Thursday, June 18, 2009

Rationing is Not a 4-Letter Word

Finally a mainstream article (in the NY Times, no less) redefines the misunderstood notion of rationing and healthcare reform.

David Leonhardt's timely and important article deconstructs (I love that word; here's one definition of it: textual analysis that can reveal hidden ideological assumptions) rationing. Here is a definition of rationing: the controlled distribution of resources and scarce goods or services.

Most Americans do not feel they get sufficient time and attention from their medical providers. They find the prices of drugs (or even their fractional co-payments) too high. They do not get enough information on wellness and prevention. Hello. Those problems are the result of an unacknowledged system of rationing. And the current rationing system works to prevent doctors conversing together about your medical problems, to prevent doctors reviewing your old medical records, to prevent doctors educating you about wellness. That is because the current system rations those services by failing to pay for them.

Oh, and by the way--don't you dare come down with an illness that cannot be successfully treated with a drug or operation, because other forms of treatment are highly rationed in the current system.

Most Americans put up with long waits for care, too-short visits, too many tests and not enough face time, because they have been led to believe they have the best healthcare system in the world. If best is costliest, with the most varied and numerous medical devices, procedures, and specialists, then we do have the best system. But if best is measured by outcomes, then we aren't doing very well.

What we really need is rational rationing. Not decided by medicare bureaucrats or by default, but by the stakeholders. We have got to get the price of healthcare down, and that will take rationing. Let's do it in ways that enhance health, longevity and safety. (I could name hundreds of ways to save that would yield better results.) Hello.

Anyway, Leonhardt makes these points so much better than I can. Read his short piece. Uwe Reinhardt discusses the misunderstood concept of healthcare rationing in another excellent article.

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