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ALL 'care' systems ration one way or other [1st misnomer/euphemism -- we have sick care, not care that really promotes health].  Here, we ration by $ -- either your own, or 'insurance' [another misnomer/euphemism - not like auto, home, or other insurance to cover more extreme risks -- but funding scheme to pay for nearly everything everyday].   In others, they do it thru 'advice' on appropriate treatment ("NICE" in the UK), or long waitlists (Canada). 

The question is HOW we ration 'health care,' not whether we will.  We don't need 'Death Panels' (altho' that might not be a bad idea -- some societies have grandparents wander off into winter when times are tough), altho evidence-based comparative effectiveness results should guide us -- much $ is wasted on ineffective procedures, especially on elderly in the last months of life.

Rational approach already tried here in Oregon - priorities ranked by effectiveness and cost (bang for buck).  Those at top get $, and at some point the budget runs out and those further down list don't get public funding.

Important!  This does not mean no other 'treatments' are offered, just that public/taxpayer doesn't pay for it.  One can pay on one's own, or have 'insurance', or in more extreme cases folks do charity drives. ['Treatment' is used loosely here - science shows most of what passes for 'treatment' is not supported by rigorous study, and in fact, many 'treatments' pose the risk of more harm than good - see, e.g., iatrogenic illness.]

Higher costs come because we have an 'insurance' system to fund it. Basic economics of 'price illusion' (seems 'free' because little or no payment @ time/point of service, even tho quite expensive because you've prepaid via premiums or taxes), and 'moral hazard' (folks take on more risk because they now have the 'risk pool'/other people taking up financial risk). Collectively & historically we have made it much more expensive by having "someone else" pay for these services.  That said, we have legacy system and most are loath to change (they prefer the devil they know rather than unknown).  Given that, there are many ways to reduce costs -- standardize & streamline paperwork, etc.  Other Western systems do this to varying degrees by centralization of one sort or another.  Unfortunately, current legislation doesn't really do this.

posted 3 years, 1 month ago
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Seems to be a lot of huffing & puffing out there.  I've lived with dogs, cats, and birds all my life, and for the life of me, can't really understand why folks think they can take an animal anywhere with them.  Yes, I know Parisians have taken dogs lots of places, including restaurants, but I've also had to dodge dog feces on those otherwise beautiful Parisian avenues.  There are obvious health issues with animals - aside from bites & urination/defecation - allergies to dander/hair, 'nosing' into food, barking/snarling (I happen to be sensitive to sound), and no, people & other animals don't always mix well.

The Oregon provisions for 'assistance animal' include a definition as follows:  '"Person with a physical impairment" means any person who has a ... record of impairment and is regarded by health care practitioners as having such an impairment, requiring the use of an assistance animal ... .'  In other words, under Oregon law, those claiming public accommodation for an 'assistance animal' must have a qualified health care practitioner recognize the need for the permanently impaired to have the animal.

Although there are lots of arguments pro & con, the court decisions I have seen have uniformly required a doctor's certification & prescription for someone to prove an ADA violation.  

I don't see what the problem is for individuals to get such health care certification & prescription - we require it for handicapped parking access, why not for animals?  If you have to have a health care practitioner recognize the need, and have to have a documented record of the impairment and need, it seems a pretty simple thing to get a letter from the qualified health care practitioner (and that is not from one of the 'service' animal diploma mills -- they aren't a qualified health care practitioner).

posted 3 years, 4 months ago
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