Health Care Rationing, Public & Private. One Bad, One Good?

by JC

Peter Singer had a thought provoking article in the NY Times yesterday, “Why We Must Ration Health Care.” He makes the case that health care rationing already exists, and the question we must ask ourselves is how best to accomplish the social goals of an equitable and sustainable system of providing health care.

Singer mostly focuses on public health care, where public policy has a large influence. But his argument can be extended to private insurance-provided health care, as rationing occurs in the private system as well. Many people (commenters here at 4%20 included), though, tend to ignore the role of private industry in rationing, as it seems to be ok to let the “free market” dictate how health care is rationed–and who lives and who dies, depending on who is offered a policy or a life-saving procedure–while decrying the federal government’s role in rationing public health care resources.

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it. Health-insurance premiums have more than doubled in a decade, rising four times faster than wages… Health care now absorbs about one dollar in every six the nation spends, a figure that far exceeds the share spent by any other nation. According to the Congressional Budget Office, it is on track to double by 2035.

President Obama has said plainly that America’s health care system is broken. It is, he has said, by far the most significant driver of America’s long-term debt and deficits. It is hard to see how the nation as a whole can remain competitive if in 25 years we are spending nearly a third of what we earn on health care, while other industrialized nations are spending far less but achieving health outcomes as good as, or better than, ours.

Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. 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?

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  1. easy

    I used to think government-involved health care for everybody was the only way to go.
    Now, after reading this, I’ve changed my mind.
    Only private industry can do the job of rationing health care.
    Public option? First there’s the screams about abortion and contraception, and it goes downhill from there. Actual discussion of what happens when old people want new organs, discussion of providing drugs and who gets them and what they cost and such?
    Only private industry can make those decisions.




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