Although the average American fears health care rationing, most Americans are unaware that health care rationing has been taking place quietly in the United States for years. This is not something new, brought on by the Affordable Care Act. It’s not a result of Obamacare. It’s not a liberal plot to trick us into opting for socialized medicine or universal coverage.
On the contrary, capitalism has slowly and quietly led the United States down the path of health care rationing.
As health care costs in the U.S. increased, the cost of providing health insurance to employees and their families became increasingly burdensome to U.S. businesses. Even the federal government felt the pinch of increasing health care costs as it saw Medicare spending increase.
Businesses looked for less expensive employee health insurance options. Health insurance companies innovated to fill the need for health insurance that kept health care costs in check while delivering quality care. Health insurers used several techniques to control costs, creating a whole new genre of health insurance products and health care delivery methods known collectively as managed care.
The idea was that, by managing the care that was provided, the insurer would also be managing the cost of care. If the insurer could keep the cost of providing health care down, it could sell its health insurance product for a lower price than the competition.
Insurers that managed to offer quality health insurance coverage at reasonable premium rates prospered.
Consumers (in this case, businesses, the government, and individual citizens) demanded a product at reasonable rates. America’s health insurance companies responded with innovation and competition.
That’s capitalism in action. But, the innovative methods health insurers used to keep costs in check were quietly weaving health care rationing techniques into the mainstream of United States health care.
Most insured people in the United States have a managed care health plan like an HMO, EPO, or PPO, so most people have experienced some form of rationing. Health care rationing in the United States isn’t as blatant as saying “No, you’re not allowed to have this health care service.” Instead, U.S. health care rationing is more subtle and usually presents in one of two forms:
Examples of how health care is rationed in the U.S. by limiting access to certain types of care or providers include:
Examples of how health care is rationed in the U.S. by increasing barriers to care include:
Note that the Affordable Care Act’s health insurance subsidies aim to decrease this last form of rationing by giving financial aid to those who can’t afford to buy health insurance on their own.
Although we’ve rationed health care in the U.S. for years, the idea of health care rationing is still objectionable in the United States. Sarah Palin tapped into that sentiment when she claimed that the Affordable Care Act would create “death panels” that would decide who would get care and who would be left to die without care.
It would be nice if the world had unlimited resources and everyone could have everything they want. However, that’s not the world we live in. The tough fact is that health care is a commodity; money is a commodity.
Doctors and nurses provide health care as a way to earn money, to support their families, to pay their bills. Pharmaceutical companies make drugs that they can sell at a profit. If a company doesn’t make a profit, it will go out of business and won’t be there to make any drugs next year.
Many people feel health care should be the exception to capitalism, it should be a basic human right provided to everyone because people cannot live without health care. However, in the United States many things people cannot live without are rationed economically.
People cannot live without food, yet we must pay for food in the grocery store. Those on food stamps must carefully ration the funds the government provides so they don’t run out of food. People cannot live without shelter from the elements, yet we must pay for housing and for clothing. Those who can’t pay suffer.
Is health care rationing bad? In some ways, yes. People suffer when they postpone care they can’t afford or when they go without health care.
Is health care rationing good? In some ways, yes. Rationing care helps us to use our limited resources more wisely, picking and choosing among options and trying to get only the care that’s truly necessary.
Ultimately, health care rationing is a necessary evil. We’ve been living with it since our ancestors paid the town doctor with chickens. We live with it now when we have to get our MRI scan pre-authorized by our health plan. We’ll live with it in the future as long as time and money are finite resources.