What is the best eay to ration health care? By need or ability to pay?

Very true, but we both know of the likelihood of our federal government ever acting in a responsible and efficient way.

Agreed. Decisions made by these scientists would actually be logical and practical. Hence, they couldn't make absurd promises to everyone. Hence, they would never get elected (this is the major reason why Ron Paul wasn't even considered a viable choice as the Republican nominee).

 

It does matter. There must be a standard definition of "need," since this term is inherently vague. My definition of “need” may be different than your definition of “need.” Please see the following examples.

Case #1: A 100 year-old male nursing home patient comes into the hospital in respiratory distress. He has a history of metastatic small cell lung CA and severe Alzheimers dementia to the point where he requires 24-hour nursing care. His prognosis, given his advanced age and Stage IV lung cancer, is terrible, and if he is intubated and placed on mechanical ventilation, it is likely that he will not be able to be extubated, thereby becoming ventilatory dependent and requiring tracheotomy. However, his son, who is the healthcare proxy, refused to make him a DNR, states that his father's wishes were to live as long as possible.
Do you agree that this 100-year old needs to be intubated and admitted to an intensive care unit, since his is in acute respiratory failure? On the flip side, however, his prognosis is already grim, and intubation/tracheostomy would only be prolonging the inevitable, right? Placing the patient on a morphine drip would be less cruel to the patient (not to mention MUCH less costly), but, at the same time, the healthcare proxy insists that his father would have wanted to be intubated. What if the patient was wealthy and could pay out of pocket for the entire hospitalization: Would this change your view of what should be done? So now you see that this "need" becomes more vague and unclear.

Example #2 A 29-year old homeless illegal immigrant with a history of alcohol abuse since age 14 presents with hepatic encephalopathy. He is admitted to your hospital and a CT scan of the abdomen demonstrates cirrhosis and he will need a liver transplant for long term survival. If he demonstrates sobriety over the next six months, should be placed on transplant list?
Why should a homeless illegal alien who was perfectly healthy but CHOSE to destroy his liver with alcohol be placed on the same transplant list as Americans who did not chronically overindulge in alcohol? Does he even deserve to get a liver transplant at all (which will be fully paid for by our tax dollars?) On the flip side, he will die without the liver transplant , so in that sense he “needs” this surgery, right?

Example #3: A 90-year old male is a epitome of good health: He has been eating only healthy foods since his 20s, exercising moderately at least 5 days per week, and sees a primary care physician annually. Due to his good genetics, diet, and exercise, he amazingly has no health problems. He himself was a physician, and contributed much to his community, but has long since retired. Suddenly, while watching TV with his wife, he goes into cardiac arrest. He was resuscitated by EMS, and in the nearby emergency room, he was found to have recurrent ventricular tachycardia, which contributed to his cardiac arrest. He was assessed by a cardiologist and was recommended to have an automatic inplantable cardiac defibrillator (AICD). However, the cost of one of these is $30,000.
Should the taxpayers fund this? He has already lived a very long life, and, despite his healthy lifestyle, it is unlikely that he will live much longer. Couldn’t that money be better used on a younger patient? On the flip side, this man has lived a healthy lifestyle and has put in so much money into the system via taxes while he was working. Thus, isn’t he entitled to the AICD?

These examples above are just a few examples of cases that we deal with every day in my profession. My question to you is, what do you feel is the criteria of "need" in this cases? Certainly, all of the three patients in the above cases meet a basic criteria for “need. However, your OP was about ways to "ration" care. In that sense, there is certainly rationale for denying care in all three cases. As I stated before, “need” is far too vague a term to be used as a standard for who should receive care, since it can be entirely subjective (as demonstrated by the above examples).

 

Tell us about the lines for the 50 million Americans who don't have healthcare coverage under our wonderful system.

Oh that's right. You don't care.

Thank God I'm not a conservative.

 

I don't see how your question relates to my posts at all.

 

Healthcare should be rationed based on contribution to society and likely contribution to society. The people who have contributed most to society or who are likely to contribute the most to society should be cared for before people who have contributed little or nothing to society.

 

Who decides say a man is low income, chooses to be low income and use his free time volunteering to help others prefering to do that? What about a homemaker older whose children are in college? What about a military vet they are no longer of value should they get less care over a soldier who can fight and stay in the service? What about a child born with cerebral palsy so bad they likely will always be a burden should they get care? What if someone is a street artist and sells his art for a low profit just because he loves making jewelry and just wants to make enough to get by?

I would think all these people are valuable people who contribute just not as a consumer so what is someone worth to keep or not and who decides?

 

We already, effectively have universal healthcare, since hospitals can't deny treatment for those who can't pay, and many low-income people simply default on their bills. Sure the hospital could sue them for re-payment like any debt collector, but unless the debt was exhoribantly high, it would rarely happen.

So we might as well just make universal healthcare official - it exists de facto - the only way it really could not exist is if hospitals would leave you there to die if you couldn't pay, and obviously this ain't ever going to happen. The fact that prisoners have better access to health-care (no insurance, no 'pre-existing condition rules', etc) shows how screwed over the average American is anyway - we should just implement it and get over the charade of 'coercion, socialism, govt tyranny' etc - people live under more de facto 'tyranny' under our current healthcare system.

Universal healthcare will continue to exist no matter what - the only difference is the way it exists now, is it rewards people too lazy, or unable, to pay their bills, while driving up the cost for responsible people who pay just because it's the responsible thing to do - not like there's a snowball's chance in hell the hospital would actually sue them for repayment anyway.