6.18.2009

Rationale behind rationing

Amidst the cave drawings and plethora of bikini-clad beauty queens, the Troglopundit has touched on an important issue in the upcoming health care debate (such that one exists) and offered a nice rebuke of David Leonhardt's most recent column in the New York Times.

Anyway, when we Righties complain that nationalized health care will lead to “rationing,” we might as well be complaining that Autumn will lead to Winter. In an economic sense, rationing is happening already. Always has been, and always will be.

The real argument in health care isn’t whether there will be rationing, but how that rationing will be done. I’d prefer more of an “I, Pencil” approach. Nationalized medicine proponents like Leonhardt prefer to substitute nests of government cubicles infested with a few thousand white-collar workers.


Exactly right. Rationing exists naturally as part of the free market, but it is important that it is done by the free market and not by government. In my mind, rationing as described by Leonhardt in the opening paragraphs of his column is dead on. Rationing in this sense is a painless (relatively speaking) function of supply and demand.

Where Leonhardt - and other proponents of universal health care - goes wrong is in making the leap to government handing out the rations. I do not dispute, and indeed I know of no rational person who does, the need to modernize our medical records and do a better job of identifying procedures and treatments that actually work. The difference is in who makes those decisions.

A truly independent review panel that evaluates procedures is a good thing, but if we use that as the only guide to treatment are we not running the risk of stifling innovation? Currently, we have doctors over-medicating and over-testing to avoid lawsuits. Do we really want to risk swinging too far the other way?

Transparency and information on quality and efficacy can only help our health care system, but the ultimate decision as to how that information is used must be in the hands of the patient and their doctor.

Also, to quibble with Mr. Leonhardt on semantics, when those of us on the right argue against government rationing it is not because we oppose paying for effective treatments. It is because we recognize that in "the process of allocating scarce resources" the United States economy can ill-afford to pay for all medical treatments for all of our people in a government-run system. One need only to look at the looming fiscal crisis of Medicare and Social Security to see the demographic writing on the wall.

Once we reach the point at which we cannot pay for all of our health care needs, rationing - in the sense of deciding who and what will be covered - must take place. In this type of rationing, health care as a "right" goes out the window and cold number-crunching comes into play. Put bluntly, does the 85 year old woman get knee replacement surgery? What about the 88 year old man that needs a new hip? Nope. They don't get the procedure. It doesn't matter about the technique at that point, all that matters is the bottom line.

Individuals may be content to make that decision for themselves. Patients can refuse treatment at any time. What I think no one is prepared to do is turn that decision over to a government agency or bureaucrat.