Wednesday, February 11, 2009

On Rationing in Health Care

Rush Limbaugh has gone wild talking about the scary monsters hidden inside the stimulus package, including the assertion that the proposal to increase the use of IT in health care means that the government will decide if you are gonna get treated or not. Rush's monsters are not real, naturally, but once he released them into the wingnut space of the media they cropped up elsewhere:

Summary: During appearances on Lou Dobbs Tonight and Glenn Beck, Dobbs and Beck allowed Betsy McCaughey to advance the false claim that provisions in the economic recovery act would permit the government to control health care. In fact, the provisions she cited address establishing an electronic records system in part for the purpose of "reduc[ing] health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information." It does not say that the federal government will determine what constitutes "unnecessary care."

My reason for talking about this is this: We are always going to have something or someone determine what constitutes "unnecessary care." Right now in this country it's likely to be your insurance provider, perhaps your health care provider and ultimately your wallet. Note that for someone without any insurance and not much money practically all care is deemed "unnecessary."

It's important to be clear about this. Even a completely unregulated market system of health care provision has rationing of care. It just doesn't look like that to us, because we are used to seeing such a system as somehow fulfilling every need we have. But it does not. And the way care is rationed in such a system is by the ability of the patients to pay.

In a mostly government-owned system, such as the one in Canada or the U.K., care is indeed at least partially rationed by the governments. But that does not mean that a civil servant sits in at your doctor visits and refuses treatments. It's just that some treatments are not covered by the national systems or that they have a long waiting time.

Thus, the choice we have is not between some kind of an imaginary system of abundance-for-all and some type of rationing; the choice is between different types of rationing.