Rationing

Current medical practice is enormously expensive, often without clear long-term benefits. A few examples: End-of-life care at New York University averaged $105,000 per patient in the last two years of life, without evident improvement in mortality rates. Costs at other centers were nearly as high, also without evident benefits. Studies document that providing intensive care to infants born at 22-23 weeks resulted in more than 1,700 extra days in intensive care, with fewer than 20 percent of the infants surviving -- only 3 percent without profound impairment.

Sometimes, it is worth our time to step back, to take the long view about seemingly intractable issues affecting our country. My long view begins with the gas line days of 1973-74, when a recently minted owner of a 1966 Ford Falcon began the daily commute between his home in Arbutus and Gilman School in Roland Park. Domestically, huge price hikes at the pump and draconian gas rationing (remember the "even-odd" license plate system?) nearly destroyed new automobile sales, a crushing burden for a father employed as a "commission only" car salesman.

The United States will soon be forced to make brutal choices about rationing health care as the costs continue to outpace society's ability to pay for treatments, a Johns Hopkins anesthesiologist told a national conference yesterday.While he did not offer a rationing plan of his own, Dr. Mark C. Rogers said intensive-care physicians may have to curtail "futile attempts at saving lives" and the use of experimental drugs, some of which cost $3,000 per dose, if there is little chance the drugs will work.

A plethora of contemporary political phenomena that may otherwise seem only bizarre — the various "pledges" not to compromise, the rejection of Social Security as a Ponzi scheme, the denial of evolution and climate change — begin to make sense once one recognizes that the historical analogy used to describe the movement responsible for them is inaccurate. Don't think 1774, 1776 and the Boston Tea Party. Think 1832, 1860 and nullification. Historically, nullification meant the sheer refusal of a state government to accept and abide by national legislation — specifically, in 1832, a tariff law with which South Carolina was unwilling to comply.

RIYADH, Saudi Arabia -- Iraq's recent announcement that it would ration gasoline was a maneuver to persuade Baghdad's enemies to postpone any attack on Iraqi forces occupying Kuwait, several Kuwaiti oil industry executives and European military affairs experts say.The rationing announcement, the experts said, was intended to give the impression that the United Nations economic sanctions against Iraq were working well enough to make an attack by the United...

AMERICANS want health care that's affordable. But are we prepared for rationing?If you're used to the highest technological medical advances, which we are, why would you want to forgo expensive treatments simply because government bureaucrats have determined it's not cost-effective to keep you alivefor a measly year or two or five?Or what about having to pass up surgery for a terrible backache because it's not a life-threatening condition?And what about age? Should older people be denied certain costly treatments so that younger people can get them?

WASHINGTON -- If President Clinton's health reform plan becomes law, millions of Americans may begin to hear a word to which they're unaccustomed at the doctor's office: No.Mr. Clinton would force health plans -- groups of insurers, doctors and hospitals -- to live under tight budgets, with limits on the premiums that people would be charged for health care.Administration officials strongly deny that any kind of rationing would result. But many experts believe that the pressure on health plans to control costs would force them to refuse patients access to some tests and treatments.

TEHRAN, Iran -- A quota imposed on the purchase of subsidized gasoline sent Iranians into the streets yesterday, where they torched at least 12 gas stations, damaged government-owned banks and department stores and shouted slogans against the president, Iranian news agencies and witnesses reported. To limit rapidly increasing consumption of gasoline, the government of President Mahmoud Ahmadinejad began enforcing a rationing program yesterday that limits most motorists to 26.4 gallons a month at the subsidized price of 42 cents per gallon.

WASHINGTON - Ruling that federal law gives HMOs a clear right to cut costs by providing less expensive treatment, a unanimous Supreme Court yesterday barred federal court lawsuits against managed-care doctors and organizations when they ration medical services. Even if an HMO's doctors get paid a bonus or a share of the savings for lower-cost treatment, the court said, patients have no right under federal health benefits law to sue for damages for what they consider inadequate care. "No HMO organization could survive without some incentive connecting physician reward with treatment rationing," Justice David H. Souter wrote for the court.

25 Years Ago (Week of June 9-15, 1968):* Nathaniel J. Gibson was named principal of Waterloo Middle School. Mr. Gibson would be the first black principal appointed in the county since the desegregation of the public schools.50 Years Ago (week of June 13-19, 1943):* Penalties were levied against a number of county residents for violation of wartime rationing restrictions. Several drivers were fined (in rationing coupons) for driving at excessive speeds and thereby making unwise use of rationed gasoline and tires.

There's always a great temptation after a political tussle like last week's federal budget showdown to immediately declare a winner and a loser. House Republicans can claim victory by setting the budget-trimming agenda in Washington, while Senate Democrats can claim they successfully defended against an ideological assault on women's health, Head Start, public broadcasting and other popular programs. The reality is that both won, but only in the sense that they were saved from themselves.

It probably came as no surprise to Chef Bryan Voltaggio that when Robert M. Parker Jr., the country's leading wine critic and a Baltimore County resident, came to dine at his VOLT restaurant in Frederick last November, he brought wine from his own cellar. Selections like a 1982 Cheval Blanc St.-Emilion (which retails for about $1,000, if you can find it) aren't usually available on restaurant wine lists. But when the influential Mr. Parker gushed over the quality of the 21-course meal that ranged from goat cheese ravioli to squab with Brussels sprouts in his newsletter, "Hedonist's Gazette," this spring, it was Mr. Voltaggio who almost got stuck with the bill.

Austin Lopez's sensible argument in his op-ed "Open your mind to hallucinogen research" (June 8) speaks volumes to the contradictions and inconsistencies in America's body of law, and nowhere is such absurdity more apparent than in our drug laws, in that while we criminalize relatively harmless drugs like marijuana, alcohol, with its often tragic collateral damage, is perfectly legal. Pharmaceutical companies advertise directly to consumers, through all forms of media, drugs that are far more harmful than LSD and other hallucinogens, most notably the psychiatric "medications."

The late Nobel Prize-winning economist Milton Friedman famously commented, "It's just obvious you can't have free immigration and a welfare state." As we've noticed in recent years, what was obvious to Mr. Friedman and indeed to the great majority of American citizens is apparently a mystery to many of our political leaders, Democrat and Republican alike. They have not effectively addressed the issue of the ongoing invasion of the United States from south of the border by millions of destitute Mexicans, Guatemalans, Salvadorans and other Central Americans desperate for jobs that pay a living wage.

Current medical practice is enormously expensive, often without clear long-term benefits. A few examples: End-of-life care at New York University averaged $105,000 per patient in the last two years of life, without evident improvement in mortality rates. Costs at other centers were nearly as high, also without evident benefits. Studies document that providing intensive care to infants born at 22-23 weeks resulted in more than 1,700 extra days in intensive care, with fewer than 20 percent of the infants surviving - only 3 percent without profound impairment.

I cheered Ruth Wooden and Andrew L. Yarrow's commentary, "Reclaim the 'town hall' for genuine public engagement" (Dec. 21). It aptly expressed a frustration that I have felt for quite some time and actually offered an alternative to today's devolved "town hall" that is designed to include those who have rational opinions and thoughtful questions about the issues under consideration by the government. I think we the people are more divided than we have been in years, and I believe we owe much of that division to the loud voices of the "town hall" naysayers who have received an inordinate amount of publicity - especially, but not exclusively, on cable TV stations.

50 Years Ago* The Carroll County Rationing Board announces that fourth-quarter gasoline rations for trucks are ready for distribution and may be called for at the Rationing Board in Westminster on and after Friday, Sept. 29. -- Democratic Advocate, Oct. 6, 1944.75 Years Ago* Dr. Richard Lynch Garner announced his intention of establishing a colony of chimpanzees and gorillas in the United States to uplift the entire ape race. The professor said he believes apes, if given the advantage of modern education, would develop into a race that would sow and reap and toil.