inner circle, Dr. Ezekiel Emanuel, brother of Rahm Emanuel, advocates major reductions in spending on these two groups of patients. He calls it "the complete lives system," and it openly states that these two groups should get less health care than the average person, presumably since their return on investment is not as great.

All developed nations ration health care, but some ration more than others. For instance, a coronary bypass surgery patient waits one year in England, five months in Canada and seven days in the U.S. Diseases don't stop because of a waiting list.

Dr. Jeffrey Turnbull, the incoming president of the Canadian Medical Association, practices at a leading academic medical center, The Ottawa Hospital, a 1,200-bed facility serving Canada's capital. A recent letter in the Canadian Medical Association Journal from Dr. Turnbull shows the results of rationing. He wrote, "At my hospital, occupancy usually sits around 105 percent, dozens of admitted patients line the hallways and 150 of our acute-care beds are filled with patients who should be receiving more appropriate care elsewhere -- except that care is unavailable. We don't bother calling this the 'new normal.' Today it's just the norm, and it also affects vulnerable populations who do not receive the care they deserve and pay the price of this inequity with their health."

Canada is not a poor nation. They can afford the care -- but they won't. The reality of rationing is that the budget becomes the primary goal, not the patient's health.

If a repeal of the current health care law is not accomplished in addition to passing meaningful health care reform, the U.S. will soon emulate our Canadian counterparts.

John V. Mackel of Cape Girardeau is a medical doctor who has practiced medicine in the United Kingdom's National Health Service, Canada's Medicare system and in the U.S. He also is an adjunct professor in the College of Business at Southeast Missouri State University.

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