Thursday, December 4, 2008

There will always be rationing

Andrew Sullivan,

One reason I'm a conservative is the British National Health Service. Until you have lived under socialism, it sounds like a great idea. It isn't misery - although watching my parents go through the system lately has been nerve-wracking - but there is a basic assumption. The government collective decides everything. You, the individual patient, and you, the individual doctor, are the least of their concerns. I prefer freedom and the market to rationalism and the collective. That's why I live here.

Andrew claims he lives "here" but his view of the health care system "here" in no way reflects the reality of health care in America.

His description of bureaucratic hell with government workers getting between doctors and patients perfectly describes the American health care system only the bureaucrats in question are employees of Blue Cross or some other insurance company. Unless you are wealthy (as Andrew is) and can afford to bear the costs of your own treatment all Americans who are insured must receive the blessing of their insurance company before they undergo the simplest of treatments. Never mind the tens of millions of Americans who don't have insurance and thus rarely if ever even see a doctor.

Andrew sets up a false choice - we can adopt a national system of some sort and have our health care rationed or we can have a system based on the market that would, supposedly, be free of rationing. There is no medical utopia whereby rationing of goods and services in health care is not neccesary. There are a finite number of doctors, a finite number of nurses, hospitals and there's a finite number of dollars to pay for their services. That's just reality, anything else is pure fantasy.

So once we come to grips with the fact that rationing of some sort is unavoidable we can deal with the real question at hand, how do we allocate (or ration) those finite resources? In the United States we currently ration our health care based on wealth. The richer you are the greater access to health care you have. This has proven inefficient as we see by the relative costs per patient and the medical outcomes of the United States compared to nations with universal coverage. In a national health care system care is rationed based on medical need. Which is a more equitable and efficient form of rationing? That's the actual question that we must deal with.

1 comment:

Dean said...

Sullivan also conveniently fails to mention that the UK has the only truly socialized medicine amongst westernized governments. Doctors and nurses are actual government employees, as the state controls health care from soup to nuts.

No serious player in the U.S. is proposing, nor would they propose, imitating the UK system. It's worse than our system. It's proven inferior to most Euro health care systems which utilize the government as payee while most other personnel and properties are privately held. Extra, or advanced health care policies are available and produced by private insurers. With the exception of the UK, by a large margin other European health delivery systems are superior to ours at a significantly lower cost (measured as a percentage of GDP).

You've got to wonder if the choice of the UK as a comparison was more than a simple residency matter.