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HOST) The health care debate is so complex that commentator Bill Mares has been thinking about individual aspects of it – one aspect at a time.
(MARES) I’ve been thinking about the necessity of allocating scarce resources. The word for it is rationing – and it’s a dirty word in the health care reform debate; but it shouldn’t be. It’s a fundamental part of any economic strategy, and anyone who thinks we have unlimited resources to spend on health care or anything else isn’t being realistic.
As numerous economists have said, the United States spends far more on health care than other societies, but we get far less; and that means we’re rationing badly.
We’d rather promise everything to everybody, even though we know better. And if we were really honest, we’d admit that we already ration health care – without calling it such. It’s a kind of rationing when we, as individuals, short-change other expenses to pay for health care. And when companies are forced to pay more for employee health insurance, the result is that wages are "rationed."
But pediatrician Joe Hagan, my good friend and running buddy, had some cautionary comments for me: "To put rationing at the core of health care reform seems an over-simplification. For example: overhead on insurance premiums is about 11%, for which we get no "health" value. The cost of processing claims for multiple insurance companies, each with an idiosyncratic way of doing business, is a small fortune in practice or hospital overhead. And as a nation – and this includes doctors – we often spend our health care dollars unwisely: little preventive care, little mental health care, and lax safety standards. A case in point: why aren’t bike helmets the law? They not only save lives, they save money!"
OK, OK, Joe, I concede. Rationing is not the only solution, but it should still be in the calculus because it brings a certain universal clarity to the debate. Here are some other bits of evidence.
Although the analogy is not exact, both the Department of Transportation and the Consumer Product Safety Commission make annual decisions based on how much we can reasonably invest in saving lives.
And the British have determined that the public is willing to spend up to $49,000 to give a person an extra year of life.
One way to combine the economic, political and ethical in making these difficult choices is by using a method called QALY – or Quality Adjusted Life Year. For more than 30 years it’s helped us measure the cost-effectiveness of various medical procedures, when the public foots the bill.
And then there’s the openly two-tiered system proposed by Princeton bioethicist Peter Singer. There would be a "Medicare for All." If you wanted to receive more treatments recommended by your doctor, you could opt out of this program as long as you could demonstrate you had private resources when you fell ill. Or you could remain in it, and buy supplemental insurance.
As Singer writes: "Rationing explicitly, openly, honestly means getting value for the billions we spend on health care. We have a right and a duty to set limits on which treatments should be paid for out of the public purse."