Now Is The Time To Start Talking About Health Care Rationing

We are right to mock the hypocrisy of elected Republican officials that criticize the Affordable Care Act (aka Obamacare) for leaving millions of individuals uninsured and doing little to address the high cost of health insurance. Instead of creating policies to address these two Obamacare shortcomings, Republicans decided to exacerbate them by withholding funding to insurance companies that all but ensure that premiums will rise even higher and fewer individuals will have health insurance. We are also right to sneer when conservative intellectuals and Libertarians extol the virtues of a so-called free-market health care system where people are free to buy or not to buy any level of health insurance, and from any location they want. When the reality is that health insurers aren't in the habit of offering a la carte health plans. There's also the issue of opaque pricing with “free market health care.” Another issue with conservative and Libertarian views on health care is that half of the purchasers can buy insurance at a significant discount because of the workplace health insurance premium tax exclusion and the other half have no such benefit.

But at some point, and I think the time is now, Obamacare supporters and proponents of single payer or universal health care will have to realistically and publicly address how their proposed policies will deal with the problems of health care costs and affordability. Unlimited health care at any cost paid for by the government is not a realistic option, and no such system exists anywhere in the world. There are and should be limits on the amount of medical care an individual receives if they are not paying for it or if doctors and hospitals determine additional care would have no meaningful impact.

Our current U.S. health care system already places limits on the amount and form of medical care individuals receive. Sometimes these decisions are based on ability to pay the cost of care, and at other times they are based on medical science. However, this approach of rationing medical care won't be sufficient in a Medicare For All style system. Rationing of medical care will have to be front, and center of any government paid health care system. But that is not to say that people will not have access to care the government won't pay for; they are free to purchase health insurance or health care individually.

Some people may believe that a government codified system of medical care rationing harms the poor and favors the rich. Not necessarily. First, the poor won't likely pay anything for their medical care, and they will have access to preventative and continuous care that should improve their health status. Second, the poor won't have to pay for costly medical innovations, one of the real drivers of outrageous U.S. health care costs, but they will benefit from them. And third, the stigma applied to government-provided health care is diminished and so is the incentive for doctors and hospitals to treat the poor differently.

Okay, But Not Now

Right now proponents of government-paid health care for all our engaged in a battle to keep the poor from losing access to medical care. They may feel that they have to accomplish this goal first before they can start the conversation about their ideal health care system. Meanwhile, opposers of government-based health care use the socialists, communists, and hippie-dippy, out-of-control spending argument to make universal coverage look less attractive than the status quo. And I fear they are winning this argument because of a weak counter-argument of a greedy, evil opposition.

There is no perfect reasoning for unlimited, at any cost medical care, because health care is about more than emotions. We are all entitled to basic and major health care, but we also have a responsibility not to overburden each other, and one way to enforce that responsibility is to place limits on the amount of government-paid medical care each of us receives. There is also no perfect time to make the difficult policy proposals to ration medical care, but at least we get a say in the matter.


No one wants to be in the position of denying a person medical care, but there are times when it is necessary and appropriate. It may be
impossible for parents to accept that their newborn child is terminally ill and that no amount of additional medical care will save him, but these are exactly the types of decisions we have to be willing to make unless we are prepared to spend more on medical care than we currently do. Our country does not benefit from having millions of unhealthy, unproductive people, which is why access to affordable health care should be one of our highest priorities. On the other hand, our society is no better off spending huge amounts of resources on health care for little or no benefit at the expense of other services.

Some may claim that rationing of care is the biggest downside to “socialist” medicine, but rationing has always been a part of American health care, we just don’t call it that. Instead we claim that no one is denied medical care, leaving out the part that this is true of those that can afford it are not denied care. We need to have an honest conversation about the impossibility of paying for any and all medical care no matter its benefits. It may be the toughest thing we ever do.

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