The Rationing of Medical Care

Rationing of medical care has existed in the US for many years, and the denial of its existence has been around just as long.

Most people in the general public don’t recognize rationing when it happens, and many health professionals refuse to admit to its use or disingenuously deny that it exists.

In the past six months, nearly every politician has mentioned rationing in order to deny that it will ever happen under the new healthcare system.  The fact that it already exists in the current system is unaddressed.

Rationing is a normal part of our lives.  Everyone uses it on a daily basis.  What is actually meant by the word “rationing?” When resources like money or food are in limited supply, they require sparing and prudent use – in other words, rationing.

For individuals in a group to conduct rationing on a fair and equitable basis requires what is called, “the ethics of distributive justice.” The group must create the rules of rationing, and must agree on how these rules will be applied. This principle applies in the rationing of medical care, but it has not been followed.

In the US today, the decisions about who will receive funding for medical care and who will not are made by insurance company administrators who base the decisions on the healthcare underwriting rules of the company, protecting the company stockholders. This is a proprietary rationing system with little public input.

With the introduction of Medicaid and Medicare in the 1960s, the government has also been involved in rationing a good portion of medical care.  Most of the rationing policies there, however, have not been established with much public input and comment.

Much of the onus of the rationing decision today has been shifted to physicians and to the institutions providing care.  Since the patient interest comes first for healthcare professionals, this conflict of interest has resulted in an unrelenting assault on professional ethics, and has been very counterproductive.

Coming to agreement on the rules of rationing will satisfy the same needs as universal care – everyone will feel that healthcare is being delivered in a fair and equitable way, given the limited resources today. If the healthcare reform process leads to a public debate on the rules of healthcare rationing, we will have accomplished a great deal in the process.

Norman Makous, M.D.

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