Healthcare Rationing

By Author: Marcus Stalder
Total Articles: 491
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More or less wherever you look, you will find the GOP propaganda machine churning out articles warning you that rationing is coming if the Affordable Care Act is fully implemented. The latest scare stories surround the entirely reasonable proposal to appoint an Independent Payment Advisory Board to recommend cost-saving changes to the reform program. This is a return to the death panel debate where a panel was going to sit to decide who should get treatment and who should be allowed to die. The GOP point to the British who have a panel called the National Institute for Health and Clinical Excellence (NICE) which often rejects expensive drugs, e.g. for the treatment of cancer including leukemia. In fact, NICE does quite often reject drugs, but only when there are cheaper alternates and there's no evidence to show the more expensive drugs produce better results. Inevitably, some of these decisions are considered controversial by the British themselves but, so far, NICE has done a good job in keeping British healthcare service reasonably affordable to the taxpayers. For those of you who've forgotten, Britain has socialized medicine ...
... funded by the state.

Anyway, the GOP is convinced our new panel will decide the really ill, the elderly and the disabled will not be eligible to life-saving drugs and they will all be allowed to die. This will be rationing with intent to kill. All of which leads us to ask whether we have rationing now. As you may also have seen or read in the media, some 52 million Americans are without medical insurance. In simple terms, they cannot afford to buy a private health plan. So the current reality is that we have rationing today, but instead of it being based on patient need, it's based on the patient's ability to pay. Turning it around, those with the money in hand can afford to buy health cover. Everyone else either falls into a federal safety net or is left to fend for themselves.

As an example, let's think about a young couple living together, both earning and producing just enough income to fall outside the Medicaid limits. They take no precautions and she now discovers her pregnancy. Instead of this being a time of joy, it's a catastrophe. Assuming no complications, the pre-natal care and delivery usually costs about $20,000. With bad luck, this can double with some complications. It will cost her about $600 for an abortion. The comparison with Britain is instructive. If she lived there, both the birth or the abortion would cost her nothing. Whatever she chose would be free. Yes, their income tax as a couple would be higher but, averaged out over a lifetime of work, they would be better off. No matter what criteria you pick: access to care, the quality of care delivered, the efficiency of the services, the fairness of the decision-making and the general health of the nation, Britain comes out ahead of us.

So, given rationing already affects our heath insurance services, survival depends either having the money to pay the premium rates or staying healthy. We would benefit from a universal system, but the GOP is determined to frustrate any move in that direction. Republicans believe our health insurance provision is not broken and needs no fixing.