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- A tumblr site dedicated to the people and places that make up Oregon and Southwest Washington.
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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