What kind of backwards society have we become where things like this can happen?

• The program in question is run by the Oregon Department of Human Services, not directly by the legislature.
  • The standards of care, coverage and reimbursement schedule are entirely developed by that agency with no direct legislative input. The Oregon state legislature votes on a budget for the Oregon Department of Human Services, but does not vote directly on how the department spends that budget.
  • The standards of care are subject to greater likelihood of judicial review than direct legislative review.
  • Since the majority of the money to fund all Medicaid programs comes from the federal government, HCFA exerts stronger influence in the development of state Medicaid standards of care, than do the state legislators.
• In the instant case, the denial decision was not rendered by DHS, but rather by a private contractor (LIPA) based on their interpretation of the standards of care developed by DHS and bolstered by the past practices of DHS and as shaped by local court decisions.
• The issue in this case is one of formal health care rationing, not of legislative gridlock or compromise.
• Formal health care rationing is part of every socialised health care system.
• In socialised health care plans around the world (Canada, UK, France, Holland, US state plans), health care is routinely denied to: the elderly; the obese; those who smoke; those who drink too much; those who've purchased health care at their own expense; those with certain life-threatening conditions that are not predictably responsive to treatment; and others who don't fit the standards enforced by the administrators of the health plan.
• Rationing is accomplished by limiting resources (staff, technology, drugs) associated with particular services, thereby introducing significant delays to access or denying them outright.
• Rationing is often linked to health plan cost-saving
• The Wagner case is exemplary of 'health plan-centered care', as contrasted with 'patient-centered care'.
• Health plans around the country routinely lose more 'denial of service' cases in the courts than they win, due to the civil rights/equal opportunity implications of rationing decisions.
  
  Right now in the UK, there is a growing storm of protest gathering about the policy of the NHS to deny future care for those who "top up" their health care by paying for treatment outside of the NHS. The rationale for this policy is that under the NHS, care is provided based on clinical need, not ability to pay. Paying for one's own treatment, usually provided in a foreign country, is seen as an assault on the system, and warrants denying that person future treatment. You'll notice, however, that there is no corresponding cut in the taxes extracted from that person, meaning that they're still paying for the NHS, they just can't use the NHS. That's fair, innit?
  
  Under "universal" nationalised health care, people will no longer die because they don't have insurance; they will die because they DO have insurance. We'll all have insurance, but it will be insurance that won't cover administratively unfavourable, socally unfavourable, expensive, or less than 100% effective treatments. I use the quotation marks around the word universal because there will still be people excluded from care, and every study coming down the pike shows it will be the same old suspects - the poor, the elderly, the infirm. Those in the lower socio-economic groups will continue to have worse health care outcomes than those in higher socio-economic groups, but it will no longer be because they don't have insurance, but rather, it will be the result of them being disproportionally hit with health care denials based on weight, smoking, and other lifestyle-based activities. To this we will add those wealthier people who will be denied care because they went outside the "system". It is possible that under "universal" care, we will do collectively do worse in providing health care than we do now.
  
  There is no perfect health care delivery system, and most people do agree that we do need to find a way to fund broader coverage. But the current top-down proposals are unworkable, fiscally and practically. Unfortunately, proponents of "universal" health care delivery systems routinely paint their solution as a Utopian panacea while glossing over the very real and very difficult limitations of such systems. They want to sell a pig in a poke to the American people in order to get elected and then stick us with a significantly expanded reach of government bureaucracy into the most intimate decisions in your life. Most people don't know the real issues at play in this debate. They hear the politicians and get sucked into the rhetoric without understanding the limitations of the programmes that are being proposed. For example, Hillary often referred to expanding our health care system to 49 million new people. The problem with this is not just in the amount of money involved to pay for it, it's the whole supply side of the equation. I wonder where she was planning to find the doctors, nurses, ancillary providers and equipment to provide health care to 49 million people. If an average physician has a practice of five-hundred patients, 49 million new patients will require 98,000 new qualified doctors to appear from somewhere. By the way, the average consultation that patients have the their doctors right now is only 6 minutes - what will it be with 49 million new patients in the system? Hospitals already can't hire enough qualified nurses in many areas to meet state-mandated staffing ratios - now we're going to chuck 49 million more patients into the mix? In California, the state DHS demands a ratio of six patients to each nurse for general care wards - specialty units go much lower. 49 million patients hitting the hospitals will require several million new qualified nurses from somewhere. What about X-ray techs, phlebotomists, lab techs, respiratory techs, dieticians, etc.? Where are the new MRI's, CAT scans, Gamma Knife's and other high-priced technologies needed to provide care to those 49 million people going to come from?
  
  It all boils down to this - how are you going to feel when you're told, like Ms. Wagner, that we'll pay to kill you, but we won't pay to help you? What if it's your spouse, parent, child, significant other, or best friend who's affected? How will you feel when you're told that seeking treatment outside the system is reason to deny you all further treatment here? How well will it sit with you to be told that the life-saving surgery you need will just have to wait until those ahead of you in line get served, even if that means that you die in the meantime?
  
  Will you love the new "universal" care then?