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Wednesday, January 5th 2011

What It Means To Ration

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.