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Rationing puts care beyond reach

More than three-quarters of a million Floridians are victims of health-care rationing, state Rep. Fred Jones said Friday. The rationing isn't a diabolical plan, he said, but the result of a haphazard health-care system. Victims are low-income, uninsured workers who lack private health insurance but aren't covered by public programs, either because they don't qualify or can't squeeze into the overcrowded clinics.

"(Rationing) is here in Florida, and for us to pretend that it's not is a mistake," said Jones, D-Auburndale. "We have to address it."

The specific estimate of the number of rationing victims statewide, Jones said, is 884,728, or one in every 14 Floridians.

Jones is chairman of the Florida Task Force on Government-Financed Health Care, which must come up with a plan to relieve the crisis. Whatever the plan, he said, it will require "a pound of flesh" from every sector, including lawyers, doctors and the insurance industry.

He was one of a half-dozen experts who appeared at the Florida Medical Association's "Media and Medicine" conference Friday to address the question of whether health-care rationing lies ahead. All the speakers agreed with Jones: Rationing doesn't lie ahead. It's already here.

They said it is most blatant in Dade County, where uninsured patients with serious diseases _ even cancer _ must wait on lists at Jackson Memorial Hospital for biopsies or surgery. Jackson's governing board has begun discussing whether it should devise a formal, written rationing plan.

James Bracher, executive director of the Florida Health Care Cost Containment Board, said that while rationing is worst in Dade, it's happening across the state: "The situation is becoming almost intolerable."

Bracher noted that an unusually large proportion of Florida's population _ 17 percent _ has no health insurance. If everyone were insured and paying the same amount for hospital care, he said, the average charge per day could drop from $1,100 to $700.

The middle class, which pays the bills for the uninsured through higher taxes and insurance premiums, is beginning to feel the pinch, Bracher said. He predicted that the demand for change will grow.

"We need the help of the medical profession in making the right decisions," he told doctors in the audience, and warned, "Changes are going to be made whether you help or not."

Speakers at the conference Friday concluded that what is needed is not rationing of health services but reform of the entire system. It's illogical and morally wrong to deny care to the uninsured, they said, while providing unnecessary and even unwanted tests and treatments to others.

Dr. Robert Misbin, associate professor of endocrinology at the University of Florida, talked about an elderly woman in the terminal stages of cancer who was nevertheless resuscitated and treated aggressively when she was burned in a house fire _ even over the objections of her husband. Hours of pain and thousands of intensive-care dollars later, she died.

Often, Misbin said, "our efforts do not sustain life, but merely prolong the act of dying. . . . It's the technological imperative: If a treatment is available, we physicians feel compelled to use it whether or not patients will benefit.

"Given a choice, most patients would rather die at home surrounded by their loved ones, instead of at the hospital surrounded by machines," he said. "Rarely are they given the choice."

Many respected studies have provided abundant evidence that unnecessary care goes on when there is money available to pay for it, said Dr. David Orentlicher, an ethics adviser for the American Medical Association.

"There's a lot of good evidence that we can cut costs," Orentlicher said. "We can afford to provide care for all."