Everyone knows that Obamacare will institute health care rationing. The response to Obamacare boosters to those of us worried about this has been paradoxical: First, deny that they want rationing, and second, justify the coming rationing with the claim that we already ration care, so we should do it more fairly.
The latest example of the latter is a column in today’s Washington Post. From the column:
A patient at my clinic doubles over in pain. I order a CT scan of the abdomen, but the insurance company will not approve it right away. I haggle. Is the insurance company not rationing care?
No, it isn’t. The patient is not precluded by law or a bioethics central planning board from getting the test based on being a member of an invidious category, such as age, that applies across the board. The insurance company is ensuring that the test is medically warranted. Those are not the same things at all.
Back to the column:
In its broad definition, rationing is the allocation and prioritization of scarce resources. It is one of the strategies for cost containment. The paradox of rationing is that it seems fair, just and equitable, and it makes sense when applied to a population. But when it applies to my patient or my mother, it makes me uncomfortable. That said, rationing is necessary and inevitable.
No, it doesn’t seem fair to create categories of people who will receive different levels of care than other categories of people. That’s precisely what the opponents of Obamacare are yelling about. The Establishment just doesn’t want to listen. They want a centralized rationing board:
Patients, too, don’t want their doctor to be their gatekeeper; rather, they want their doctor to be their advocate. In ways, we need a national independent institution that will look at cost-effective and cost-efficient treatments and procedures and decide what to pay for.
Which brings us back to the utilitarian rationing board NICE in the UK—which has, as I posted about earlier today, has now restricted pain control. In today’s system, the doctor can pressure the foot-dragging insurance company—as can trial lawyers. In a formalized health care rationing scheme, only government appeals would be permitted, which is a prescription to drive sick people and their families nuts. For anyone who has ever appealed an adverse Veterans Administration benefits ruling—as my family has—that can be a true nightmare.
Fugettaboutit! This is not the American way. The people will not stand for it.
