09 April 2010

Captain Renault is shocked to find out there is rationing going on in here.

Allow me to quote an old post of mine:
If you abandon one solution you must choose a replacement.

We live in a world of scarcity. More people want things than can have them. [...] There are four basic ways of deciding who gets what:
(1) Price mechanisms.
(2) Random lottery.
(3) Queuing.
(4) Dictatorial fiat.
Why am I bringing this up?  I'll let TJIC explain:
NYT before socialist health care was passed: “there will be no rationing!”

NYT after socialist health care was passed: “rationing is the most important part!”
That's right, the NYTimes has suddenly discovered that health care is scarce and rationing is necessary. After spilling barrels of ink previously claiming that no rationing would be required, they have now turned the corner are claiming rationing is "the most important part" of health care reform.
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 issue.”


But I suspect that these arguments [that rationing resources for health care will "will free up resources for other uses."] won’t be persuasive. They have the faint ring of an insurer’s rationale for denying a claim.
Faint ring? It's the same thing.  Insurance companies do that because they know they have $X dollars in revenue and can only afford to spend k•X on procedures (where 0 < k < 1).  That's the same situation the federal government will be facing on medical costs as well.

People, in their folly, decided the best way to strike back against the perceived bureaucratic coldness of insurance companies was to hand the whole operation over to the feds, an institution known for cold, bureaucratic aloofness. This makes about as much sense as deciding that The Gap is too homogenous and corporate, and then shopping at Walmart instead.

As Ed Morrissey said a couple of days ago, "we’re slowly turning the entire medical system into an HMO, only this time with Congress and the executive branch running it."  These are not people I trust in charge of anything more complicated than a waffle iron.
Eventually, we may well have to decide against paying for expensive treatments with only modest benefits.
Note the collectivization going on there. In reality "we" will not be deciding these things. Somebody else will be deciding for each of us. There will be only one decision, and it will apply to everybody. It's the same arrogant homogenization of individual desires that the FDA imposes on drugs writ large.  Here's what I said about it a few months ago:
In attempting to serve everyone they can only cater, in the best case, to the Everyman. But the Everyman doesn't exist. He's fictional. I suppose if you find yourself right in the middle of every health-related opinion, if you have median preferences and modal habits, if you make only the common choices, if you have only the common desires, if you like to live your life exactly as prescribed by average opinion then you might find yourself well served. If not, well, tough luck.
Returning to Leonhardt's NYTimes piece:
But given how difficult that would be for this country, it makes sense to start with the easier situations — the ones in which “no” really is the best answer for patients.
Once again this system requires that there must a single "the best" answer. Such a thing does not exist, especially not for systems as complex as human medicine. I really wish it were otherwise. The idea that we could find objective, empirically verifiable answers to these problems is very enticing to me, but it is beyond our grasp.
The better bet for the new reformers — starting with Donald Berwick, the physician who will run Medicare — is to channel American culture, not fight it. We want the best possible care, no matter what.
How is that remotely helpful? We also want ponies and rainbows and free flat screen TVs and chili cheese fries that don't give us love handles. We wants lots and lots of things. But not everybody can have everything they want. That was true pre-Obamacare, and it's true post-Obamacare. All that's been done is shifting us from a price-based mechanism of distribution towards a dictatorial-based mechanism. In doing so the reformers have managed to reinforce people's naive idea that we can all get what we want without having to pay for it ourselves. What's worse is they've also limited the incentive and ability to produce more, and to figure out how to distribute production more efficiently, making scarcity more prevalent, not less.  Way to go.

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