Rationing: Good vs. Bad

One of the more powerful sounding rhetorical chants is that the government financed health care system is going to conduct “health care rationing!” In simple terms, if the budget money is short, the health care will have to be also, thus “rationed out.” Fact: for decades health insurance companies, and Medicare and Medicaid and the Veteran’s Administration, have rationed health care delivery to greater and lesser degrees.

Some procedures will always be delayed from immediate coverage, and that is not rationing, just delay. Like “elective” surgeries, i.e. hip replacements and liposuction, stomach stapling, and defensive angioplasty. There’ll be a waiting list for these types of procedures, because they are not of life saving need. And when forty to fifty million new people enter into the health care system literally overnight, you can bet, that without many more doctors and nurses and equipment, life saving procedures will take priority. Elective procedures will likely be covered (as they are comparatively in most universal health care systems), but you probably won’t be able to call the date of surgery on your own.

Economically speaking there is good rationing and bad rationing. Good is when efficiency is increased without harming quality and those measures save money for the system.

Bad rationing is when cuts are made in budgets at the cost of the quality of life of the patients or of the public as a whole. The difference between good and bad rationing should not be a matter of opinion, but a matter of well agreed upon facts and well collected statistics. An example of bad rationing might be: a budget that cuts back, to refuse to provide vouchers for gym and health clubs, or weight loss clinics and smoking cessation classes, or self diagnostic equipment.

Good rationing would be for instance: when computerization from state to state, hospital to hospital, and hospital to doctor’s office, finds and eliminates repetition and redundancy, thus saving money and allowing for a budget that reflects those savings.

Under the public option plan, which leaves private health insurance companies in place, those with a private plan can get their elective surgeries whenever their wallets and their precious schedule allows. But those in the public option plan may find that the difference is in waiting times for elective procedures.

Rationing was invented the day that some health insurance company executive realized he could increase profits by cutting back on care. For example, don’t pay for little Jimmy’s bone marrow transplant and save $400,000. Money that can address the bottom line: profits. The best way the American public can avoid rationing in a new health care system is to assure that budgets reflect true need determined by good rationing and not budgets motivated by bad rationing. Health insurance companies have had decades to conduct good rationing and not bad. But instead countless stories of the victims of bad rationing, who had health insurance, are too common.