Selective denial or ‘rationing’ of health care?

According to Karl Denninger, it’s likely in due course, thanks to budget pressures.

I claim no special power here, nor any inside information.  This is simply arithmetic coupled with logic.

. . .

… on the math, we have roughly 5 years before the US Federal Government will attempt to spend $2 trillion a year between Medicare and Medicaid annually, $600 billion more on a yearly basis than it spends now.  It may try to forcibly shift some of the Medicaid spending to the States (as the AHCA did) but the bottom line will continue to expand at its ~9% annualized rate.

That cannot be financed.

It is mathematically impossible to do so, and thus it will not happen.

If the government tries to “print” it (via Fed machinations) doing so will further depress productivity which will go negative from its already-suppressed levels (as a result of the last ten years of deficit spending) and at that point GDP collapses and so do asset prices and tax revenue.

So they won’t do that either because unlike in 2007 when the total between those two programs was $830 billion they can’t get away with it at nearly three times the price.

What they’ll probably do instead, therefore, is unilaterally and sadistically cut people off.

If you’re one of them you will either suffer, die or (probably) both and they’ll target those who are both fat and sick figuring, quite properly, that you’ll be physically unable to do anything about it.

The low-hanging fruit, where a full 25% of the spending happens today, is on Type II diabetes.

If you’re Type II diabetic you’re ****ed, in short.  You better fix that if you can, right now.

If you’re overweight and especially if you’re obese you had better fix that too, right now, because that has a very high probability of leading to Type II diabetes.

It is my prediction that this is where they’ll target first.

There’s more at the link.  Scary, but recommended reading.

I think Mr. Denninger is probably both right and wrong.

• He’s probably right, in the sense that such ‘rationing’ of health care is already taking place, discriminating against smokers.  There have been many reports that smokers are being denied surgery and other health care options because their habit makes it more difficult to produce a satisfactory outcome.  That’s the cause of much debate at present, in the health care community and in the wider civil rights arena.  It’s not much of a jump from there, to rationing health care to obese people or those suffering from diabetes.
• He’s probably wrong, in that overweight and obese people (which includes many diabetics) make up a very large proportion of the US electorate.  Any attempt by any administration, Republican or Democrat, to cut health care to these people would result in a ****storm that would make present political tensions seem like a minor disagreement at a Sunday School kids’ party.  I suspect neither political party will risk that – at least, not overtly.

What I suspect is more likely to happen is that rationing will occur ‘administratively’.  Bureaucrats will craft rules and regulations that will never be referred to Congress (which will tacitly condone them by not taking action to stop them).  Those rules and regulations will predicate that health care expenditure will be incentivized by the government on the basis of the success achieved by local hospitals and other facilities.  The definition of ‘success’ may also be modified.  This will allow bureaucrats to control access to health care in terms of cold, hard cash.

• Your surgeons have a 60% success rate?  That’s terrible!  We’re denying you incentive payments until you improve.
• Your surgeons have an 80% success rate?  That’s pretty good.  Here, have some more subsidy money.
• Your surgeons have a 95% success rate?  Outstanding!  Here’s more subsidy money and bonuses for your heads of department, to distribute among their medical staff at their discretion.

Money talks.  Once that sort of politically-correct bribery becomes common, you can expect hospital admissions staff to be very cautious about approving surgery for those less likely to recover quickly and/or fully from it.  That will, of course, include smokers, the obese, and diabetics.  Their reduced chances of health care success will impact the ‘success’ of the facility as a whole – and, therefore, the financial incentives it receives.  Such patients will therefore run into delays, and paperwork issues, and demands for more tests (at their expense, of course) to ‘ensure that they can safely undergo surgery’, and every other administrative roadblock that can be imagined.

I hit those problems last year, when I needed gall bladder surgery.  The fact that I’m a heart attack and bypass surgery survivor, and have a fused spine and other complicating factors, meant that the hospital demanded ‘cardiac clearance’ before it would proceed with the operation.  I’d had two kidney stone procedures just the year before, under general anesthetic, with no problems whatsoever, but they refused to take that into account.  I had to jump through all the hoops, all over again.  I was infuriated, but what could I do?  They weren’t refusing surgery to me – just demanding extra steps, and extra costs, before proceeding.  If I couldn’t or wouldn’t have complied, there would have been no surgery for me;  but that would have been regarded as my fault, not theirs, because I’d ‘failed to comply’ with their ‘reasonable requests’ and procedures.

I suspect more and more of us will encounter such demands in future.  It’s a form of health care rationing, whether we recognize it as such or not.  It also allows health care providers to take care of each other, by ensuring that they ‘spread the wealth around’, making patients spend money unnecessarily on procedures and tests they don’t really need.

Thus, health care rationing will probably be applied, but I suspect it’ll be administratively and financially, rather than by overt denial of care to specific classes of people.  That doesn’t make it any easier or more bearable if, as I am, you’re in one of the high-risk population groups for denial, of course.  Sucks to be older or less healthy, I guess . . .

Peter