Rationing in universal health care

Rationing of health care is perpetuated in the U.S.A. as a reason not to incorporate universal health care. No one wants their granny to not get a kidney transplant when she needs it, and no one wants to hear "we won't fund this". The American mindset is that each individual should have options for their own life, and this unfortunately does not coincide with the idea of universal care.

Articles similar to this one, which Happy from Happy Hospitalist and Carpe Diem quote to bring attention to cost-cutting measures, often provide sappy stories of people dying without some very expensive drug that is the only treatment option.

As sad as these stories are, there is no 'other-side'. Privacy laws do not allow commentary by physicians to say whether this treatment option would work, or whether the state of the person's illness was so severe there would be no quality of life for the person afterwards, despite them living for a few more weeks. It seems as though the people who are requesting these drugs are in terminal stages of their disease. Although I commend them trying to fight for life, there comes a point when we need to say enough is enough and the person should be allowed to die with some dignity.

Oftentimes health bloggers rage about the 'fruitless end-of-life' attempts where people in terminal disease or the extreme elderly have full code status. It is not uncommon for these bloggers to also disagree with rationing. How is this possible? What they are suggesting is specifically to rationalize. Or is it only for the elderly? How is that fair?

So you know my personal position, after the age of 80, or if I have a terminal illness where treatment benefit is marginal, I will put myself as a DNR. As much as I may have 'good years' left post illness, I can honestly say I would not have advanced measures be taken to continue my life. My decision is based on my own observations and experience. I have seen people intubated, I have personally pounded on chests and broken bones. What quality of life are we offering these people? So they go to the ICU and instead of dying in emerg (or even at home when their family finds them unconscious), they spend another month lingering and then pass in the ICU.

For those who really don't like the idea of rationalized care and promote private insurance as the way to get around it, unfortunately rationing of health care dollars is not uncommon in the private care model. Private insurance places guidelines on repayment and reimbursement schedules, and primary care doctors have to fill out pre-approval forms for patients to get an MRI or CT. The movie John Q emphasizes how John's private employment-based insurance stated they would not cover the cost of his son's heart transplant.

Whereas rationing of health care isn't an ideal situation, I'd rather have that then not have universal coverage for everyone else. There is an impossible triad of health care, you can have two of the three options: Affordable, Quality, and Accessibility.

Universal Health Care

An election has just finished here in Ontario, and I keep thinking about our 'universal' health care and somewhat comparing to what our 'neighbours to the south' have. In Ontario it would be political suicide for any politician to suggest a two-tiered system, yet more and more health care procedures are becoming less 'medically necessary' and thus dropped off the formulary for funding.

Costs for universal health care are skyrocketing due to the ability to keep people alive longer, labour demands, increasing technology, and an aging population. With all this, the question of supplementary private healthcare has emerged as possibly being the solution to reduce the waiting times for surgeries and cancer treatment. In addition, with salaries being higher in the United States, it is not uncommon for Canadian-trained physicians and nurses to head to the US to get a better salary. This means less health care workers staying here in Canada, where they are also desperately needed, yet paid less.

I was recently in the USA and I met people who were working in the local mall. Being the health conscious person I am, I kept wondering to myself if they would have insurance through their jobs. In my experience, working retail doesn't give you a huge paycheck. What kind of healthcare insurance could a low-income worker expect to get? It seemed very odd to me that the person who I was talking to at the clothing shop wouldn't be able to go to a family physician without worrying about the cost. They aren't different then myself, yet I have no worries about paying for my last physical. I didn't know this, but I just looked it up and according to the U.S. Department of Health & Human Services, 43.6 million people in the United States, or 14.8% of the population, had no health insurance. Those people then delaying primary and preventative care, and then head to the emergency department when things get really bad, ultimately costing them more money, and taxpayer money as well. Compared to other countries, the US spends the most on health care, yet they still are unable to provide it to all their citizens.

I strongly believe that universal heath care is the way to go. As a future nurse, already I see people who would never be able to afford health care (or have jobs where they wouldn't receive private insurance) be able to get quality care because they need it. I think my ultimate fear as an upcoming nurse would be wanting to help someone but having them head home without my help because they couldn't afford it. Although universal health care does have its flaws, I don't think it should be up to your wallet size.

I have heard that the "greatest country is not the country who has the most stuff, or is the most rich. The greatest country is the one who takes the greatest care of their poor". That hits home and makes me think.

I would love to hear opinions of those who are against universal health care, and why.