In an L.A. Times editorial, Doyle McManus points out two ways in which rationing occurs now:
First, we ration health insurance. We make affordable insurance available to some people but not to others.
Second, our insurers — insurance companies or the government, if you’re on Medicare or Medicaid — ration what they’ll pay for. They’ll reimburse some costs but not others.
He adds:
The worst thing about our current “system” is that it’s irrational; decisions are often based on seemingly whimsical standards. Who gets affordable health insurance? Full-time employees of big companies — but not many part-time workers, small-business employees or individual entrepreneurs (despite being heroes of the free market). Who decides what medical costs are paid? Not “the patient and the doctor”; that only happens in the utopia of Republican rhetoric. As every insured American knows, those decisions are actually made by a not-very-accountable hierarchy of insurance executives and Medicare bureaucrats. It’s not exactly rationing — but as far as patients are concerned, “it’s the same result.”
The results look a lot like rationing too. In 2005, Joseph J. Doyle Jr., an economist at the Massachusetts Institute of Technology, studied the health outcomes of people who were seriously injured in automobile accidents — a population he chose because they had little control, at that moment, over what insurance they had or what care they received.
He found that uninsured patients stayed in hospitals for less time, received 20% less care and died at a rate 37% higher than the insured. Their care wasn’t “rationed” in the classical sense, but as far as they were concerned, it was, again, the same result.
He discusses the current proposals on the table in Washington, and concludes:
So the bad news is: Yes, there will be rationing. The good news: Whether we realize it or not, most of us are used to it already.
You can read his column here.
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