Health care rationing

This Peter Singer article about rationing is the most interesting thing I’ve read about health care reform since Atul Galawande’s New Yorker piece about McAllen, TX (see Galawande respond to critiques of the piece here). Here’s the thesis:

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it. Health-insurance premiums have more than doubled in a decade, rising four times faster than wages. In May, Medicare’s trustees warned that the program’s biggest fund is heading for insolvency in just eight years. Health care now absorbs about one dollar in every six the nation spends, a figure that far exceeds the share spent by any other nation. According to the Congressional Budget Office, it is on track to double by 2035.

President Obama has said plainly that America’s health care system is broken. It is, he has said, by far the most significant driver of America’s long-term debt and deficits. It is hard to see how the nation as a whole can remain competitive if in 26 years we are spending nearly a third of what we earn on health care, while other industrialized nations are spending far less but achieving health outcomes as good as, or better than, ours.

For those who don’t know, Singer is a utilitarian philosophy professor at Princeton known for his controversial views in favor of euthanisia, foreign aid, and animal rights. Read his Wikipedia page for a synopsis.

But yeah, read the whole article, it’s good, etc. Here’s an additional point from Matt Yglesias after the jump:

Now consider something else. If you’re a parent in Montgomery County Maryland, you pay taxes to the county and you get to send your kids to very good public schools. But even though the schools are good, they won’t just do anything you want. Your kid can learn Spanish at government expense, but the taxpayers won’t foot the bill for your kid to learn Burmese. But you don’t normally hear anyone say that the presence of a “public option” for elementary and secondary education involves “rationing” of foreign language instruction. If people have the means and want to arrange private lessons for their children of various kinds nobody is stopping them. And certain forms of this sort of supplemental instruction—Hebrew school in synagogues, Sunday school in churches, piano lessons or Kaplan test prep—are quite common.

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