The Rationing of Healthcare for Profit

If medical care is an entitlement, our society cannot afford to pay for everything that is currently available. We need to set goals regarding who receives what care and for how long.

This requires rationing, by definition. In the US, rationing of medical care has always been with us. We are in denial, and we tend to avoid the term “rationing.” It’s perceived as un-American, so we refuse to acknowledge it.

One common method of rationing is by queue. People await their turn. Another method of rationing long in use in the US  is the limitation of  care through age discrimination. For example, organ transplants frequently are denied to those above a certain age.

Today in the US, rationing decisions are made by medical insurers based on profit motives. An individual’s healthcare needs are limited by the insurer’s financial goals. The decision-making process and its implied social values are considered part of the free-enterprise system. The methods for decision-making are hidden from the general public.

To achieve a consensus on rationing methodology, both the goals and the limitations of healthcare in the US should be recognized and thoroughly discussed. These should be debated, whether the system is called socialized medicine or universal healthcare, and whether the system remains a version of the for-profit, free-market system we now have, or becomes a fully government operated program, or is some blended version of the two.

While Medicare and Medicaid have paved the way for acceptance of comprehensive healthcare – which contains key elements of rationing – the lion’s share of the debate lies ahead. To be effective in the US, the system must be equitable, and it must be perceived as equitable. This requires a great deal of open discussion.

Norman Makous, M.D.

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