Tuesday, June 30, 2009


Judge Smails sends in a quote from a recent column that I also found to be useful:
With no comment on the merits of the article, I thought Michael Kinsley provided a nice practical definition here (in comparison to the relatively useless fear-mongering vs. everything is already rationed debate):
Here is a handy-dandy way to determine whether the failure to order some exam or treatment constitutes rationing: If the patient were the president, would he get it? If he'd get it and you wouldn't, it's rationing.

I like it, because it sets up an easy to consider metric while also allowing that some rationing is reasonable (most people expect the President to get modestly better care than themselves).

We all know that health care rationing already occurs to a high degree in this country -- wealthy people can afford better care. Some of this occurs because they actually pay more for a nicer room with no roommate for their hospital stay. But, some of it is more structural -- Boston is a nice city to live in with a lot going on, so lots of people want to live here, so housing is expensive. One of the 'things going on' in Boston is Harvard Medical School, so there are a lot of highly skilled doctors around, so all things being equal, you're better off getting hit by a car here than in Topeka. I can't find a good citation for it, but I've heard time and again that one predictor of cancer survival is how far you travel for treatment -- you're going to get much better treatment, with newer imaging and access to clinical trials, if you happen to be near a major cancer center. So if you live in Nebraska and have little means of traveling far, you're kinda screwed.

PS Back in the States; Ireland was great.