Pricing Life: Why It’s Time for Health Care Rationing
Pricing Life: Why It’s Time for Health Care Rationing Books
Product Description
Although managed health care is a hot topic, too few discussions focus on health care rationing–who lives and who dies, death versus dollars. In this book physician and bioethicist Peter A. Ubel argues that physicians, health insurance companies, managed care organizations, and governments need to consider the cost-effectiveness of many new health care technologies. In particular, they need to reckon about how best to allocation health care. Ubel believes that standard medical training should provide physicians with the expertise to choose when to withhold health care from patients. He discusses the moral questions raised by this position, and by health care rationing in general. He incorporates ethical arguments about the apt role of cost-effectiveness analysis in health care rationing, empirical research about how the general broadcast wants to allocation care, and clinical insights based on his do of general internal medicine. Straddling the fields of ethics, economics, research psychology, and clinical medicine, he moves the debate forward from whether to allocation to how to allocation. The discussion is enlivened by actual case studies.
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Let’s say you have a grandma who is still nearly and kicking at age 74. She is the only thing that stands between you and a huge inheritance. Well, give her this book as a gift for her 75th birthday and see if she gets the hint.
If that seems a bit selfish, you can easily discuss why younger people need health care more than the ancient folks. Plus, if grandma exits stage left early, she will be helping preclude Social Wellbeing from going insolvent. Rationing health care is also a fantastic way to reduce the carbon footprint of the obese, the elderly and people who no longer benefit the social excellent. As a M.D. who has written on obesity, Ubel makes a excellent case for reducing health care for the stout. Many of these policies are being considered in Europe, a part of the world that is much more intellectually sophisticated than our redneck dominated culture here in the US. Britain is even rationing insulin for elderly diabetics.
Buy this book in conjunction with Logan’s Run.
Rating: 1 / 5
Dr. Peter Ubel has written and vital and helpful book. He describes very clearly how medical care in the U.S. is already being rationed–even though we might not call it ‘rationing,’ or even realize it. He gives clear examples of how that administer is being taken place; the arguments for and hostile to it; and a very coherent argument that medical rationing will continue, and grow, because it is economically inevitable.
This book is vital because it tells the reader that rationing will take place–with or without an informed patient role. It is up to those who receive medical care to know what’s at stake to make sure they do play an active part in the choice-making administer.
The book is very clearly written, but more examples, particularly in the latter part of the book, would make is more readable.
Rating: 4 / 5
Modern medicine is one of the fantastic successes of industrial civilization. This remarkable progress, but, has come at a very high price. In the USA, for example, we spend close to 15% of our GNP on health care. We are the champion health care spendthrift of developed world but other industrialized countries spend huge amounts on health care. It is not surprising that huge pressures are exerted to hold down expenditure; HMO management in the USA, coming up lists for complex procedures in many countries; top secret access to specialists in Fantastic Britain. All of these cost containment involve rationing of health care services. It is a surprise, then, that this excellent book is one of the few to explicitly address rationing of health care. Dr. Ubel makes a run of cogent, indeed, commonsense points. Rationing is common. Rationing is inevitable in any system without infinite resources. Physicians, even those who judge that they are not rationing health care, either do rationing at the bedside and are enmeshed in systems that make rationing decisions. Ubel decries properly the existence of this type of implicit rationing and argues instead that since rationing is inevitable, physicians should participate in explicit and rational efforts to allocation care. This leads Ubel to a run of fascinating recommendations. One is that physicians are in the best position to make certain kinds of rationing decisions, “bedside rationing’, because they can individualize care and are best able to attempt to reconcile the needs of patients with the existence of limited resources. Ubel is an advocate of a certain type of utilitarian analysis, cost effective analysis (CEA), as a tool for deciding the value of tests and interventions. He exposes the limitations of CEA carefully and suggests ways in which it might be improved in order to become a helpful tool. I reckon this book is primarily aimed at academic physicians with the hope of influencing physician education and approach to this kind of trying problem. In this respect, this is a successful effort.
There are several problems with the book. As Ubel acknowledges, it is not a rigorous or systematic book, but more polemical in spirit. There is certainly a need for a major systematic work(s) on this topic. Another problem is Ubel’s recommendation of CEA. He is very clear about the limitations of this method but he recommends it because he views it as bendable enough to incorporate societal preferences. Even if this were methodologically possible, I doubt this would work in the USA. In relatively uniform and consensus oriented countries like Sweden or Japan, this approach would have real value. It has, but, been a long time since Americans reached consensus on many, many fundamental issues correlated to values, and this situation is unlikely to exchange. Finally, Ubel does not go far enough. Given resource limitations, methods like CEA,which help make choices among tests and interventions, will not address the really tough issues regarding who should receive care and how much is apt. These are horribly trying problems but must be faced squarely.
Rating: 3 / 5