Rationing in the Health Care Reform Bill

Most of the attention directed to the Affordable Health Care for America Act is concentrated on the provisions for the extension of health insurance coverage to a greater proportion of the population. Those provisions that reduce Medicare coverage for seniors are interpreted as “rationing” and pointed to with horror. The other significant aspects of rationing addressed in the bill are largely ignored.

Among these is the provision that health care benefits will be chosen by a Health Care Commissioner and by a government committee.  This will include benefit levels for private plans. How can this be done in order to be just and equitable and not based on cost savings alone? That’s the question on which public attention should be focused.

Instead of continuing to deny that we have had and still have rationing, and that it must continue, the necessity for rationing should be admitted.  The mechanisms must be closely scrutinized to help insure that they are just and subject to the least amount of lobbying and for-profit abuse.

The rationing system must not be left to politicians, bureaucrats and insurance company executives. Public values must control our methods of rationing.

Norman Makous, M.D.

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