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Rationing of Health Care?


June 30, 2011 by wcobserver

Having been a child during WWII, I still have memories of rationing. Money alone would not buy such things as shoes, sugar, gasoline, or tires for your car. You also had to have your ration stamps from the government. Rationing is viewed as a harsh system imposed by the government when supplies of certain commodities are scarce.

In more normal times we depend on the economic principle of supply and demand to regulate prices.  In the case of health care services the demand always seems to exceed the supply. Or as the Economist might say, demand is “elastic.” Some of us will take all the health care we can get, provided someone else will pay for it. My Chiropractor recommends a monthly adjustment to keep me in shape, but cautions that my Medicare will not cover it since it’s routine and not medically necessary. “You see, Martha, that’s why the insurance wouldn’t cover your face lift,” he explains patiently.

Which brings up the factor of third-party payers:  we tend to be indifferent if our insurance is paying, whereas if I’m paying for a service out of pocket I become more concerned.  In my own case my Medicare limits (rations) the amount of care I may have.  The same is true with your group health coverage. In the case of the aforementioned cosmetic surgery, they generally limit that to cases of injury or trauma. The face lift is only one of the things excluded in order to keep the policy affordable. And did you notice that Grandmother got sent home from the hospital early because Medicare has a limit on the number of days?

If people hated rationing during the war, they still hate it today. Nobody likes to be told “no,” but somebody has to do it. Private health care companies often get scathing criticism because they deny expensive experimental treatment. When the government seeks to limit care, politicians take a lot of heat and often resort to demagoguery. We don’t want to hear the truth. And the truth is that there is not enough money in the system, be it public or private, to cover all our perceived needs and wants for health care. Without limits neither premiums nor taxes would be tolerable.

I shudder every time our Lawmakers go to Little Rock.  Invariably, one of them is on a mission to get another medical mandate passed. In the last session a crusader from NWA pushed through a law requiring coverage for Autism. The thought seems to be that if we can just force Blue Cross (or whatever carrier) to cover this, the public will not be burdened with the expense. Such “mandates” just force increased premiums, which shifts the burden from taxpayers to policyholders. The real question is not whether Autism should be covered, but rather who should pay and what are the limits.

In the past, such things as Autism and Attention Deficit Disorder were considered under the rubric of “mental health.” Demand for mental health services is more open-ended and “elastic” than with treatment for an appendectomy or a broken bone.  It’s extremely difficult to draw a bright line as what is medically necessary, or when treatment should cease. For that reason, private health policies limit mental health coverage by number of treatments, or to an annual dollar limit.

Generally, the government does a poor job of saying “no.” That’s got to change. Get ready​ for more rationing. It’s necessary, but we won’t like it.



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