Why We Must Ration Health Care

In a New York Times piece, a bioethics professor defends rationing in health care, stating we have to do it.  He uses a number of examples in which the cost of prolonging a persons life a few years, or months is just too high.

He is largely correct.  I made the same point at a health care forum last week.  It would be impossible to provide everyone all the possible medical care, treatments, and tests available – the cost would far exceed our entire GDP. 

But the question on which I disagree with the article is “Who should ration care?”.  In all cases, it would be the party that controls the money.  Should be it the government?  Do you want Congress, President Obama, or a new bureaucracy in Washington DC telling you when you can’t get health care?  (Note that in Canada, it is illegal to pay cash for health care, though the law is largely ignored, because so many violate it.)  Or should consumers be the ones making that choice?

There are alternatives to government takeover of health care, that put consumers and patients in charge.   Consumer-driven health plans allow individuals to make their own decisions about “rationing.”

I have a couple of other quibbles with the author.  He writes, “In the U.S., some 45 million do not [have insurance], and nor are they entitled to any health care at all, unless they can get themselves to an emergency room.”  This is obviously untrue, in fact, at that same health care forum, Kathryn Serkes of the Association of American Physicians and Surgeons talked about how many doctors are refusing to take insurance because of the cost of compliance, and instead dealing in cash only (at a much lower cost).

Secondly, he makes the old claim that “estimates of the number of U.S. deaths caused annually by the absence of universal health insurance go as high as 20,000.”  Indeed, there is little doubt that those without insurance are in worse straits those with coverage (though to claim deaths were caused by lack of insurance is poor logic).  But those on government insurance have even worse health outcomes than the uninsured.

This only further makes the point that rather than putting more people on government insurance, we should adopt reforms that allow more individuals and families to afford private insurance.