The ACP Advocate Blog
by Bob Doherty
Friday, April 17, 2009
It's time to talk about the R word
Public opinion researchers have warned advocates of health reform to avoid using the "R" word. Lake Research Associates, a Democratic leaning polling firm, found that 62% of voters would express more doubts about health care reform if told it will lead to rationing.
Yet, a serious discussion about rationing is beginning to take place in the health care blogosphere.
One school of thought says that the United States already rations care, but irrationally and unfairly, based on ability to pay. This is how health economist Uwe Reinhardt describes it in the New York Times Economix blog:
"Evidently, many Americans do sincerely believe that when a public health plan refuses to pay for a procedure it is 'rationing,' while denial of health care to an uninsured, low-income individual who cannot afford to pay for that care is not. But as textbooks in economics explicitly teach, the role of prices in a market economy is precisely to ration scarce resources among unlimited demands. The American health system has rationed health care by price and ability to pay all along for a sizeable segment of the United States population. In its report "Hidden Cost, Value Lost," for example, a distinguished panel of experts convened by the Institute of Medicine of the National Academy of Sciences estimated that some 18,000 Americans die prematurely for want of health insurance and timely medical care. That is rationing life years."
Others acknowledge that the American health care system provides unequal access to care, but they favor rationing by markets, over rationing by government. This comment from conservative blogger Andrew Sullivan, responding to a reader's comment, says that markets enable rich people to buy more care than they need while leaving poorer people with less:
"And why should we have a problem with free people choosing to 'pour everything they have into high intensity, high tech, high cost, but in the end marginal extensions to their lifespan'? And isn't the market a more neutral and less politically manipulable form of rationing than government? I think you really do have to live in a socialist system to see how rational it looks from the outside and how mediocre, passive and bureaucratic it feels from within."
I think it is good that we are at least beginning to have a serious discussion about rationing, and that the question being addressed is not if the U.S. rations care (we do), but whether markets or government will do a better job. Even if the public and politicians don't want us to talk about it.
Today's questions: If rationing is inevitable, who do you think would do a better job at it - the government based on guidelines on cost and effectiveness, or markets based on ability to pay?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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