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Ration End-Of-Life Care

The BriefGet Up To Speed

Taking place at Chicago Ideas Week:

Just because we can extend life, should we? The U.S. is expected to spend $2.8 trillion on health care in 2012. Medicare alone will cost taxpayers $590 billion, with over 25% going toward patients in their last year of life. If health care is a scarce resource, limited by its availability and our ability to pay for it, should government step in to ration care, deciding whose life is worth saving? In other words, how much is an extra month of life worth?


In the name of expanding health care insurance to all, the administration and liberals in Congress are quickly leading the country down the road to government-rationed health care—where government holds the power of life and death over every American. In such a system, boards of “experts” will evaluate the relative values of human lives and make coverage decisions accordingly.

Tuesday, July 21, 2009
Randy Pate

Once the precept that one should do ‘all one can’ to avert death is given up, why stop there?

Saturday, June 11, 1988
Amitai Etzioni

White House health-care adviser Ezekiel Emanuel blames the Hippocratic Oath for the 'overuse' of medical care.

Thursday, August 27, 2009
Betsy McCaughey

With Obamacare handing over the reins of the health care system into federal hands, is rationing really far from our shores?

Saturday, August 25, 2012
Margaret A. Bengs

If Congress enacts universal health care coverage, we are undeniably headed for a medical system of rationed care that must inevitably deny care to some terminally ill and elderly, which will shorten their lives, perhaps by years.

Thursday, August 20, 2009
Patrick Buchanan

A pattern is emerging that at least gives the appearance that payment can be denied if therapies are seen as too costly.

Thursday, January 6, 2011
Grace-Marie Turner

Rationing should be done by policy, not by individual doctors and patients at the bedside, policy must be set by democratic process, policy must be carried out in a transparent way, and there should always be a provision for appeal.

Tuesday, March 27, 2012
Daniel Callahan

In short, free markets are not an alternative to rationing. They are just one particular form of rationing.

Friday, July 3, 2009
Uwe Reinhardt

As health spending grows, year after year, roughly twice as fast as the payroll that supports private health spending in this country, Americans sooner or later will have to confront the hard questions about access to expensive treatments, perhaps after a rational national conversation, if such can still be had in America.

Friday, August 14, 2009
Uwe E. Reinhardt

Unless we start allocating health care resources more prudently—rationing, by its proper name—the exploding cost of <a name="medicare" id="medicare"></a>Medicare will swamp the federal budget.

Sunday, September 16, 2012
Steven Rattner

We cannot continue to have all our demands met; thus rationing of care will become a necessity.

Tuesday, March 1, 2016
J.M. Freeman

The authors recommend an alternative system—the complete lives system—which prioritizes younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.

Saturday, January 31, 2009
Govind Persad

Here we go again. A clumsy bit of rulemaking by the Obama administration has revived nutty talk about "death panels" — the inflammatory but thoroughly debunked notion purveyed last year by opponents of the new health reform law.

Thursday, January 6, 2011
USA Today

Panelists in a Miller Center program debate the motion, ‘The United States must ration costly end-of-life care.’

Wednesday, March 24, 2010
Miller Center of Public Affairs and MacNeil/Lehrer Productions

A summary of some of the arguments for and against rationing end-of-life care.

Wednesday, December 31, 1969
Lois Shepherd

America is undergoing a demographic revolution, with a rapidly aging population blessed with greater longevity. While this is a triumph of modern medicine, it also presents an unprecedented ethical and fiscal challenge for individuals, families, medical professionals, and policymakers. The Center for Policy Innovation asked two leading scholars of ethics and health policy to engage in an exchange on these issues.

Tuesday, July 24, 2012
Daniel Callahan and Peter Lawler

As the ranks of the elderly swell, and demands on the nation's scarce health care resources increase, the once whispered suggestions that health care should be rationed by age are now growing audible.

Wednesday, December 31, 1969
Claire Andre and Manuel Velasquez

We realize some may read our ruling and conclude that we believe the Obama plan will mean more drastic rationing. But we think it's more accurate to say the bill seeks a more rational way to ration. Whether it can succeed is a topic for legitimate debate.

Saturday, August 1, 2009

Rationing happens every day at every level of our healthcare system.

Friday, December 4, 2009
Sarah Burd-Sharps and Kristen Lewis

People’s choices of what and what not to buy and sell at which prices create an arrangement of goods and resources that tends to be intelligible in terms of consumers’ subjective priorities. But that does not warrant calling the process rationing or allocation.

Sunday, July 15, 2012
Sheldon Richman

Voters subjected to the sound bites of campaign ads will never learn that the dirty little secret of both approaches is that they embody a form of rationing.

Tuesday, August 14, 2012
Merrill Goozner

One-third of Americans recently surveyed said the new health law would allow a government "death panel" to make decisions about end-of-life care. They are dead wrong.

Friday, February 10, 2012
Arthur Garson Jr. and Carolyn Long Engelhard

IPAB is a controversial board that is at the heart of House Republicans' efforts to upend the 2010 federal health law.

Thursday, March 22, 2012
Bara Vaida

Death panels also are back. At an appearance in Florida over the weekend, Mr. Ryan criticized the Independent Payment Advisory Board (IPAB) established under Obamcare to “contain” Medicare costs.

Monday, August 20, 2012
Washington Times

There is much talk in the wake of the recent Supreme Court “it’s a tax” indigestion that the Senate can now repeal the individual mandate without fear of filibuster. Perhaps. But repealing the mandate/tax wouldn’t rid us of one of Obamacare’s most dangerous big-government intrusions: the Independent Payment Advisory Board (IPAB).

Friday, July 6, 2012
Wesley J. Smith

U.S. health care spending and quality compared to other OECD countries.

Thursday, June 28, 2012

One report presents updated projections of the budgetary effects of the coverage provisions of the ACA to reflect the Supreme Court's recent decision. The other report presents a cost estimate for the repeal of the ACA that passed the House of Representatives on July 11th.

Tuesday, July 24, 2012
Congressional Budget Office

In 2008, 1 percent of the population accounted for 20.2 percent of total health care expenditures and 20.0 percent of the population in the top 1 percent retained this ranking in 2009. The bottom half of the expenditure distribution accounted for 3.1 percent of spending in 2008; about three out of four individuals in the bottom 50 percent retained this ranking in 2009.

Sunday, January 1, 2012
Steven B. Cohen and William Yu

‘Death panels’ are a bad idea, but asking hard questions about health care is not.

Monday, August 27, 2012
Laura Beil

Democrats and Republicans agree that the next U.S. president will have to contend with rising healthcare costs that pose a growing, destabilizing burden for families, employers and government budgets. But two articles published in the New England Journal of Medicine on Wednesday show how far apart each side stands on the question of what to do, ahead of a November election showdown between President Barack Obama and presumptive Republican nominee Mitt Romney.

Wednesday, August 1, 2012
David Morgan

What a Texas town can teach us about health care.

Monday, June 1, 2009
Atul Gawande

Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures.

Sunday, December 1, 2002
Donald R. Hoover

Spending for health care services is highly concentrated among a small proportion of people with very high use. Conversely, a significant portion of the population has very low health care spending.

Sunday, July 1, 2012
NIHCM Foundation Data Brief

‘In addition to its effects on patients’ quality of life, unnecessarily aggressive care carries a high financial cost. About one-fourth of all Medicare spending goes to pay for the care of patients in their last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease,’ said David C. Goodman, M.D., M.S., lead author and co-principal investigator for the Dartmouth Atlas Project.

Tuesday, April 12, 2011
D.C. Goodman

The Ronald Reagan U.C.L.A. Medical Center, one of the nation’s most highly regarded academic hospitals, has earned a reputation as a place where doctors will go to virtually any length and expense to try to save a patient’s life.

Tuesday, December 22, 2009
Reed Abelson

Some experts say to control medical costs, America must ration health care. Others argue that care is already rationed in the U.S., often in hidden ways. It’s a highly charged issue. Even the term "rationing" is subject to dispute.PRI's The World takes a global look at the topic with four perspectives from four countries.

Wednesday, December 31, 1969
The World

What we have in England and Wales is the National Institute of Health and Clinical Excellence (NICE) with the job of deciding whether or not a new treatment or intervention is cost-effective.

Thursday, April 26, 2012
Jonathan Wolff

The well-worn notion that patients in the United States have unfettered access to the most expensive cancer drugs while the United Kingdom's nationalized health care system regularly denies access to some high-cost treatments needs rethinking, a team of bioethicists and health policy experts says in a new report.

Saturday, December 26, 2009

NHS patients should expect continued rationing of common operations for years to come, while hospital closures are ‘inevitable,’ according to an influential think tank.

Friday, June 29, 2012
Stephen Adams

NHS hospitals are rationing the number of operations they perform to balance their budgets.

Tuesday, June 19, 2012
Claire Bates

The U.K. is shifting responsibility for cost control from faceless bureaucrats to general practitioners. Will this change lead to the kind of implicit health care rationing long seen in the U.S.?

Wednesday, April 27, 2011
Rudolf Klein

In a study that sheds new light on the effects of end-of-life care, doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared — but they also lived nearly three months longer.

Wednesday, August 18, 2010
Donald McNeil Jr

Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives.

Wednesday, December 31, 1969
Karen M. Detering

The paragraphs, buried deep in the 1,000-page House health reform bill, appear innocuous, but they have ignited a firestorm among critics predicting government-sponsored euthanasia. Yet physicians who work with patients on end-of-life planning say that while they are surprised and upset about criticism of the proposal, it has brought needed attention to what they view as a long under-funded and overlooked service.

Friday, August 14, 2009
Jessica Marcy

Studies show the frank discussions that palliative care engenders can ease pain, forestall guilt and increase the chances of a peaceful death. And, significantly, they can save money.

Friday, March 5, 2010
Susan Brink

The United States lags France, Britain and Germany in reducing the number of preventable deaths, researchers found.

Wednesday, August 29, 2012

During the Great Recession, when many hospitals across the country were nearly brought to their knees by growing numbers of uninsured patients, one hospital system not only survived — it thrived.

Tuesday, August 14, 2012
Julie Creswell and Reed Abelson