Rationing health care in the US
The dirtiest word in health care reform is “rationing.” The American public is deathly afraid of being denied a medical procedure by someone else. When it comes to government-led health care reform, this someone else is a “bureaucrat” which is an equally dirty word in health care reform debates.
The fundamental point Americans must realize before any meaningful health care reform can occur is that we already ration health care in this country. It is rationed on ability to pay. Even insured Americans are denied medical procedures all the time by their insurers. Peter Singer argues this very point in a recent article in the NY Times Magazine. As with all well-written articles, it should be read in its entirety. I only want to highlight the following paragraph:
Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.
Health care reform can only succeed when the American public understands this point.