Medicine’s Dirty Little Secret

The proportion of the GDP that we spend today on medical care is already high, but it is just a fraction of what will be required in the future. Consumer demand and the continuing advances in technology will exert unrelenting pressure on medical costs.

Within this context, there is a huge push by many people for universal care provided by the government. We are the only country in the world that is applying the capitalistic, free-market approach to the delivery of healthcare. This commercial approach has limited our access to care.

Key questions about universal care include: How much care should be guaranteed? Who will manage it? And, who will pay for it?

Many people insist that universal healthcare must be delivered by the private sector with government oversight only. Even with the private sector approach to universal care, the costs will continue to rise dramatically.

With the economic squeeze today, the only way costs can be effectively controlled is through increased rationing of care. Today, rationing occurs behind the scenes through the insurance underwriting system. Approval for coverage of tests, procedures, and the amount of care is a form of rationing. This is medicine’s “dirty little secret.” Rationing of healthcare has been with us for decades.

In the future, we need to ration with values and terms that are openly discussed and agreed upon. The decisions about who does and who does not receive care cannot continued to be made in the back offices of insurance companies.

Norman Makous, M.D.

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