Sunday, November 29, 2009

No Rationing?

I bet you have heard the wingnut argument that health care reform will introduce rationing to the U.S.! Faceless bureaucrats deciding over your life-and-death! Having to wait in dreary waiting-rooms smelling of dirty socks and prison food! Forever!

You may also remember me writing that every single health care system rations. Some do it on the basis of triage and waiting times, some do it on the basis of money, some on the basis of whom you know. All have some combination of each of these.

The point is that the current U.S. system rations care, too, and it does most of it on the basis of ability to pay:

John is a sawmill worker from Yamhill County, Ore., where I grew up. He was a foreman at a mill, he felt strong and healthy, and he had very basic insurance coverage through his job. On April 18, he was married, at age 23, and life was looking up.

Ten days after the wedding, he was walking in his backyard carrying a neighbor's dog — and he suddenly blacked out. That led, after rounds of CAT scans, M.R.I.'s and other tests, to the discovery that the left parietal lobe of his brain has a cavernous hemangioma. That's an abnormal growth of blood vessels, and in John's case it is chronically leaking blood into his brain.

John began to have trouble walking and would sometimes collapse. He developed spasms and restless leg syndrome, he began to use a cane, and his mind suffered.

"He forgets stuff a lot, he bumps into things," said his new wife, Esther Brodniak. "But he keeps things light. He jokes about it."

Perhaps the worst is the pain — blinding, incapacitating headaches that have left him able to sleep only in short intervals. He vomits daily when the pain surges.

"The pain is constant," John said. "It's a 7 or 8 on a scale of 10, and then it hits the high peaks and makes me vomit."

With John unable to work, he lost his job — and his insurance coverage. Esther had insurance for herself and for her two children (from a previous marriage) through her job building manufactured homes. But she couldn't add John to her plan because of his pre-existing condition.

Without insurance, John has been unable to get surgery or even help managing the pain. When he collapses or suffers particularly excruciating headaches, Esther rushes him to the emergency room of one hospital or another, but an E.R. can't do much for him. One hospital has told them not to come back unless he gets insurance, they say.

Esther used up her family leave time to look after her new husband. "Then I went back to work, and he fell several times," she said. "I told my boss that I had to quit. Taking care of John was more important than building someone else's house."

John has been rationed out of the system. Indeed, his new family has been rationed out of it, too, because Esther had to take up the nursing care John was denied.

My point is not to argue that everything in, say, a publicly controlled and funded health care system would be peachy. But let's not pretend we don't ration right now and let's not pretend that it has no dire consequences.