The Bankrupt Rhetoric of Rationing

Filed in National by on June 18, 2009

Health care rationing that is.

David Leonhardt at the NYT has another Must Read article detailing all of the ways that health care is rationed in the US.

Today, I want to try to explain why the case against rationing isn’t really a substantive argument. It’s a clever set of buzzwords that tries to hide the fact that societies must make choices.

He spends his article taking a look at how rationing is something of an economic fact of life (there aren’t many of us driving one of these) — the allocation of scare resources requires active management, actually making decisions about how those recourses are allocated. Except as far as our medical care is concerned, we don’t actively think about allocating medical resources. So there is a built in passivity (or avoidance behavior of the decisions) that is ratcheting up the cost of our care and ensuring that our outcomes are collectively in the middle of the pack. To that end, they’ve included a very cool graphic:


Ezra Klein also writes about this article and he provides some compelling examples of the premiums we pay for avoiding the rationing decisions:

Want another example? Turn your attention to the dread “waiting lines.” A 2001 survey by the policy journal Health Affairs found that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent. This, Americans will tell you, is the true measure of our system’s performance. We have our problems. But at least we don’t sit in some European purgatory languishing without our treatments.

There is, however, a flip side to that. The very same survey also looked at cost problems among residents of different countries: 24 percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn’t fill a prescription. And 22 percent said they didn’t get a test or treatment. In Britain and Canada, only about 6 percent of respondents reported that costs had limited their access to care.

The numbers are almost mirror images of each other. Twenty-seven percent of Canadians wait more than four months for treatment, versus only four percent of Americans. Twenty-four percent of Americans can’t afford medical care at all, versus only 6 percent of Canadians.

Much of what you’ll hear as an argument for the upcoming “rationing” of health care pretty much asks you to forget that most of us do not have insurance policies that are not subject to some faceless bureaucrat on the other end of the phone whose concern is not in your health care outcome. And it is clear that the so-called not rationing that we have now, is incredibly expensive for what we get in return.


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"You don't make progress by standing on the sidelines, whimpering and complaining. You make progress by implementing ideas." -Shirley Chisholm

Comments (9)

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  1. pandora says:

    Oh, we wait as well. We just fill the time with specialists and tests. All treatments are prioritized. If you need a hip replacement chances are you’re not getting one the next day.

    I really wish we could be honest about waiting periods, instead of acting like a person who comes through the door with a knife in their chest is told to take a number.

  2. Read the Supreme Court decision written by Justice Souter which detailed the nature of all insurance ( government also) and particularly HMO’s is to ration care.

    The key to reform is a system which is patient centered, hassle free, flexible to your lifestyle and not tied to employment.

    The existing system does not do that and neither will the public option.

    Mike Protack

  3. # The bill, if passed, would increase the federal deficit by about $1.6 trillion over 10 years and still leave millions without insurance.
    # There are now an estimated 46 million people in the United States without any health insurance.
    # Once the reform plan was fully implemented about 39 million people would get coverage through new insurance exchanges — a kind of clearinghouse for medical plans.
    # The number of people who receive coverage through an employer, currently the main provider for health benefits for most Americans, would fall by about 15 million, or 10 percent.
    # The number of people covered by government programs would fall about 8 million as they move into policies offered through exchanges.
    # The CBO concluded that under the Kennedy plan, “the net decrease in the number of uninsured people would be about 16 million” — far short of President Obama’s goal to provide healthcare coverage to all Americans

  4. We’re spending a lot of money for not as good quality.

  5. farsider says:

    This is just another giant ripoff. Once they have control of our healthcare they will be able to expand that to anything they want. We do spend too much, spending an extra 1.6 billion wont help that much though.

  6. farsider says:

    sry, trillion the numbers just get so big it is silly

  7. cassandra_m says:

    Oh good! 3 people on this thread never even bothered to read the post before cutting and pasting their talking points here.

  8. Tom S says:

    so is healthcare the reason for your statistics…if we had better healthcare, I could smoke like a chimney and live longer? So if we could just reduce the ice cream sales, we could reduce the drownings since they’re also correlated. Correlation does not necessarily mean cause and effect…

    Also what is the definition of “5 year survival rate”? 5 years from what?

  9. cassandra_m says:

    The chart shows a comparison of the 5 year survival rates for treatment of certain conditions among a shown group of countries. It shows that treatment outcomes for some major illnesses for US patients are mixed. We do very well in breast cancer outcomes but not so well if you have colorectal cancer. Since we spend vastly more money on health care than any other country, you’d expect that our health outcomes would be routinely better. They aren’t. So this is used in the article as support for the idea that we have to use the money we do spend much smarter than we do.