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in 2009 there is no bigger issue

Rationing - what does it mean?

From Wikipedia:  "Rationing is the controlled distribution of resources and scarce goods or services.  Rationing controls the size of the ration, one's allotted portion of the resources being distributed on a particular day or at a particular time."

As Goodman wrote in his book "Lives at Risk", NCPA, healthcare demand is near infinite.  So in a sense rationing occurs all of the time, for demand  for more care is always somewhat unfulfilled.  As any economic service or product, demand is not met entirely, but sufficiently.  The democratic nature of the free market system allows for ways to convey the needs versus wants of the populace, and allow the providers to optimize the results. 

In this case there is no mandate as to what is bought or how much it costs, but rather a continual process of optimization to secure happy customers and profits.  The poor benefit from the cost reduction that results, as indicated by the cost of a TV and a computer over the years.  It is true that the rich have more things, but the general public generally benefit from having a market process guide services and pricing. 

So why is it that some want healthcare to follow a different curve?  The stated intentions is that all would receive the same level of care and be assured of receiving care through insurance.   What we have now is the result of trying to mandate, legislate, buy our way to that condition with a lot of government intervention and processes, a piece at a time.  As is argued in other parts of this website, the result is far from a market economy, and the conditions are far from ideal.   The status of Medicare is that it is bankrupt shortly, even after tipping into the general tax revenue, among other problems. 

The irony is that the problems exist, it can be argued, because of the government intervention, and will become worse because of even more intervention.    

The bottom line is do the citizens want the government to determine how to apply further rationing approaches to their healthcare choices or do they want to make those choices?   If asked in such a simple manner then the answer is quite clear.  Obama keeps promising more choices not less, for he knows the citizens will reject the real nature of Obamacare if they see it as a choice reduction policy. 

WSJ writes"The White House Council of Economic Advisers issued a report in June explaining the Obama administration's goal of reducing projected health spending by 30% over the next two decades. That reduction would be achieved by eliminating "high cost, low-value treatments," by "implementing a set of performance measures that all providers would adopt," and by "directly targeting individual providers . . . (and other) high-end outliers.""

Another irony is that in order to provide coverage to all, possible with a free market not the one we have, the government want to push healthcare to a state where the government will make many of the decisions that are made today by patients, doctors, and insurance providers.   What the government is good at is establishing bureaucracies not increasing effectiveness. 

So why would the citizens go for Obamacare?   The answer is they would not if they comprehended the full nature of the policy.  In the article below, Obama explains how rationing is likely and difficult, although he will not use the R-word, it is a part of Obamacare.

TThe choice is clear, government driven decisions in the long term or market driven decisions.  Make your voice heard.  Review the article referenced below.

Obama's "Astro-Turf" Health Care Conversation/a>

Shikha Dalmia, August 15, 2009, 9:35am

The Wall Street Journal this morning reprinted the excerpt below from an interview that President Barack Obama gave to columnist David Leonhardt in the April 14 New York Times magazine:

"The President: Now, I actually think that the tougher issue around medical care-it's a related one-is what you do around things like end-of-life care.

Mr. Leonhardt: Yes, where it's $20,000 for an extra week of life.

The President: Exactly. And I just recently went through this. I mean, I've told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she's in the hospital, and the doctor says, Look, you've got about-maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that-you know, your heart can't take it. On the other hand, if you just sit there with your hip like this, you're just going to waste away and your quality of life will be terrible. And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just-you know, things fell apart.

I don't know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she's my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn't have a hip replacement and she had to lie there in misery in the waning days of her life-that would be pretty upsetting.

Mr. Leonhardt: And it's going to be hard for people who don't have the option of paying for it.

The President: So that's where I think you just get into some very difficult moral issues. But that's also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

Mr. Leonhardt: So how do you-how do we deal with it?

The President: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance. It's not determinative, but I think has to be able to give you some guidance. And that's part of what I suspect you'll see emerging out of the various health care conversations that are taking place on the Hill right now."

Well, guess what, Mr. President, you got your wish. The nation is having that "very difficult democratic conversation" right now. So why are you upset? Could it be because you can't control this "difficult" conversation -- unlike the ones you routinely hold at "astro-turf" town halls stacked with your supporters?