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Rationing of care

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Healthcare rationing may refer to the restriction of medical care service delivery based on any number of objective or subjective criteria. Republican Newt Gingrich argued that the reform plans supported by President Obama expand the control of government over healthcare decisions, which he referred to as a type of healthcare rationing. President Obama has argued that U.S. healthcare is already rationed, based on income, type of employment, and medical pre-existing conditions, with nearly 46 million uninsured. He argued that millions of Americans are denied coverage or face higher premiums as a result of medical pre-existing conditions.

Peter Singer wrote in the New York Times in July 2009 that healthcare is rationed in the United States and argued for improved rationing processes:

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most healthcare is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for...Rationing healthcare 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 healthcare or provide it directly, it is crazy not to try to get value for money. The debate over healthcare reform in the United States should start from the premise that some form of healthcare rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?"

According to PolitiFact, private health insurance companies already ration healthcare by income, by denying health insurance to those with pre-existing conditions and by caps on health insurance payments. Rationing exists now, and will continue to exist with or without healthcare reform. David Leonhardt also wrote in the New York Times in June 2009 that rationing is a part of economic reality: "The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to healthcare than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally."

Palin's death panel remarks were based on the ideas of Betsy McCaughey. During 2009, former Alaska Governor Sarah Palin wrote against alleged rationing, referring to what by her interpretation was a "downright evil" "death panel" in current reform legislation known as H.R. 3200 Section 1233. However, Palin supported similar end of life discussion and advance directives for patients in 2008. Defenders of the plan indicated that the proposed legislation H.R. 3200 would allow Medicare for the first time to cover patient-doctor consultations about end-of-life planning, including discussions about drawing up a living will or planning hospice treatment. Patients could seek out such advice on their own, but would not be required to. The provision would limit Medicare coverage to one consultation every five years. Rep. Earl Blumenauer, D-Ore., who sponsored the H.R. 3200 end of life counseling provision, said the measure would block funds for counseling that presents suicide or assisted suicide as an option, and called references to death panels or euthanasia "mind-numbing". Republican Senator Johnny Isakson, who co-sponsored a 2007 end-of-life counseling provision, called the euthanasia claim "nuts". Analysts who examined the end-of-life provision Palin cited agree that Palin's claim is incorrect. According to TIME and ABC, Palin and Betsy McCaughey made false euthanasia claims.

The federal requirement that hospitals help patients with things like living wills began when Republican George H. W. Bush was President. Section 1233 merely allows doctors to be paid for their time. However, an NBC poll indicates that as of August, 2009, 45% of Americans believed in the death panel story.

Slate columnist Christopher Beam used the term "deathers" to refer to those who believed rationing and euthanasia would become likely for senior citizens. The Rachel Maddow Show aired a program called "Obama and the Deathers" in which Maddow discussed conspiracy theories that included "a secret plot to kill old people." Daily Kos and other web sites had used the term for about a week before Hari Sevugan, national spokesman for the Democratic National Committee, sent out an email with the subject line "Murkowski: Deathers 'Lying' 'Inciting Fear.'" The message included an article about a town hall statement by Senator Lisa Murkowski, a Republican from Alaska, that no version of healthcare reform included "death panels".

Sevugan explained the term "deathers" to Patricia Murphy, who used to write a Politics Daily column called "The Capitolist":

By "deather," I mean an opponent of change who is knowingly spreading false information regarding the existence of an alleged "death panel" in health insurance reform plans despite the fact the claim has been repeatedly and unequivocally debunked by independent fact-checking organizations. Like "birthers", "deathers" are shamefully lying and trafficking in scurrilous rumors to incite fear and achieve their stated political objective of derailing the president of the United States.

Others, such as former Republican Secretary of Commerce Peter G. Peterson, have indicated that some form of rationing is inevitable and desirable considering the state of U.S. finances and the trillions of dollars of unfunded Medicare liabilities. He estimated that 25–33% of healthcare services are provided to those in the last months or year of life and advocated restrictions in cases where quality of life cannot be improved. He also recommended that a budget be established for government healthcare expenses, through establishing spending caps and pay-as-you-go rules that require tax increases for any incremental spending. He has indicated that a combination of tax increases and spending cuts will be required. All of these issues would be addressed under the aegis of a fiscal reform commission.


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