Fear of Medical Rationing Unfounded

Fear is, in essence, by nature, irrational. Let someone say something to trigger fear, and rational discussion becomes simply impossible. Republican operatives know this, and have exploited it for political gain. Their issue is not winning an argument, but dealing a defeat to the black guy who's president.

August 25, 2009
Policy Experts Call Fear of Medical Rationing Unfounded
By Reed Abelson

“Rationing.”

It is what many people say they fear most from an overhaul of the health care system — the prospect of the federal government’s limiting the medical care they can receive.

Even some people who now have private health insurance through their employers have expressed this concern in opinion polls and public forums. They say they worry that the enormous price tag for providing care to tens of millions of additional Americans will eventually force everyone else to make do with less.

Is that a realistic fear?

Policy experts say people are rightly concerned about the nation’s health care costs. But they also say there is nothing in the current proposals in Washington to suggest that the country is likely to embark on a system of medical rationing anytime soon.

Those fears, the experts say, seem to stem from talk of a government-run health plan or proposals for government-sponsored research to determine which medical treatments are most effective. But few health policy experts see the likelihood of lawmakers’ adopting some sort of new system in which government bureaucrats decide whether someone’s grandfather can get his hip replaced or a wife can have her cancer treatment paid for.

“I don’t think all of this fast-forwards to something called a national rationing program,” said Paul H. Keckley, the executive director for the Deloitte Center for Health Solutions in Washington, a unit of the Deloitte consulting firm. “Our culture is not going to allow that.”

And people who worry about the government’s playing such a role may not remember that even now private insurers make decisions “about what is medically necessary and what is not,” said Mike Thompson, a principal in the health care practice of the consulting firm PricewaterhouseCoopers. The private insurers, Mr. Thompson said, might decide that a certain cancer treatment was experimental, for example, and refuse to pay for it.

What is most likely under a health care overhaul, Mr. Thompson said, is that people may initially have a harder time finding a primary-care doctor as more insured people seek treatment from the same number of doctors. Even if no one is denied care, he said, “if it takes longer to get an appointment, it certainly feels that way.”

Paul Ginsburg, the president of the Center for Studying Health System Change, a nonpartisan research group in Washington, said he was more concerned about the opposite of rationing: that lawmakers do not seem to be focused enough on controlling costs, by making sure people do not receive unnecessary care or unproven treatments.

People should be more worried about what will happen if none of the legislation addresses the current inefficiencies of a system in which people do not receive the right care at the right time, said Peter Lee, who oversees health policy for the Pacific Business Group on Health in California, an alliance of big employers.

“It is a huge concern to add 50 million Americans to a health care system that does not have its financial house in order,” Mr. Lee said.

If nothing is done, he said, “health care is going to break the bank of not the only federal government but of every household in America.”