Who Do You Want To Ration Your Health Care?

04/28/2009 04:28 pm ET | Updated May 25, 2011

2009-04-28-RatCardFinal.jpg The label on your bottle of today's bitter medicine reads: "Health Care Rationing."

Before the 20th century, health care was cheap. Very little could be done for a sick person. Starting around the Second World War, a cornucopia of medical and surgical treatments became available, all expensive. Now we have $50 pills; coronary artery stents; artificial parts like ceramic hips; replacement parts such as liver transplants; and soon stem cell even gene therapy.

Partly because of medical advances but primarily due better public health and nutrition, more of us are living longer meaning there are more old people. Health care for old people is very expensive.

People often behave against their own best health interest. They smoke cigarettes. They do not exercise. They eat to obesity with all of its complications. They fail to get regular check-ups. When ill, they delay seeking medical care so when they do, the illness is much worse and more expensive.

These are only three of the nine reasons for out-of-control healthcare costs.

Demands for health care services are increasing for reasons noted above. Supply of health care services is contracting, especially its personnel. With rising demand, decreasing supply and under our present system, supply cannot balance demand. Something or someone must create balance. That is called rationing.

Rationing means control by someone other than you of distribution to you of goods and/or services. Rationing is a very negatively charged word because it has been associated with periods of extreme scarcity: the Great Depression and two World Wars. The word itself comes from Latin "ratio" meaning to think or to reason. Strictly speaking, rationing is a process to create a "reasonable" balance between supply and demand.

If anyone other than you controls the balance of your demands with the available supplies, whatever euphemism they call it, that is rationing. In the USA, payers - insurance companies and the Federal government - delay or deny payments and pay according to predetermined schedules. By controlling payment, they control [ration] the delivery of goods and services.

What about countries with so-called universal health care? In Canada and Australia, the government determines what services it will pay for and how much. If what you want or need is not on the list, you do not get that ration. In Great Britain, the National Health Service "rations" by queueing: yes, you can get a hip replacement or dialysis...but you go on a waiting list and might wait years before your name comes up. If you die before that time with neither hip replacement nor dialysis, there is no expense.

SOMEONE will ration your health care. Call that someone the system, the government, the insurance company, the evil empire, or...could we create a system where WE ration our own health care? The answer is yes and that is what we need.

Healthcare is and will be rationed. Who do you want to do it?