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Karl Loren
Username: Kloren

Post Number: 42
Registered: 05-2003
Posted on Friday, September 12, 2003 - 10:42 am:   Edit Post Print Post    Move Post (Moderator/Admin Only)

Some months ago I ran straight into the wall of health care rationing.

I broke through it.

Millions don't try.

Is health care rationing real?


Here is an excerpt from the Wall Street Journal, September 12, 2003:

The nurse manager in intensive care, Ms. Micheletti makes daily battlefield decisions that influence whose lives should be prolonged and who should leave the ICU.

As her hospital faces a cost crunch, she's under pressure to get patients out of the glass-walled unit quickly.

While she can't deny or withdraw care, she uses not-so-subtle means to decrease patient stays. She cajoles doctors to move their patients along. She pushes the hospital's pharmacy committee to relax guidelines that require patients on certain drugs to stay in the ICU. She prods families to let some very ill patients die with less medical intervention.

Without any official rules, she uses only her judgment from 27 years of experience. "You get a feel for it," says Ms. Micheletti, 50, who mixes straightforward talk and a ribald sense of humor to get her way. "Nine out of 10 times I'm right. Every now and then I'm proven wrong. There are always a few cases that are miracles."

The word for what Ms. Micheletti does every day at this 173-bed hospital is one of the big secrets of American health care: Rationing. Although the U.S. spends far more per person on health care than any other country, and it spends ever more each year, there aren't enough doctors, drugs and dollars to do everything for everybody. So who gets the care? And who makes these momentous, life-or-death decisions?

How did this happen to me?

My wife had a "bad" knee. We went to the surgeon within our insurance coverage. Fortunately we saw, first, the young new guy. (I say "fortunately" because it was easy for the senior surgeon to have a senior view of things than it would have been for the senior surgeon to reverse an initial opinion.)

This young "inexperienced" surgeon said, "You are not in enough pain to have a knee replacement."

I wrote a formal letter of complaint to the insurance company, copy to the doctor.

Shortly thereafter the insurance company sent a polite letter but the doctor's office called to suggest another visit, with the senior doctor.

The senior surgeon was quick to schedule my wife for the knee replacement, and got it.

The younger doctor (I cannot prove this, but I did allege it) has the job of turning patients down. If he allows too many to get through, silently that medical group is no longer included in the insurance coverage.

So, the rationing does take place, but, so far, the various players in this scenario are sensitive to a well written letter of complaint.

It is actually about the best we could do if we want to avoid a much quicker bankruptcy of the system which is broke, almost impossible to fix, but is limping along enough to get by without the (knee) surgery.

Eventually, surgery on medical care will be necessary.
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