David Sirota caught something in today’s edition of The New York Times that backs up what those of us supporting single-payer healthcare have been saying for years: Private insurers ration care.
Here is a quotation from Cheryl Tidwell, 45, director of commercial sales training for Humana, the “country’s fourth-largtest insurer”:
“We believe there’s a better way to control costs by controlling utilization and getting people involved in their health care.”
Translation: We control costs by controlling access, by deciding what will be covered and what will not be. In a word: Rationing.
As Sirota points out, “we’re supposed to think that private for-profit health care companies don’t ration care, while government-run programs like Medicare do – but as the insurance industry admits right here for all to see, that’s just not the case.”
The obvious truth is that the health insurance industry works hard to “control utilization” – that is, it works hard to make sure that when you need a costly medical service, you are “controlled” (read: prevented) from getting it.
As I said in a recent post, anyone who thinks rationing will not be a part of a future healthcare system, whether administered publicly or privately, is fooling themselves. Triage is part of medicine — doctors make decisions every day based on need and effectiveness.
The difference is that private insurers make their decisions based on profit, while a public entity — at least in theory — would make its decisions based on the good of the patient and the good of society.
Free-marketers like to extol the virtues of the market, but the market — because it is profit-based — just doesn’t function well with these kinds of life-and-death questions. Insurance companies make their money, after all, by paying out less money than they take in — which creates a perverse disincentive. Remove the disincentive and maybe, just maybe, the healthcare system will start to behave in a more humane and rational manner.
Hank Kalet 
Health care is a human right and a civil right.Health care is just as important as the national defense or interstate highways. We need universal health care now. We signed on to The Universal Declaration of Human Rights, adopted by the United Nations in 1948, which included health care. According to the Constitution, we are bound by any international agreements that we have signed on to.Article 1, Section 8: \”….provide for the common defense and general welfare of the United States;\”Health care is certainly part of the general welfare of the US.The fact that we believe that everyone should have access to the ER tells me that we do indeed believe that health care is a right. ER care is just for dire emergencies and it is not free, the hospital will pursue payment, they will go after whatever assets you may have. If you are destitute, then everyone else's insurance premiums will go up and/or it will be absorbed by the hospital. You cannot go to the ER for regular check-ups, for follow up care or for palliative care. ER care is the most expensive care and if you're in the ER for a medical condition, it's often advanced to a critical and terminal state. If you had had regular check ups, the condition would have been detected long before it became critical.It's time for universal health care, Medicare for all.
Two \”minor\” points.FIRST!!!\”Health care\” is not a \”human right\”! Place a human alone in a forest. Where is their \”human right\” to health care?If you assert that is a \”right\” then their is an obligation for some one to provide it. If I have a RIGHT to health care, then my neighbor is FORCED to provide it. If he's a butcher, baker, or a candlestick maker, then my health care will not be so good!OH, you're just going to FORCE him to PAY for my healthcare. Just as I am going to be forced to PAY for his. Don't you see the moral hazard in that? Don't you see the stupidity in that? Don't you see the inefficiency and ineffectiveness of that?Argh!Please go back and revisit the whole history of John Locke and concept of negative rights. SECOND!!!No one want to see people treated like in a third world country. Sick and dying, covered in flies, in human misery.BUT, (there is always a big butt), you have no right to compel \”charity\”. America is an unbelievably charitable country. You can not \”force\” it. When you make it a gooferment program, then you have \”free loaders\”. Part of our current problem is that people want something for nothing. In my childhood, there was charity care in hospitals. My relatives would pass the hat around the family rather than have a relative use \”charity\”. They were embarrassed to have their neighbors think that they didn't love their family member enough to care for them. Freeloaders weren't tolerated; down on your luck, you were given a hand up. That's the essence of true charity.Remember the great hospitals in America were created by the Churches and Fraternal Organizations. Only when the gooferment took over, did we create the mess we have now.SUMMARY(1) Health care is not a right. (2) There will be true charity without the gooferment intrusion.
So why isn't charity taking care of the tens of millions uninsured and UNDER insured. Charities have been around forever and the uninsured have kept growing in spite of charities. It's not just the uninsured, people seem to forget the under insured, who have high deductible insurance with high premiums. They delay going to the doctor because they can't afford the cost of regular visits and check ups which aren't covered. If charity is so great why doesn't it supply affordable health care to the tens of millions who lack access to regular care or any care because they are uninsured or UNDER insured????????????Charity had decades and decades to cover all Americans buTTTTTT it failed, OK, got it NOW? Charity can help a small, infinitesimal fraction of the populace and intermittently at best. Charity is hit or miss, dependent on the state of the economy, geography and is not a dependable source of care for the whole uninsured population. Charity is just a fig leaf for libertarians so they don't have to give a damn about anyone but themselves. Health care is a civil rights issue. If you don't think that we should allow people to lie dying in the streets, then you are indeed saying that health care is a right. We pool our taxes all the time for the greater good, for the general welfare, for things that we can't do as individuals.If someone has a $150,000 medical bill, I really don't think charity will be able to foot that bill and then the subsequent rehabilitative care and all the medications and follow-up visits. My neighbors have their own problems, I can't hit them up for $150,000 and then later for an additional $60,000.
*** begin quote *** So why isn't charity taking care of the tens of millions uninsured and UNDER insured. *** end quote *** I would assert that charity takes care of a lot of people that you don't see. AND, the supposed millions of uninsured really maps to less than 10 million of the supposed 45 million when you factor out the young who feel they are immune, the free riders who feel they want to spend on other things rather than insurance, and our old friends those \”illegal\” immigrants. If the goofernment was not up to its elbows \”mandating\” coverages, limiting choices, and in general making a mess of things, then there would be much cheaper coverages. If we had tort reform, then current costs would come down. If we kicked out the FDA, down ever further. If we could get out of gooferment licensing, down further still.Not everything requires the creation of a new \”Post Office – Amtrak – TSA\” all rolled up into one. Argh!
Libertarian is just making up numbers and facts concerning the 46 million uninsured (from the US Census Bureau). If anything, that number is probably low considering the state of the economy.NEWS FLASH: We are paying for illegal aliens now when they go to the ER for health care or for a genuine health emergency. The young may not buy insurance unless their job supplies health insurance as a benefit. They are gambling with their health. Guess what, young folks do have accidents and they can end up in the ER. Who pays for their ER care?No matter how you slice it, there are tens of millions uninsured and this is a huge cost and drag on our society.Libertarian says nothing about the under insured who are paying big premiums and big deductibles. As a result, they don't have the money to go to the doctor for regular check ups. They wait until the pain becomes unbearable before they go to the doctor. They don't get any coverage until they pay the huge deductible ($5,000 is a common deductible). Small business people and the self employed often cannot afford insurance or they have to buy crap insurance. Libertarian says nothing about insurance companies that refuse care, deny claims just when you need them the most. Insurers won't cover people with pre-existing conditions. They drop people when they get too sick. They deny coverage when a premium payer gets an expensive illness or condition. This is just plain criminal.More than half of all personal bankruptcies are due to medical costs and more than half of those people had insurance!!!!!When you consider the uninsured, the under insured and people who think they have good insurance until they actually get sick and find out the insurance company won't honor their policy, we are talking about a huge chunk of the population. People with health insurance do go bankrupt from health care costs, this is a travesty. It's not just the uninsured.More and more employers are raising their employees' share of the health insurance costs and more and more employers are dropping the health insurance benefit altogether.In a few more years, we will have 60 million uninsured if we do nothing.
ROFL, will you at least concede that mandating \”hair plug replacement\” coverage might just might raise the cost of insurance. And, that an intelligent consumer might be will to forgo that coverage for a break in the premium. Liberals, they are so cute when they don't get their way.