May 23, 2018
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Everything Is Rationed

As the debate about health care reform sharpens, we will hear more and more about “rationing.” Sally C. Pipes, a California researcher who has fought the Canadian plan, the Clinton plan and the Massachusetts plan, opened her attack on the current plan with a piece in The Wall Street Journal headlined “Obama Will Ration Your Health Care.”

This scare tactic usually raises the specter of faceless, unelected bureaucrats who will tell us which therapies or procedures or drugs we can have. But our health care already is rationed — by cost, by shortages, by waiting time, and, yes, by another corps of faceless, unelected bureaucrats, the insurance industry’s specialists in protecting its profits by rejecting people with prior illnesses and slapping hefty deductible and coinsurance fees on those accepted for insurance.

More fundamentally, health care and other goods and services are rationed by price, as Princeton economics professor, Ewe E. Reinhardt, wrote July 3 in The New York Times. He rejected the idea that only governments ration things, quoting from a well-known economics textbook an explanation of the effect of the price of bread: Because the supply is limited, an equilibrium price determines who buys the bread. Those who pay it get the bread. Those who don’t, don’t.

Sounds hard-boiled? Sure, but that’s life. With health care, the same rationing has always worked. Waiting for a response from a doctor’s office or hospital is a form of rationing. So is the cost of the service or the insurance that may help pay for it.

Part of the emerging national health plan is support or incentives for digitalization of health care records. Besides reducing errors and clarifying the often-undecypherable scrawl of a doctor’s or clerk’s handwriting, digitalization will create a huge database. It can show which health providers make the fewest errors, which provide service at the least cost and which ones are preferred by patients. It can show which procedures and medical devices work best and which work worst.

Digitalization thus can help patients make rational and informed choices in seeking health care. It can also guide administrators in encouraging or discouraging various services, devices and procedures.

Complications will arise as patients try to decide for themselves which medications to take and what procedures and devices they want to use — all on the basis of surfing the Internet, reading and listening to print and broadcast advertising, and the advice of friends and relatives.

Running a national health plan will always be controversial, just as is the present nonplan. And various forms of rationing will always be with us, plan or no plan.

Fear of rationing is no reason to oppose this year’s effort to devise a plan that will work better and cost less and catch up with the systems of most other developed nations of the world.

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