30 August 2009

Steve Benen, at the Washington Monthly blog, once again tipped me and other readers off to a couple of good articles by Ezra Klein and David Leonhardt, concerning health care reform and the issue of rationing.  Leonhardt sums it up:

The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly.

One of the more clear discords between What Is and What Is Imagined in the health care debates seems to be rationing. Some seem to fear that the Government will institute rationing of health care.  But it seems clear to me that we’ve had rationing since health insurance was invented. Choices are made to restrict or deny care by people above our nurses and doctors, folks who routinely limit care from their desks at insurance companies.  Unlike most of the health reform issue (elsewhere, I described the confusion of issues as spaghetti), the issue of rationing seems very obvious to me. 

Leonhardt is right.  It’s not a question of whether we get rationing or not.  We currently have it.  It’s done by folks we have absolutely no control over – we are customers (or not) of private companies, not shareholders.  If we had government involvement, we’d be like shareholders, with some right to have a say over what goes on.  We can elect leaders who are able to shape the system.  There’s a significant chance that what rationing must inevitably occur in any system will at least be meted out fairly, and not because of profit incentive.  And we, as citizens have standing to complain if things go badly.

As Leonhardt says, the choice is between good and bad rationing. We can’t be perfect, all things to all health consumers.  But certainly we can do better than what is happening right now.