Expert advocates
‘rationing’ of health careA professor says there are often
cheaper treatment alternatives
Americans spend billions of dollars a year on health care for their pets, while each year there isn't enough money to provide health care for all who need it, says a University of Hawaii professor.
"We preach palliative care and hospice at the end of life, but they're not in place," James Pietsch told a medical ethics conference at St. Francis Medical Center.
About 250 doctors, pharmacists, medical economists, nurses and other specialists met yesterday for the start of the two-day, sixth International Bioethics Conference.
Pietsch said there isn't enough money for aging programs, yet Americans in 1999 spent $25.5 billion for health care, grooming and food for their dogs, cats and birds.
Congress has allocated $190 billion over the next 10 years to reform Medicare while Americans in that period will spend about $250 billion on pet care, Pietsch said.
"Doctors should talk to older patients about the kind of care they want at the end of their lives," Pietsch said. "They may surprise you. They may not want to use up all the resources we're begrudging them."
Dr. Peter Ubel, author of the book "Pricing Life," told delegates that "it's time for health-care rationing" because of rising prescription drug costs, technology growth, inflation and competing social demands.
The University of Michigan professor of internal medicine defined rationing as "anything allowing patients to go without the best possible health care."
The most expensive prescriptions and treatments aren't always necessary, Ubel said, and there are often alternatives, such as physical therapy, a new mattress or better office chair for lower-back pain.
He said "bedside rationing" occurs when physicians must consider costs in health-care decisions.
The national nurses' shortage stems from a heavy workload and burnout at hospitals "desperate to hold down costs," he said.
Patient care has suffered as a result, he said, noting a study that showed patient deaths increase when nurses are required to care for an average of six patients each rather than four.
One of the biggest obstacles to rationing is who should determine health-care limits, he said, advocating an approach that includes patients, doctors, hospitals, government, insurers and managed care organizations.
But Dr. Arthur Matas, director of the Renal Transplant Service at the University of Minnesota, said, "Before we start talking about health-care rationing, we should be spending money to give everyone health care."
He said America's medically uninsured population of more than 40 million is growing and that there are 500,000 bankruptcies a year related to unpaid medical bills.
