Many severely obese people would benefit medically from bariatric surgery. Yet it’s often not covered by insurance, nor is there currently enough capacity in the healthcare system to treat everyone.

So given this reality, how do we decide who gets care? Draw names out of a hat? First-come, first-served? Set up decision criteria for who’s likeliest to benefit? Or something else?

Chime in below.

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Canadian Physician Warns, “Obamacare Rationing Inevitable”
By Lee Kurisko, MD, http://www.medibid.com

Under Obamacare, the federal government will inevitably decide what kinds of care will get funding and who will get it. Comparative clinical effectiveness research is now a reality as a part of the U.S. government reform of the health care system. As a Canadian Physician, I know this research leads to only one thing – rationing.

http://www.medibid.com/aboutus

Dr. Lee Kurisko

Patients who don’t like the care they are getting from their doctors are always free to leave them and find a new one – if they can fnd one in these days of chronic physician shortages. But do doctors have the right to “fire” a patient?

That’s what Jennifer Thomson has been asking herself. She had been a patient with her family doctor for about four years when she recently got a letter in the mail telling her that her doctor was “terminating” her as a patient, effective immediately.

“I didn’t know they could fire you. It was a complete surprise that they can do this,” she told CTV News.

L, Szugy

You were unaware perhaps that an utterly demented Czar, Rhambo’s brother Ezekial actually had in mind with Obama Care. Szugy lets the hidden agenda out of the bag.  A great job from a potential pod member. Rational thoughts while observing the passing charade, I’m J.C.

Appreciating Parallels for the Emerging US Healthcare System?

By Mahsa Ghari

Aim of the Conference

In the late 1990s, the Dutch government started to experiment with ‘regulated competition’ in social health insurance. A milestone was the new Health Insurance Act in 2006 introducing a compulsory health insurance scheme for the entire population, carried out by (for-profit) health insurers, contracting individual and institutional health professionals. Safeguarding equal access, the new health insurance scheme introduced several preconditions like compulsory insurance, a basic benefit package, the prohibition of risk selection, a risk-equalization fund, etc. The idea of competitive health insurance was combined with deregulating hospital planning and liberalizing health care tariffs. 

Merit Considerations

In the new scheme medical need is still decisive in health care access decision-making, but merit-considerations are becoming important too. Shortening waiting times, priority arrangements were considered and/or introduced, based on non-medical criteria. Simultaneously, in terms of financing, health status has become important due to own payments-arrangements, limited insurance package options, etc. At the same time, health status disparities due to socioeconomic inequalities seem to be increasing.

Under these circumstances, confronted with increased health spending, we can expect the “R” word becoming more eminent in the Dutch health care debate.

Relevant Rationing Questions

Emerging relevant questions are:

• Who is responsible for rationing (markets, governments, bureaucrats, MDs or others)?
• How does it function (explicit or implicit)?
• What are relevant selection criteria (QUALYs, DALYs, health status, sex, age, etc)?
• To what extent is current rationing just?
• What can be done to make it more just?
• How will health care rationing affect equal access to health care?
• What is the relationship between rationing and differences in health status etc?

There is a wealth of literature in political theory, as well as in health care policy, economics, social medicine and law addressing these issues. What is needed is a consideration of the values involved, and the impact of, policy decisions on the expression of these values.

The Erasmus Observatory

Therefore, the Erasmus Observatory organized an international conference to discuss health care rationing from a wide range of perspectives.

Speakers

The following speakers have confirmed their contribution:

• Dr. Bert Boer, Executive member of the Health Care Insurance Board (ethics)
• Prof. Werner Brouwer (Erasmus University Rotterdam) (economics)
• Prof. Norman Daniels (Harvard University) (philosophy, medical ethics)
• Prof. Leonard Fleck (Michigan State University) (philosophy)
• Prof. Colleen Flood (Toronto University) (law)
• Dr. Anand Grover (Special Rapporteur United Nations) (law)
• Prof. John Harris (University of Manchester) (bioethics)
• Prof. Frances Kamm (Harvard University) (philosophy)
• Prof. Johan Mackenbach (Erasmus University Rotterdam) (public health)
• Prof. Alan Maynard (University of York) (economics)
• Prof. Chris Newdick (University of Reading) (law)
• Prof. Erik Nord (University of Oslo) (economics)
• Prof. Bettina Schöne-Seifert (Münster University) (medical ethics)
• Dr. Keith Syrett (University of Bristol) (law)

Assessment

The conference language will be in English, in Rotterdam on 9 – 10 December 2010, The Netherlands: info@erasmusobservatoryonhealthlaw.nl

Registration: CONFERENCE REGISTRATION FORM[1]

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Via Breitbart and Naked Emperor News 
It’s stunning how the truth has found its’ way to the light of day once the massive health care legislation finally passed. When Sarah Palin talked about “death panels” she was then, and is now, scoffed at by the media and members of the Democratic elite. Now we see the President’s Budget Director touting the wonders of the Independent Payment Advisory Board that will be ultimately responsible for denying treatments they deem excessive and setting Medicare reimbursement rates. This the group with the power to decide the pain killer vs. the operation question.  Members of the panel will not be accountable to the electorate as they will be appointed by the President.  As Orszag makes clear in the video at Breitbart this board will be very powerful.

The IPAB drew significant opposition from the health care industry though this was not made widely known to the public during the debate. The powerful IPAB advisory board represents a significant shift in decision making away from your doctor and towards Washington:

Medicare providers and suppliers could be subject to significant payment cuts if the proposed IPAB is enacted and overall Medicare spending continues to increase at its current rate. A group of providers and advocacy groups, including the American Hospital Association, joined in a January 11, 2010, letter opposing the IPAB, noting that it would not be accountable to anyone but the president (who appoints its members). Shifting payment authority from Congress to an independent commission would be a significant change, and is viewed as one of the most meaningful measures in health reform legislation with respect to bending the cost curve in health spending.

In spite of the power invested in the IPAB, a recent report by the President’s own Medicare Advisory cautioned costs will continue to rise under the new health care law. The report further predicted cuts to hospitals and other care providers could force some into the red while others will be driven from the Medicare market entirely.

There can be little doubt, a shortage of providers faced with increased demand for services will lead to rationing and/or higher costs. While advocates of health care legislation argue there is rationing in our current health care system, this rationing is done primarily by the insurers driven by free market forces.  There is a distinction between rationing by political bureaucracies and rationing by competitive free market systems. Given my druthers, I would take my chances in the free market every time.  Anyone recall the price of their first VCR?  If you’ve priced one lately you’ll know that is one market government has managed to stay away from.   All things considered the health care legislation seems quite short on hope and jam-packed with change of the unintended and undesired sort.  Sadly, some in the administration still consider these revelations a good thing.

http://rubyslippersblog.blogspot.com/2010/04/peter-orszag-touts-wonders-of-powerful.html

http://hotair.com/archives/2010/04/27/video-orszag-explains-how-obamacare-imposes-rationing/

CBC News – Health – P.E.I. tackles mammography frustrations.

David Leonhardt spends about a 1,000 words in the New York Times banging around the edges of what has to be done by government to cut health care costs. Or, as he calls it “In Medicine, the Power of No”. He wonders if we can every really learn to say “no”. And, of course, he’s talking about saying no to sick people, to patients – denying them care.

From an economic perspective, health reform will fail if we can’t sometimes push back against the try-anything instinct. The new agencies will be hounded by accusations of rationing, and Medicare’s long-term budget deficit will grow.

So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform. “Being able to say no,” Dr. Alan Garber of Stanford says, “is the heart of the Heart of the Issue.”

http://rightwingnews.com/2010/04/are-we-in-death-panel-territory-yet/

If you really want to know how this “Power of No”  works- please– a  must read: http://blog.contempomag.com/2009/08/13/the-obama-rationing-plan-why-senior-fears-are-real/