"The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?"
Indeed, and we can't have that debate as long as the magical thinkers are stuck on the notion that there would be no rationing in a single-payer system.
Rationing medical care the way we used to, that is, by what individual consumers were willing and able to pay for a la carte, has the inherent ability to control costs. Just as soon as you use common monies to pay for medical care, be they from what we now call health insurance or be they from the public coffer, we lose that inherent cost control. When we lose it we can either let costs runaway or we can impose some other form of rationing, a centrally controlled rationing scheme to replace the natural market rationing scheme. Which will it be? Clearly we can't let costs run away indefinitely or we will bankrupt the country although we can let the inevitability slide for some period of time until the crisis is upon us. It would be healthier to look at the issue now, have a public discussion, and decide on the rationing scheme although politics make it difficult to sustain that long term.
Which is why I prefer the natural rationing that comes with everyone paying his own way one earache and antacid at a time for routine medical care and using major medical/catastrophic insurance policies for the big, unlikely stuff. Supplemented by primarily charitable support for poor children and the disabled.
But that flies in the face of the notion that there is a human right to all the medical care anyone might "need." If that notion prevails, as it seems to be, then we absolutely must face up to the fact of centrally determined rationing. It would be great if that discussion could be held openly and constructively.
|
