There's some sad and shocking news for those who have been manning the ramparts in opposition to health reforms that would allow our government to ration medical care.
The rationing has already begun. Our crafty government has been imposing rules that determines who gets what care for decades. What we're talking about now can more honestly be seen as the end of that process rather than the beginning.
Today's real questions are whether the rationing system already operating should be expanded and can be used to yield improved results. Asking whether Americans will allow rationing is untimely and irrational. The answer is clear -- they already are. Efforts to avoid rationing entirely are a quixotic effort to close a barn door that's been open so long the hinges have rusted away.
In my continuing quest for truth, justice and transparency, here's an effort to strip away some of the veils cloaking this clandestine rationing. Consider these:
l. America's largest insurance plan, Medicare, pays for some procedures, but refuses payments for others or sets standards that must be met that help some patients while denying treatment to others. For instance, bariatric surgery for the obese is only available at selected institutions and only reimbursed when the patient has another weight-linked disease. I'm told private insurance plans make similar decisions.
2. A bureaucratic government agency known as the Food and Drug Administration decides what drugs can be sold in the United States. A delightful painkiller my South African friends recommended simply isn't available in the U.S.
3. Hospital emergency rooms are required to provide at least some treatment to stabilize the condition of those whose lives are at risk, but there's no similar mandate for chronic conditions. So motorcycle injuries are guaranteed treatment, but cancer isn't.
4. Most insurance plans are required to offer new moms a 48-hour hospital stay and the benefit expands to 96-hours if the baby is delivered via a cesarean section, but the federal government doesn't mandate a hospital option for heart attack victims.
5. My insurance plan, sponsored by my former employer, the American government, doesn't generally pay for abortion services. That decision was made in Congress by some of the very folks who today are most outspoken against rationing.
6. Really sick people who need an organ transplant are at the mercy of an allocation system backed by the government. Demands exceeds supply, so rationing is required to help decide who the lucky winners are.
In the absence of a health care fairy who will provide anything we want at a cost we can easily afford, there's a need to set priorities. Priorities is a polite word for rationing.
We used to have a simpler system in America. A half century ago, when there weren't near as many expensive cures as exist today, we had a much simpler system that was mostly based on money. Those who had a lot of it -- or good insurance -- enjoyed an all-you-can eat health care buffet.
And those who didn't, didn't. It was a simpler system. But no one I know suggests it was fairer. Ever since then we've been trying -- with more than a little success (something both sides of this debate seem strangely loathe to acknowledge) to come up with a better system.
Today's debate is simply the latest chapter, but it won't be the last one.
Rationing, it would seem, is here to stay. And its time for those who apparently missed the inaugural announcement to confront this long-established reality.
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