Rationing in the American Medical System

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How Obamacare effects physicians and patients

This week Brett and I are discussing rationing and medicine. As our population ages, and Obamacare has brought more people into the group receiving healthcare under the universal healthcare plan, we must have a conversation about how to stretch the system to deliver the medical treatments promised, and that means decreasing medical services to some to provide services to the increasing number of patients. Rationing is a term used in government but one that has only recently been used in regard to medicine. The act of rationing means denying care to some, which is not provided for in the Hippocratic Oath doctors take when they commit their lives to healing. The contradiction between what physicians have agreed to and what rationing requires is the subject of this podcast and the important task everyone should consider when agreeing to this governmental dictum.

Rationing of healthcare is driven by several factors: the current economic reality of fewer Americans available to financially support a growing number of retired Americans (the Baby Boomers);the increasing cost of every element of healthcare; and trend in this country to more obese and sicker population; and the fact that the patients who are being added to the group of “insured” are people who generally have medical illnesses that have kept them from being insured. It is the moral conflict that occurs between the oath of medical doctors to keep each and every patient healthy, and the limitations of money, doctors and medications that has been voted by politicians into law that will cause the future malfunction of this system. We hope our listeners will become involved in this discussion before it is enacted, as citizens and as consumers.

Rationing in medicine can be discussed in so many different circumstances. Some are already in place in terms of big picture situations. This happens currently when accrediting agencies help determine whether or not a community hospital can open a new heart center or cancer center. This rationing is based on need of the community. Rationing can refer to very personal medical care when discussing the triage of emergent medical care, which many people have experienced in the ER when patients are seen in order of the severity of their illness and not in order of when they come in to the ER. In this program everyone is seen, but the order in which they are seen is a judgment of the triage nurse or doctor. Rationing is done differently in war, which makes the decisions of care based on whether a patient can survive until transport comes, which actually leaves some patients to die. This is not a system that is used currently unless there is a war or a huge disaster. It is an exception to the way doctors are trained based on an unusual circumstance. Future rationing is sure to become necessary in the new universal healthcare system called Obamacare. In the doctors office when care is decided based on how expensive it is and how much care and money the last patient required. We must have conversations about how the new system will handle a doubled patient load in the same number of hours. That inevitably means each patient will get less time. how much time they should spend with that patient. That, too, is a form of rationing.

As a physician I am concerned because I was trained thirty plus years ago to see the patient in front of me as an individual who is presenting with symptoms and a history and individual needs for treatment. It is my job to take the time to make a good diagnosis and then consider the optimal