03/18/2010 05:12 am ET Updated May 25, 2011

Health Care Rationing: Why the "R" Word is a Red Herring

America has long needed a rational discussion of what we as a society are willing to pay for in a health care system and how best to provide it. Part of that discussion is rationing.

For example, it is fair to say that most Americans do NOT want to pay for other people's cosmetic plastic surgery. That's rationing and it has to be discussed.

Proponents of private health care are fear-mongering with the "R" word -- a specious tactic. First of all, it is ludicrous to imply that private insurance companies don't flat-out refuse procedures that people genuinely need or desperately want; and that they don't make those determinations based on cost/benefit analysis. A private policy is crammed with exclusions and conditions-- which is rationing.

Secondly, even if America opts for a private health care system, government always has and always will set the ground rules for coverage. The obvious example is preexisting conditions clauses. Many states have slapped on rules to prevent this unfair form of rationing, and now some conservatives are actually proposing federal regulations for the same purpose. Because private companies pursue the profit motive, not public health, government oversight is necessary.

Third, it is false to assert that government will necessarily be the more restrictive arbiter of what will and won't be paid for by "the system." Evidence in other sectors suggests precisely the opposite. Consider the plight of Special Needs children in private schools. In my state it is a given that Special Needs kids go to public school, because private schools have the legal right to reject them flat out, and they do so everyday. Only in public school are parents guaranteed services. And believe me, savvy parents armed with lawyers and "advocates" work the system to get what they need, and sometimes more than they deserve for their Special Needs children. These are realities that must be examined, problems that must be solved -- and the "R" word isn't helping.

Which brings us to the greatest hypocrisy underlying the "health care rationing" hoopla. Partisans raising this red herring have no compunction about rationing care they don't want to pay for. The obvious examples are illegal immigrants and their children, and pregnant women who want an abortion. No matter what you may think about either of these categories, it's rationing. And if you scratch the conservative mind a bit deeper, you find a rather coherent libertarian argument that, hey, taxpayers who take care of their health should not have to foot the bill for people who choose to smoke or over-eat and thereby incur diabetes and obesity. Some go a step farther: healthy people who don't go to doctors should not have to pay for the infirm and the hypochondriacs among us.

The suggestion that private health care plans relieve citizens of these burdens and dicey choices is simply false. We pay for each other's health care, one way or another. In the public option, through taxes. In the private option, through premiums, which are increasingly exorbitant -- not just because of "frivolous lawsuits" but also because of over-prescribing and personal freedom to seek care when we want it.

It's time to put away the "R" word and the misinformation associated with it. Choosing what to cover and what not to cover is a key factor in the health care debate. For that, America needs to have "ration-al" discussion.