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Robert Lamberts, MD  
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Healthcare Rationing: Necessary or Evil?

May 14, 2009 - 26 comments
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healthcare rationing

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I met a urologist from another city recently.  Since it had been a much discussed issue recently, I asked him what he thought about PSA testing. His answer was immediate.

“I think PSA testing has been proven to save lives, and I have no doubt it should be done routinely.”

When I mentioned the recent recommendation that prostate cancer screening be stopped after a man reaches 70, his faced turned red.  “That report is clearly an attempt by the liberal media to set the stage for rationing of healthcare.  It was a flawed study and should not be taken as the final say on the matter.”  He went on to recount cases of otherwise healthy 80 year-old men who developed high-grade prostate cancer, suffered, and died.

I chose not to debate him on the subject, but did point out that his view was that of one who sees the worst of the worst.  I personally can recall less than ten patients who died of prostate cancer in the fifteen years I have practiced.  My view is one that sees a non-diseased general public, and not worst-case scenarios.  I also didn’t point out that even the American Cancer Society stopped pushing the test and states, and does not think as highly of the evidence as he does: “Using the PSA test to screen men for prostate cancer is controversial because it is not yet known for certain whether this test actually saves lives.” (1).

But I digress.  What really struck me in the discussion was the way he pulled out the idea of rationing as the end-all hell for American healthcare.  It is regularly used as a scare tactic for those who advocate a “free market approach” to healthcare.  They point to the UK and Canada where people are denied cancer treatment or delayed repair of a ruptured disc resulting in permanent paralysis.  Rationing healthcare seems a universal evil, and any step that is made toward controlling cost is felt by some to be a push of the agenda of the Obama administration toward universal health coverage and ultimately rationing.

So what exactly is so bad about rationing?  The word itself refers to an individual being given a set amount of a limited resource, above which none will be available.  In healthcare, the idea is that each American is given only a set amount of coverage for care and above that they are left to fend for themselves.  Those who are either go over their limit or are felt to have a less legitimate claim on a scarce resource will be denied it.  This is especially scary for those who are the high-utilizers (the uninsurable that I have discussed previously), as they will use up their ration cards much faster than others.  I certainly understand this fear.

But are all limitations put on care really a step toward rationing?  Are limits put on care a bad thing?  The answer to that is simple:  DUH!  Of course not!  Of course there need to be limits on care!  Without control over what is paid for, the system will fall apart.  Here’s why:

   1. Limited Resources - Not only are our resources limited, they need shrinking.  The overall cost of our system is very high and has to be controlled somehow.  Different interests are competing for resources, and by definition whoever doesn’t win, doesn’t get paid.  This means that someone needs to prioritize what is a necessity and what is not.
   2. Lack of personal culpability by patients - with both privately and publicly funded insurance, the actual cost to the patient is defrayed.  They are not harmed by unnecessary spending, so they don’t try to control it.  Only uninsured patients are painfully aware of the cost of unnecessry tests.
   3. Lack of personal culpability by doctors - If I order an unnecessary test or expensive drug, I am not harmed by the waste.  For example, it is common practice by emergency physicians in our area to get a chest x-ray on children with fever.  Most of this is related to defensive medicine which is understandable in the ER, but clinically the test is often not warranted.  Yet the emergency physicians are not really affected by this waste, and the hospital and radiologists are actually rewarded by it if the insurance company pays for it (which they do).
   4. Incentives for other parties - As I just said, hospitals and radiologists have incentives to have wasteful procedures done.  The urologist I spoke to has a huge financial stake in the continuation of PSA testing, as it generates enormous business for him.  Drug companies want us to order their more expensive drugs than the generic alternatives.  This doesn’t mean any of them are wrong, but they sure as heck won’t fight waste if it harms them financially to do so.

When I was a physician starting out, the insurance companies would pay for pretty much any drug I prescribed.  At that time there were very expensive branded anti-inflamatory drugs that were aggressively pushed by the drug companies.  When the first drug formulary came around, the first thing that happened was that they forced me to use generic drugs of this type.  Before, there was no reason not to prescribe a brand, I had samples, and they were a tiny bit more convenient.  But when I changed there was really no negative effect on my patients.

One of our local hospitals just built a huge new cardiac center.  Statistically, our area is a very high-consumer of coronary artery stents compared to the national average.  Yet there are many cases in which an asymptomatic person will get a stent placed simply because they have abnormalities on their cardiac catheterization.  Logically this may make sense, but the data do not suggest that these people are helped at all.  Do you think that the hospital wants these procedures halted?  Do you think the cardiologists do?  Yet if they are truly unnecessary, shouldn’t they be stopped?  Couldn’t the $200 million they spent on their state-of-the-art facility be used in better ways?  Someone has to be looking at this and making sure the money spent is not wasted.

Without cost control a business will fail, and the same goes for our system.  Yet any suggestion at the elimination of clinically questionable procedures is met with cries of rationing.  Right now we are not at the point of rationing, and the act of trying to control cost by eliminating unnecessary procedures does not necessarily imply that the end goal is rationing.  The end goal is to spend money on necessary procedures instead of waste.  I sincerely doubt there is a left-wing conspiracy to push us to deny care where it is needed.  I doubt that the American Cancer Society is in favor of rationing.

Let’s just spend our money wisely.  It’s just common sense; not an evil plot.

*This post was originally published at Musings of a Distractible Mind.*


Comments
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Avatar universal
by Rob2008, May 15, 2009
One of the biggest wastes I've noticed in my own experience as a patient using charity care is REDUNDANT TESTING done by each new doctor I've seen.

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by peggy64, May 15, 2009
If only this "policy" would be used to just monitor to make sure tests, and other aspects are not abused. This sounds as if it is to be used for drs and the medical profession to stay on top of what they are doing, and ordering. To keep costs down per say. But, unfortunately, this is not how it will be used.

I don't need a prostate test, so this example does not affect me. But what if I need my thyroid levels checked BUT, because I have reached a certain age, I hear, "sorry, but we can no longer check these levels.  It is an unnecessary expense". What if YOU need your iron levels checked because you are anemic, or have COPD, or seizures, or any other diagnosis that needs routine monitoring? Are YOU going to be okay with hearing that same statement issued, because of government control?

We can rest assured, that the governement is not looking out for our best interests. And furthermore, if we believe otherwise, we are only deceiving ourselves. Time and time again, this has been proven. The government comes at us, like they are doing us some big favor, we so blindly follow and then, WHAM!! we see their own personal agenda. And it is too late.

It will be used to ration care to those that are no longer "productive." As it will be a means to usher euthanasia in the door. Don't believe me?  Just write it down then, and wait and see.

  This might not affect me or my family at this point and time. We might be in good health, but the time will come, more than likely when one of us, needs some type of medical care and because of these rations, that are supposed to be for our benefit, will keep us from getting the care we need.

If the government had been using "our" not their money, the way it was supposed to be, this would not even be an issue. But because they and the insurance companies are so unethical and so "GREEDY," we now have to kill our "unproductive" members of society.

We can rest assured that we will one day, if the Lord allows, be one of these "unproductive, cost prohibitive" members of society. Oh, yeah, and so will our children.

The problem is, we don't want to give up any of our creature comforts, or get up from our 52 inch tvs and Barcaloungers to do anything about it!

We need to wise up, and stop letting the government just run amuk any way or down path that suits them and further lines their pockets.

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by twehner5, May 15, 2009
Oh, I couldn't agree any more with Peggy than if I had written it myself.  This guy Lamberts....is off-the-wall.  Are we SURE he took the Hippocratic Oath...?  Or did me become an MD with an insidious agenda in mind...?  Hmmm.

We'll try to "rationalize" and say we don't believe in euthanasia, but get real (!), rationing....NOW I'VE HEARD IT ALL!  "A ROSE BY ANY OTHER NAME....is STILL euthanasia."  

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by Barb135, May 15, 2009
Peggy that was very well said.  *I* DO need my thyroid levels checked on a routine basis; therefore, it would be deadly for me to have someone sit back and say "gee , sorry you are over your limit for this year or because you are now 80 yrs old, we can't do that anymore".  

Costs DO need to be cut.  But how about cutting out some of the "freebies" to people who WON'T work?  Or to the people who are in this country illegally to begin with?  I have NO problem whatsoever lending a helping hand (paying more taxes) to help out those who are US citizens and legitimately CAN'T work; however, it burns me to no end that *I* have to get up at 3:30 every morning and go to a very stressful job, ruining MY health, to not only support MY family and those who CAN'T work, but also those who WON'T work or who entered this country illegally.  

We hear all the time about all the illegal immigrants and how to stop them from coming to this country illegally and then the first thing we do when they get here is GIVE them everything they want including, but not limited to, free medical care - who wouldn't want to come here???  If we didn't make it so comfortable for them and give them all the free stuff, maybe they wouldn't be so quick to come here...

On the other side of the coin --------- why does it cost me $295 for a physical exam that takes < 10 minutes and amounts to the doctor looking down my throat, into my ears, listening to my heart and checking my reflexes, then telling me there's nothing wrong (when I feel like c*** and KNOW something isn't right), go home, lose some weight and come see me in a year.... THAT'S worth $295???  NOT..  Yes, I know the doctor has "overhead" to pay, but does he REALLY need a fancy office w/expensive paintings on the walls, fancy furniture, etc??  I don't think so.  I'd be just as happy with a competent doctor in a clean, sparse environment (a folding chair would be sufficient so long as he doesn't keep me waiting for 2 hrs like MY doctor does) - probably more so, because THAT doctor might be more concerned about my HEALTH than how much my insurance is going to pay for this visit because s/he doesn't have to worry about all the overhead........

The $200 million facility that Dr Lamberts mentioned?  Anyone stop to think that MAYBE they could have built a facility with the same equipment and capabilities for a lot less.  I don't know what this facility looks like, but I would almost bet that the decorating and landscaping were probably HUGE expenditures that MIGHT NOT have been essential to a well run facility.  Maybe they don't NEED that marble or solid oak flooring or those expensive palm trees or whatever.  Those things don't do anything to enhance the treatment of the patients.  

I know there are some people who have nothing better to do than go to the doctor, get this test run, have this MRI, etc and that needs to stop --- but WHO is going to decide, based on WHAT criteria, if *I* need the ultra sound on my thyroid or if I'm just doing it because I have nothing better to do today?  If my doctor says it's necessary to see if I have cancerous nodules or something, why should anyone be able to "second guess" that decision and say I can't have that ultra sound?  

As I see it, there are three (3) ways to cut medical costs - 1) STOP giving away medical care to illegal aliens and people who CAN, but WON'T work; 2) limit the amount doctors can charge for certain procedures  3) limit the amount insurance companies can charge for premiums.  

There are a lot of people getting rich from the medical industry and I guarantee it's NOT me (and unless you are IN the medical industry - it's probably not you either)   We need change, but that change does NOT include rationing medical care............



Avatar universal
by teko, May 15, 2009
I heard a young mother talking the other day. It was inconvenient to take her child to the doctors office, so since she was on state aid, took em to the er for a fever and a sore throat.

When you have insurance and you go to the doctor, they will run every test imaginable just cause they can get it from your insurance.  However, if you do not have insurance and are self pay, the care is limited at best.

Lots of people I know, have insurance and pay high premiums and still cannot afford to go to the doctor because of their deductable being so hi. Yet the insurance companies still get that premium every wk, regardless. In other words, people are paying for something, they still cannot afford to do, and the insurance companies make a killing off it.

People generally get their insurance thru their employer.  If they get sick, lose work and cannot keep up with the premiums, they end up paying all that money to the insurance co, and still end up not being able to get health care. Not to mention the fact that the employer can decide to drop carrying insurance for their employees if they wish.

Pharmaceutical Companies, make millions off prescription drugs, but you can get them for a fraction of the cost in say Canada. Big profits there also! But not for the consumer.

Just a few things wrong with our current system, I could go on, and on, and on.

If you are one of the fortunate to have a good healthcare plan, of course you do not want it to change, but people are dying needlessly in this country, the richest in the world, because of greed. To one of those people who have none, anything is better than what they got.

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by peggy64, May 15, 2009
Barb135, you expressed yourself so well, and all your points are so true.



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by peggy64, May 15, 2009
teko,
I have insurance, have had all my life. I can't get the drs to run hardly any tests. I don't know where you are getting that info.

In fact, if they would have run one simple little blood test 19 years ago, instead of just deciding what I had, I would not have had to endure the hell I have been through this last year. Just one little test for thyroid disease. But no, the insurance companies don't want us to have the tests and procedures we need. I am not for unnecessary testing by no means. That is unethical on many levels.


I have to pay for insurance, but the insurance companies don't won't me to have adequate care. It will cost them more money. Drs hate to contend with  insurance companies, so they do not run the tests. They just give you a pill. "here, take this anti-depressant, or anti-anxiety pill," while they are thinking: (Now, go home and shut up).  When drs would rather do this, than do what is needed to know, not just guess, we have troubles.

There needs to be rationing all right. Rationing on the insurance companies. If they were non-profit organizations this would not be a problem. But it is if FOR profit, and having to run blood tests, or any kind of test, takes money out their coffers, and then helps put some of us in coffins, because the dr missed on his guessing game.

That really irritates me, because I can stay home, look it up on the internet and guess just as well as s/he can. I want to know for sure.

Avatar universal
by teko, May 15, 2009
If you have insurance and cannot get a simple little blood test run to see if you have a thyroid issue, I would be 1). finding a different doctor and 2). Make a phone call to my health care provider to find out what the problem is.

Case in point: My husband has stents. The insurance will cover 1 ( test where they put dye into the vein and put you on a treadmill) per year.  They do this test every single year, even if he is feeling fine with no symptoms. Now that the insurance has lapsed, all of a sudden he does not need that test anymore.

Same with his hands. Before, when he had insurance and would go to the doctor for the psoriasis on his hands (caused from the heart meds he was on for years), he got steroid injections in each hand, like 5 in each hand, cream to control the itching, shot in the butt, and told to come back in a month.  Each time.

Now that he has no insurance, all of a sudden the creams are not necessary, the steroid injections in the hands are not necessary. he now gets a shot in the but and is told to come back in 3 months.

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by peggy64, May 15, 2009
If I knew now, what I did then, I would have changed drs. I trusted him and thought he was right on.

Steroid shots are not good for you every month. Most drs won't give them that frequently.  That just goes to show they mostly do all those treatments, to line their own pockets. If I were you,  I would be 1) finding a dr that would treat my husband, regardless, 2). find a new job with insurance.

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by Barb135, May 15, 2009
Okay everyone - here's another question that perplexes me..............

Why is that when I go to the doctor, they SAY it's worth $295, but insurance says they will only pay, say, $150 and the doctor accepts it, but if I didn't have insurance, I'd have to pay the whole $295??  If $150 is enough to get from the insurance co, why isn't it enough to get from me, personally??  

Another example:  A couple of years ago, I had to have 2 surgeries on my vocal cords.  Total bill on each was $3000+, but my insurance said they would only pay < 1/2 that, so it was accepted.  If I hadn't had insurance, *I* would have had to pay the full amount.......  How fair is THAT????  

Another thing -------- I've noticed that a lot of doctors are now refusing to accept a lot of insurances.  If they refuse enough different policies, will they eventually not have any patients left?  I know *I* couldn't afford to go to a doctor who won't accept my insurance.  Right now, I have a $25 co-pay for my pcp, if my doctor refuses my insurance and I have to pay the full amount, am I going to hang around just cuz I'm a nice person and like to spend $???  I DON'T THINK SO..  I'll find a doctor who WILL accept my insurance.......  



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by wonko, May 15, 2009
I see a doctor outside of insurance.  I was not happy with the care/attention that I was receiving from my insured GP.

It is a lot more money, and a personal decision.  To me, it was a worthwhile, if not downright necessary, investment.

I still have my insurance through my job for emergencies.


Avatar universal
by PlateletGal, May 15, 2009

I see my Endocrinologist, who is awesome but I also see "alternative medicine" practitioners and have better success with them than western medicine. So I also pay out of pocket and only use my insurance for chiropractic care and my follow-up visits with my specialist.


Avatar universal
by teko, May 16, 2009
peggy, that is another issue, easier said than done, especially in this econemy. Ifn ya know what I mean. lol  We need solutions, badly...

Avatar universal
by PlateletGal, May 16, 2009
"We need solutions, badly... "

Amen to that !


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by peggy64, May 16, 2009
Teko, that was meant as a point. If I had known then about the blood test, I would have done differently.

We need less government involvement, and people less dependent on the government.



Avatar universal
by teko, May 16, 2009
Well, so far that has not worked. The greed continues to win, therefore putting more people depending on the government. It is a viscious cycle. We have seen how the car industry got thereself in over their heads due to greed, the banks, the same, healthcare is there as well. My husband paid premiums of 150.00 a wk  for the last several years, never filing a claim. Car insurance, 124.00 a month for the last several years.  When you add all that money up that was never used, then the employer drops the insurance, or you lose your job and cannot keep it up. The end result is that we just donated all that cash we worked so hard for, for nothing. Just making the insurance co. richer is all. If I had saved the money instead of paying it to insurance companys, we would be sittin pretty.

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by peggy64, May 16, 2009
well, I hope you and your family stay healthy and do not need to use it. Even after he finds a job with insurance.  

  You might want to look into alternative types of insurance. My aunt belongs to one. I don't know the name, but it is different than all the big for profit insurance hogs.

Avatar universal
by teko, May 16, 2009
peggy, if you could possibly get some info on what your aunt uses, I would be eternally grateful. As far as getting a job with insurance in this econemy, Not likely, so am interested in anything I can learn about. Currently, we are putting the money that was taken out of his check for medical into a savings account, saving for healthcare emergancies.

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by peggy64, May 16, 2009
I will email her and let you know what she says.....

Avatar universal
by redplanet, May 18, 2009
Of course this country is ridiculous in it's med care. That is obvious. I spoke to a cardiac surgeon who told me he will do unnecessary procedures so he can buy a house here (Palo Alto).  

They're corrupt and if the public understood they test too much, over use diagnostic tools, operate too much,  and sell you a bill of goods and call it  preventative care, we'd have more reasonable costs. In areas where mammograms are not done routinely breast cancer deaths are much lower. Mammograms find cancers that can go away by themselves if left alone, and they are carcinogenic themselves - they are radiation and radiation is cumulative and causes cancer.  

This country needs to wake up. I have no respect for  any community that routinely harms people: western medicine. The science you need, the facts, are all online, at your fingertips.  ex: I saved my heart with d-ribose. I went from not being able to get off the couch to doing anything I wanted. Go see what board certified cardiologist Stephen Sinatra has to say. I knew enough to put my symptoms into google with his name and that's how I learned what was going on and what I needed.  Or my knee: at 60, it was starting to hurt. Then I had a slip and fall. It was swollen and felt awful. I slathered DMSO on it and the swelling was gone by the morning. I could walk again. Then I began a protocol of Joint Synergy and additional msm. The result: my knee is BETTER than before. Everyone was telling me to go to the ER. No way. I know what to do and I did it. You have that power too. None of this is magic. It takes learning how to take care of the body no one cares about more than you do.  I take many vitamin pills a day. That's the cost of med care for me instead of radiated breasts and cookie cutter med that x-rays for fever. Ridiculous - and carcinogenic.

Avatar universal
by jps1964, May 18, 2009
Lamberts actually has a point, but he has used a misleading example. The controversy over PSA testing is not just about money. It's also about doing no harm.
Most men have an elevated PSA after a certain age -- and many have prostate cancer, which is often a very slow-growing cancer. After a certain age, they are more likely to die of something else before the cancer becomes a problem.
My dad was diagnosed at age 74. He already had heart failure. I begged him to think very hard and get a second opinion before deciding on cancer treatment. I wish I had been more adamant but tried to be respectful of his wishes. He wanted to do everything in his power to stay around long enough for my baby girl to remember him. He decided against surgery because the cardiologist said his heart was not strong enough. He went with radiation. It ruined what was left of his life and, I strongly believe, shortened it. The radiation burned him up, ended his sex life with my mom, and left him incontinent. He developed a complication that no one had warned him about -- bleeding from the rectum, so badly that he required transfusions and could no longer do his exercises for his heart. He died at age 76, two terrible years after diagnosis -- official cause of death, heart failure.
I interviewed a highly respected prostate cancer specialist who says that PSA testing on anyone older than 72 is irresponsible and ridiculous. And this is from a man who stands to profit from it!
I happen to agree that everything has to have a limit. I do NOT want to be the one to decide the limits on health care. But it should be somewhere short of torturing and perhaps killing people, and calling it health care. I don't care whether this opinion is unpopular. Common sense is not very popular these days.
My dad said if he had it to do over, he would do nothing. I wish I had done things differently myself. But he always said "Never, never, never look back."
So I am looking forward. He is not here to speak for himself. As a writer for a health care organization, I consider it part of my job -- and will make sure his granddaughter always remembers him.

Avatar universal
by Poppop3, May 18, 2009
I find the justification for rationing health care not only bogus, but unconscionable. The true desired outcome is the early death of an entire (inconveniently old)  generation. For people 70 or older like me, it's a death warrant, as sure as I'm typing this into my computer. If we allow it to happen, we'll be voluntarily drinking the hemlock.

Avatar universal
by monotreme, May 18, 2009
This was a ridiculous article for med help to have on their site.  Most people who come on the forums have a chronic illness.  Can you imagine the neurology and MS forums where people sometimes utilize second and third and even fourth opinions from a neurologist trying to get their diagnosis, but be told that they have exceeded their second opinion allowance?

The government will have a two step process.  First we will be told that this new government insurance plan will only cover those who are uninsured.  Then it will start to push out private insurance and employer health insurance.  The goal is to give the government power over all of our medical care.

Rationing will be inevitable.  We will have the same number of MRI machines, doctors,etc, and the number of people who will be utilizing theses services will be overwhelming.  There will be waiting lists for everything.

And let's hope no one on the cardiology forum needs a pacemaker.  Because after a certain age they won't be covered either.



Avatar universal
by mmmartin, May 18, 2009
I believe that something needs to be done about the illegal immigrants and their multitudes of children.  They are a huge part of the health insurance problem in this country.  I feel that if you apply for public assistance, you should sign a contract agreeing to use birth control the entire time you are on benefits with the understanding that if you should have additional children while under this contract, you and your entire family become ineligible for future free healthcare benefits.  It is irresponsible to bring children into this world if you are unwilling or unable to work to support them.  It is taking advantage and just plain wrong.  Children need parents that care enough to want the very best for them and are willing to provide that by being responsible and hard-working to support them.  Sure, we can't all get the high-paying jobs, but any job is better than none.  I myself, work two jobs to support the two children I have living at home.  We do not receive any public assistance.  I also have a severe disability that I've been told qualifies me for disability benefits, but I prefer to work.  For one thing, you can't raise a family on disability or public assistance, or at least, not comfortably.  Also, I want to instill a strong work ethic and pride in my children and so far, it has worked.  My oldest child is 28 and manages a restaurant and is doing very well.  My youngest boy, 19, is about to go into management training at the restaurant he has worked in for the past three years (he's actually been working since he was 15 and graduated high school with good grades) and my daughter, 17, plans on working this summer.

Healthcare should be available to all American citizens and workers here legally.  If an illegal shows up applying for benefits or requesting medical care, if it's not an emergency, turn them away.  Tell them to go home and get treatment there.  Let other countries start taking responsibility for their own people instead of foisting them on the United States.  It is time to say "No more." and close the doors.  We can't help everyone and as they say, charity begins at home.  Make healthcare affordable and available.  If people want to help foreigners, let them make donations to organizations that provide such care.  I don't want it come out of my tax dollars.  My taxes should go only to helping my fellow Americans, particularly, the working ones.  Stop making Welfare so attractive to young people, stop encouraging laziness and greed.  Stop teaching people that they are entitled to something without ever having worked for it!

Avatar universal
by odysseus, May 19, 2009
Peggy wrote:

"We can rest assured, that the governement is not looking out for our best interests. And furthermore, if we believe otherwise, we are only deceiving ourselves. Time and time again, this has been proven. The government comes at us, like they are doing us some big favor, we so blindly follow and then, WHAM!! we see their own personal agenda. And it is too late."

Peggy, unless you're paying for your medical expenses out of pocket, then you're sadly mistaken if you believe that some profit-based organization isn't monitoring your healthcare and trying to make sure that "unnecessary" procedures aren't being performed. Of course, they're charging a significant amount of overhead in doing so.

Mmmartin, you're sadly misinformed as well: over 40 million *Americans* don't have health insurance. Stop trying to blame our country's ills on illegal immigrants.

Avatar universal
by jps1964, May 19, 2009
Most people on Medicaid are white children. Not immigrants. Everyone thinks they have the easy answer. Please.

Health care is extremely expensive. I'm not trying to kill off a generation, and I'm getting inconveniently old myself.

But nothing is infinite. Not even health care dollars. Health care has become so incredibly expensive that it could bankrupt this country, even if we send all the "illegals" home.

And too much health care can be just as deadly as to little. Just ask my dad. Oh, that's right. You can't. He's dead. See my previous post above.

The word "rationing" really should not have been introduced here. I don't want to "ration" health care -- just bring some sanity to it. We're kidding ourselves if we think we can get out of making some tough decisions in life and in health care. We can't have everything we want, and we can't test everybody for everything -- or all we'll have time to do is sit around in waiting rooms. Then we'll lose our jobs and our health insurance.

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