What’s wrong with rationing?

As I’ve previously pointed out, we already have rationing of health care by bureaucrats – by unaccountable, faceless bureaucrats whose job  is to deny treatment suggested by doctors and other health care professionals.

But, why do conservatives think that rationing is evil? Surely they would be happy to let the market allocate scare resources to those willing to pay, all the while ignoring those who can’t or won’t pay.

And, why do liberals think that rationing is evil? Surely they would be happy to have all basic health care covered and let those procedures considered frivolous or unnecessarily expensive be paid by someone else than the government?

Sadly, just as the Obama administration has taken to re-labeling the current initatives health insurance reform, I now believe it must be health care reform. We simply must do something to rein in health care costs, along with health insurance costs. And that means we have to do something about Medicare and Medicaid, as scary as that might seem. (After all, why tinker with programs that are clearly successful and still quite popular?)

As Martin Feldstein of the Wall Street Journal points out, the Federal Government pays nearly half of all health care costs in the United States. Therefore, any attempt to lower per capita costs will have to involve government one way or the other.

The place to start is, of course, the big ticket / low value health care procedures. They’re the ones taking up a disproportionate amount of our tax dollars but with the lowest contribution to a return to happy, productive life. In this category I would put experimental treatments, where there is little track record of clear benefit from administered care; cosmetic procedures, which may be sought by patients but have little medical justification; low probability treatments, which just don’t have much hope of success but take up scare dollars anyway; and many of the unnecessary tests which are sometimes used as a second or third opinion on an already diagnosed illness or injury. In each case I don’t so much question the right of patient to seek these sorts of health care, rather the expectation that government should automatically pay for each and every treatment or procedure.

I believe that every health insurance plan, including Medicare and Medicaid, already make choices as to which treatments or procedures are appropriate and which are not. Controversial examples would include acupuncture, homeopathics, and even some forms of contraception.

In countries that provide basic health care for everyone, you can still purchase privately provided health care. It is also still possible (and frequently prudent) to purchase private health insurance.   It covers privately provided health care, your choice of doctor, greater privacy in hospitals, etc.   By some estimates, in Canada around 30 per cent of health care costs (around $39 billion) are financed by non-public sources. It all comes down to who pays for what.

Perhaps we should call it health costs rationing?