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The High Tech Road to Rationing By: Tait Trussell
FrontPageMagazine.com | Thursday, June 11, 2009

The nation’s health care system faces a true crisis, even as Congress dashes head-long into drafting legislation and President Obama throws the lobbying power of the White House behind “reform.” The immense hurdle that few acknowledge is the drastic shortage of health care workers—ranging from certified nursing assistants to geriatric doctors. The critical shortfall may trigger European-style rationing through a national office created ostensibly to computerize patients’ medical records.


Statistics show fewer providers will be available in whatever system is finally legislated, especially for those most in need. “Several reports show an overall shortage of health care workers in all areas; but the case is worse in geriatric care, because it attracts fewer specialists than other disciplines and experiences high turnover rates among direct-care workers—nurse aides, home health aides, and personal care aides,” according to the National Academy of Sciences Institute of Medicine.


There are, for example, only 7,100 geriatricians in the U.S.—one for every 2,500 seniors. Turnover among nurse aides averages 71 percent a year, and nearly 90 percent of home health aides leave their jobs within the first two years. The result is a dearth of health professionals to serve the 17,000 nursing homes and 28,000 assisted living facilities.

As the leading edge of the 78 million Baby Boomers begin reaching 65 in two years, “they will face a health care work force that is too small and woefully unprepared” to meet their needs, the Institute of Medicine has reported.


Dr. Toni Brayer of the American College of American Physicians Editorial Advisory Board said the physician shortage will stop Obama’s health reform “dead in its tracks. With less than 2 percent of medical students choosing primary care medicine as a specialty and the aging physician population that is ready to retire...we have a crisis looming.” She added that there is already a “shortage of basic specialties like general surgery, neurology, and rheumatology. Even large metropolitan areas are lacking in gerontologists, general internists and family physicians. Having insurance is not the same as having access to care.”


Primary care physicians manage 80 percent of all health care needs and provide preventive care. But “young doctors are walking away from this practice in favor of better lifestyles and more pay.”


The low pay is due to one existing national health care program: Medicare. The New York Times, which sometimes can be trusted to report hard news, reported recently, “Some doctors—often internists, but also gastroenterologists, gynecologists, psychiatrists and other specialties—are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting patients with Medicare coverage...reimbursement rates are too low and paperwork is too much of a hassle.” (Emphasis added.)


Obama’s prime goal is to cut the nation’s $2.2-trillion annual health care expenditure.

One way to lower costs despite increased demand and a contracted supply may be through a provision that’s already law. The near-certainty of the rationing of care for the aged was presented under the guise of Obama’s long-standing call for universal digitized health information. The stimulus package enacted hastily by Congress in February contains a provision that has not one whit to do with stimulating the economy. That provision creates a National Coordinator of Health Information Technology. This office is intended to make sure seniors get care that is appropriate, but only—yes only—what is “cost effective.”


Obama has talked of supposedly huge savings produced by computerized recordkeeping. The stimulus bill provides approximately $19 billion over five years for health information technology (HIT) in Medicare and Medicaid. The law requires the Department of Health and Human Services to develop a set of HIT standards by 2010. The Congressional Budget Office estimates this part of the law will help roughly 90 percent of doctors and 70 percent of hospitals adopt electronic health records in the next decade. The stimulus bill promises monetary incentives for doctors and hospitals that adopt electronic recordkeeping quickly and steep penalties for those who do not. Once they are signed up, government oversight of “cost effective” measures begins.


Only too late will Americans learn nationalized health insurance by no means assures equal access. Great Britain has a similar government agency which can reject treatments, using a formula that divides the cost of the treatment by the number of years of life an older patient is likely to benefit. New Zealand’s guidelines for treating kidney failure imply that, while age should not be the sole factor, “people over 75 should not be accepted.” Elderly in Canada report difficulty in getting the kind of health care Americans have had in the past. Sweden, Germany, and Australia have been creating free-market alternatives to their nationalized health-care systems to provide more patient power rather than government power. The United States could follow in their footsteps—but suppose there are too few doctors to help.


If health care is rationed for the segment of the population that incurs most of the health care needs and costs, this may be the only way that the dearth of health care workers can handle the rest of the population’s health needs. But this would not be “universal” health care—only selective national health care. Americans could anticipate being denied vital procedures when they grow old. And increased rationing will ensure that fewer Americans ever do.

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