Rationing and limitations are inevitable in any health system

Healthcare is a limited commodity. It’s limitations are defined by the numbers of professionals supplying it and their physical limitations on the number of patients they’re able to treat, on availability of biomedical equipment and technology, on availability of physical space to safely provide medical care and, underlying all of these, on the funding for such.

And so, not everyone can get all care they need or want.

And, it is true, no system will even be able to supply such. There will always be limitations. And there will always be some rationing.

The argument from many proponents of reform has long been that at present we covertly ration healthcare and we do it haphazardly and so reform that makes rationing more transparent and planned is actually a positive. Essentially the argument is that, everyone is scared of rationing in health care reform but what many don’t realize is that such is already occurring and we should embrace making rationing more rational with health care reform.

It is an argument made recently by ration as a verb,

to supply, apportion, or distribute as rations (often fol. by out ): to ration out food to an army.

to supply or provide with rations: to ration an army with food.

to restrict the consumption of (a commodity, food, etc.): to ration meat during war.

It’s a verb, it’s an action. It implies planning and action. Not the haphazardness that defines who currently does and doesn’t get certain care within the American health care “system.”

The Economix piece quotes former CMS head Dr. Mark McClellan later,

“Just because there isn’t some government agency specifically telling you which treatments you can have based on cost-effectiveness,” as Dr. Mark McClellan, head of Medicare in the Bush administration, has said, “that doesn’t mean you aren’t getting some treatments.”

And I agree but it’s important to keep our terminology straight, at least to opponents of rationing and health care reform as defined currently by things like the Affordable Care Act. In that quote above I would claim only the former represents rationing and not the latter.

And the end results are not the same.

Rationing, the centralized distribution of health care resources is vague but for many proponents of current national health care reform efforts essentially it means the most bang for the most people for the buck. An egalitarianistic vision of health care.

However, down the slippery slope, it promises to leave peripheral exotic patients on the sideline and to limit freedom of choice.

By some quantitative quality measures health care, over the whole population, may be better. But in rational rationing these are the physicians you can see, these are the procedures you’re entitled to no matter the nature of your specific disease or your personal means. It could potentially stifle innovation in health care and certainly will limit choice.

Currently your economics and your social status influence the care you receive and they choices you have. In a rationed system, as envisioned by many proponents of current health care reform, the care you receive and the choice you have are influenced by some centralized entity who determines such. The latter is certainly more rational and has the potential to improve some measurements of health in this country but it holds the potential to inherently redefine the notion of choice within your means, of freedom upon which (and I don’t mean to be hyperbolic here) the American dream has been based. Or at least the mythos that is the American dream.

Colin Son is a neurosurgical intern who blogs at Residency Notes.

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  • http://fertilityfile.com IVF-MD

    Thanks for being brave enough to speak the truth. Other than for air, essentially everything we need and want in life is limited in supply. Therefore, the question boils down to what allocation method will result in more of the desired goods and services going to the people who want them most? The second question is what will get producers of the goods and services to produce more or the most desired goods and services?

    Even the innovation and research component is rationed. If you have a rare disease that afflicts one in a million people, you have a right to feel sad that little research is being done on it. However, is that the best use of those research dollars and man-hours? Or would it be better overall for those researchers to be spending their time and energy on curing a disease that afflicts 1 in 20 instead of 1 in a million?

  • http://www.1docsopinion.com Doc B

    Rationing is inevitable. Just depends on what you’re willing to pay.

  • Thomas Reid MD PhD FACP

    There are many types of rationing (see: http://doctors-takecharge-healthcare-reform.blogspot.com/2009/08/concept-of-healthcare-rationing-has-not.html).

    One type, fiscal rationing, is not standardly practiced in the U.S. and scares Americans. It is the limiting of health-care because of arbitrary financial constraints; e.g. where an indicated treatment (surgery, chemotherapy etc) that will improve survival and/or quality of life is not provided because of arbitrary measures (generally fiscal, but others such as age would be considered) and/or inherent delays (e.g. insufficient number of physicians).

  • BobBapaso

    So, let’s have everyone pay for their care from their Health Care Savings Account, and decide for themselves what is worthwhile and what isn’t, instead of having rationing imposed on them, as it is now by insurance companies. I think most people would agree that would be better than what we have now, and especially what we will have in the future with more central planning.

    • http://fertilityfile.com IVF-MD

      Your statement of “I think most people would agree that would be better than what we have now, and especially what we will have in the future with more central planning.” is true with respect to the doctors and the patients. But don’t forget that there is an industry of middlemen (either government or insurance) who make their living coming between the doctor and the patient. In a free market (which we don’t have), they would be “invited” by provider and patient to come between them only if they make things better and add value. In a coercive world (which we do have), they force their way in either by direct taking of money (taxes) or by unbalanced political advantages of subsidies and reduction of competition via arbitrary regulations.

  • Dorothy Green

    “Everything we want is in limited supply”. Unfortuantely not the case for unhealthy food that is the root cause of conditions that eat up most of the healthcare $$$$$ that will have to be limited or cost more.

    Sure doesn’t seem fair to me. Should I go bankrupt to pay for ovarian cancer or die while someone gets taxpayer paid stents and all the services for their diabetes type II and the cardiologist goes to a pig roast by a stent maker?. Don’t tell me about genes – it isn’t the reason.

    We know this yet it is never addressed in so many discussions on healthcare. Tax the damn processed sugar, salt and bad fats, stop the farm subsidies for unhealthy food. Then talk about everything else.

  • http://fertilityfile.com IVF-MD

    Taxpayer-funded subsidies for corn bring down the price of High-Fructose Corn Sweetener, creating an artificial incentive for food manufacturers to use this unhealthy additive and for eaters to eat it. And yet, taxpayers continue to pay taxes that fund this. Voluntarily? If so, educate your neighbor not to voluntarily support it. Involuntarily? If so, then what can we do? It must be frustrating to know that others are harming their health, but doubly so to know that money is taken from you to aid and abet the damage. Ouch.

  • gzuckier

    There is an implicit assumption in the US healthcare “dialogue” that if one had unlimited financial resources, at least then he or she could get that proverbial “best in the world” American medical care, and that our poor showing on internationanl comparisons of health care quality is just a matter of access/rationing etc. But in fact, there seems to be no particular evidence for this assumption either. In fact, the problem of quality in American healthcare may be worse if we should ever manage to give every American whatever care they want on an “all you can eat” basis. Which kind of parallels our situation with food, come to think of it.

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