Fear of health care rationing

Posted Oct. 19, 2010, at 10:06 a.m.
Last modified Oct. 19, 2010, at 3:13 p.m.

I’m a rational guy. I can, after all, (just barely) watch the Patriots trade away Randy Moss without my kidneys bleeding. What really makes me irrational, however, is when smart people who lead us complain about the rationing of health care as though it is an evil conspiracy of those who favor reform of the American health care system to deprive us of care we need. They and we should know better, because rationing has always been a part of health care and, in its better form, must be.

The latest of these smart people is the Republican candidate for governor of Maine, who reportedly said he would sue the federal government to block the federal health reform plan in part because “It’s rationed care. It scares me.” He joins a long list of politicians — Democrats, Republicans and others — who have excoriated the rationing of health care as some kind of nasty health care monster.

And in its current form, health care rationing is just that; a capricious, vicious, brute that awaits almost all who travel in the dark woods of ill health because it rations by ability or inability to pay for care. When you are sick, it stops you at the toll bridge and asks whether you have health insurance. If yes, you might pass. If no, you might just have to feed it your home, your savings, some of your health and perhaps even your life.

If you have health insurance, it asks whether you can afford your share of your health care costs. If yes, you pass. If no, well, aren’t you just a tasty snack for the monster.

The question is whether this monster of health care rationing can be tamed into a useful monster with which we can live. Can it be taught to feed on some of the wasteful care of limited value for all, instead of all of the care of real value for many? Can it eat tests and treatments that don’t help us, such as antibiotics for the common cold and intensive care when that care is truly futile?

Can it swallow up surgeries for problems that can be treated with time or medication? If we become more educated about our options as patients, can we sacrifice to it the care we get out of fear and ignorance?

Those are really the only two choices.

The tale of American health care must have a monster of rationing, because rationing health care is how we are going to reconcile the fact that Americans collectively want more care than we can afford. If we cannot afford all the care we want, we must have some way to set limits. The only question is how.

Will we ration our expenditures in a way that is consistent with our values, gives the best care for each dollar spent and makes all of our care more affordable by reducing the amount of care we get that is of lesser value? Or will we ration what we spend by cutting people off from care so they spend less than they need while the rest of us spend more than we need?

If we are going to figure that out and get to the work of taming the monster, the first thing we must do is stop running to our politicians, lawyers and other favorite monster slayers every time we hear the “rationing” word. That approach has us screaming to them to save us from the monster outside while tossing it ever more uninsured or underinsured human sacrifices over the wall. Each round of health insurance premium increases slowly strips the next rung up on our society’s income ladder of its progressively unaffordable health insurance coverage, then tosses it out to a beast that cannot be sated, only tamed.

It’s time to take a deep breath, swallow our fears and make the health care rationing monster play nice with us. He’s not a bad monster — he’s just difficult and needs to be loved; that’s all. Say, “Nice monster.” See, wasn’t that easy?

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.

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