It is common for the obvious to be overlooked in political debate. Buzzwords are allowed to fly around without, it seems, anyone slowing things down and examining the reality that is allegedly being discussed.
Double and triple kudos, therefore, to David Leonhardt of the New York Times, who penned a great column this morning about the “medical rationing” shibboleth. A moments reflection will suffice for any thinking person to come to the conclusion that any system of medical care, including the one we have now, rations care. Yes it’s obvious, but a lot of people work very hard to make sure the obvious isn’t noticed, so work like Leonhardt’s is really needed.
Leonhardt points out that there are at least three forms of rationing taking place right now:
There are three main ways that the health care system already imposes rationing on us. The first is the most counterintuitive, because it doesn’t involve denying medical care. It involves denying just about everything else.
The rapid rise in medical costs has put many employers in a tough spot. They have had to pay much higher insurance premiums, which have increased their labor costs. To make up for these increases, many have given meager pay raises.
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The second kind of rationing involves the uninsured. The high cost of care means that some employers can’t afford to offer health insurance and still pay a competitive wage. Those high costs mean that individuals can’t buy insurance on their own.
The uninsured still receive some health care, obviously. But they get less care, and worse care, than they need. The Institute of Medicine has estimated that 18,000 people died in 2000 because they lacked insurance. By 2006, the number had risen to 22,000, according to the Urban Institute.
The final form of rationing is the one I described near the beginning of this column: the failure to provide certain types of care, even to people with health insurance. Doctors are generally not paid to do the blocking and tackling of medicine: collaboration, probing conversations with patients, small steps that avoid medical errors. Many doctors still do such things, out of professional pride. But the full medical system doesn’t do nearly enough.
He’s overlooking another form of rationing that is so common we tend to forget it: the rationing to which even the insured are exposed when their insurer denies coverage for medical procedures or drugs, often unjustifiably.
As always, the real question is not whether there should be rationing, but who should be doing it. Personally, I’m not impressed with the craftsmanship of the invisible hand.
Again, great column. Wouldn’t it be nice if this sort of analysis made its way onto the tube?
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