Tuesday, August 11, 2009

The Ugly Truth: We Already Ration Health Care

Save Dick Cheney or protect 180,000 kids against measles? ...interesting question...

The debate about rationing health care and reducing choice is somewhat misleading, if you ask me. We already ration health care based on our health insurance (the more expensive, the better the coverage) and our employers decide what doctors we can see and what benefits we have by deciding which insurance companies employees can use.

A recent article by social entrepreneur Jonathon Lewis really drove this home for me today. He wrote in his blog,

"Rationing healthcare is what health systems do. No scheme, no government, no insurer, no individual (save perhaps the ├╝ber-rich) has unlimited money to buy all the healthcare everyone wants."

He contrasted the health care services received by former Vice President Dick Cheney (after years of smoking he suffered four heart attacks since age 35!) with those that would have been received by an uninsured domestic worker (those low-wage earning house keepers and landscapers the wealthy so often "employ"). Morever, he asks,

"Would you deny the Vice President, a former heavy smoker, his quadruple bypass surgery (estimated cost: $45,000.00) to pay for inoculating 180,000 children against measles (estimated cost: 25 cents per child)?"

Well, would you?

There is no use denying the fact that increasing health care services for the poor and underserved will likely draw resources away from the services provided to the top tier of society. Do I think this would have a major impact on the health of the rich? No. Such a change would only serve to improve the health outcomes of our nation as a whole. The gains to be made by making health care affordable and available to all Americans will be better for population health than small, nearly unattainable medical care services to the most well-off.

Medical care services, in general, have only led to modest gains in population health. Water, sanitation, immunizations, and environmental modifications have led to many of the greatest population health improvements in our global history. We must spend more effort and money on disease prevention (innoculating those kids with measles is a good start; preventing youth from smoking is another). Treatment will always provide great tradeoffs for societal well-being because of the enormous economic cost.

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