Fact: Healthcare is a scarce resource and therefore will be rationed somehow. This is the foundation of economics.
1) My professional opinion, as an economist, is that you are not an economist.
2) 29% of Americans reported not taking some or all of their prescribed medication because they couldn’t afford it. There is a lot of rationing in today’s healthcare system, and there is little evidence that such rationing at such levels exists in nations with universal health care.
That’s why Medicare-for-All is a winning issue.
Nope, I'm not and I don't know how good of an economist you are. I'm correct about what I said - and you agreed - rationing will happen. We just may disagree about the severity.
Also, your poll comes from where? The ones I've seen have it much less and there are far greater reasons people don't take their meds. This one for example. https://www.npr.org/sections/health-shots/2017/09/08/549414152/why-do-people-stop-taking-their-meds-cost-is-just-one-reason
Strange? I read that as the opposite of what you stated.
He seems to be saying (to me anyway) that there is rationing in our current system, and gives an example. Are you saying rationing in our current system is worse than the article states? Is that the difference of severity?
Then he goes on to state that there is little evidence of rationing in universal healthcare programs sponsored by other countries. Are you seeing “little evidence “ as a level of severity? Because I certainly do not. I don’t read that as agreeing that rationing will happen.
Rationing and prohibitive price points are not the same thing. You do not take the same actions to deal with them.
How many countries with universal health care literally have no other options if the gov't system denies the procedure/treatment, as opposed to just having to pay (far less than here) out of pocket to get it, just like people denied by insurance companies can do?
Also, does anyone know - does Medicare have any process of rationing care?
I don't understand your first question. Are you talking about the country having options? Or people within the country?
The second question: Medicare doesn't need to ration because it is in the same system as private health care and costs can be made up by providers, if necessary, by charging more for payers not limited to Medicare funds.
So our current public health care system does zero rationing for its tens of millions of members, that's what I figured.
For the first, you're contrasting rationing care with being unable to afford care and saying they need to be treated differently. I'm asking how many countries with universal health care have no means for people denied coverage for care to pay for it out of pocket, aka the same situation people denied by insurance or with none face here.
I'm trying to identify the substantive differences between being denied care due to "rationing" and being denied it due to insurance company rejection of claim. Other than far more people having no coverage at all and the out-of-pocket costs being vastly higher, of course.
We don't have a public health care system. We have a private health care system, which has some public funding assistance.
I'm speaking in economic terms when I make a distinction between rationing and prohibitive costs. Whenever you induce a price ceiling to anything (which a fully public health system would do), you risk a rationing of products/services. (In actuality, you always will see rationing in a vacuum, but depending on how the system works/cycles you may not actually experience the rationing at the checkout line.) It's important to note the difference because if you want to lower the price of something there are things you can do to incentivize that effect (could be anything from regulation, competition, subsidy etc). If you want to remove or prevent rationing, you would remove the price ceiling. I don't see how you can have a working public health system without a price ceiling. You can have a bloated public/private health system without a price ceiling, but you'd end up with basically what we have now.
One thing I've never considered is whether you can have a public health care provider system, with private insurance. That's probably the worst of both worlds, but I'll have to give it some more thought.
Okay, I admit to being a little loose with a strict definition of rationing, but only a little.
Typically when people talk about rationing in terms of universal health care, there is an implicit concern about a demand shock increasing the consumption of health care combined with the imposition of a single-payer regime that restricts the ability of pricing to respond to this increased demand. The supply of health care services are presumed to be static during the imposition of universal care, meaning demand is greater than supply. This would lead to longer wait times, maybe a complete inability to see a practitioner, and drug shortages. Distribution of services in this case might be handed out by lottery, scoring, or some other method, i.e rationing.
My point is that because at present such a large percentage of consumers in the market can not afford the services they demand, the net effect is the same at best, and I would argue worse. Consumers, due to budget constraints, practice a form of self-rationing.
I should add that many/most of these medicines that are foregone by consumers tend to have very low marginal cost to produce, and have average costs that approach marginal costs due to research costs being long ago made up. Accordingly, perfect competition would suggest that pricing and supply would meet demand, but we don’t see that. Instead pharmaceutical companies have significant economic profit. Ergo, there is a clear market failure.
A similar argument could be made about seeing medical professionals. According to this article, 54% of Americans delayed or did not seek treatment due to costs. https://www.cnbc.com/amp/2018/11/29/over-half-of-americans-delay-health-care-becasue-they-cant-afford-it.html
Other studies have put the number closer to 40%, but the point remains that the market is not able to meet demand. Meanwhile, at 2.6 doctors per 1000 people, the same ratio as Canada and 10% more than Japan (per World Bank figures), two countries that have government-run insurance, the problem seems not to be due to an undersupply of doctors.
Universal single-payer insurance is the best solution.