Monday, June 29, 2009

Reform Rx – Rational vs. Rationing

This weekend the “rationing” chatter seemed to go up a notch. This key fear tactic is one we will hear a great deal about. Those opposing reform are trying to get us to conjure up a black and white image of a dozen hacking and sniffing older patients first wallowing in a waiting room on hard back chairs in the summer heat before being called into a harshly lit metallic looking closet to be told by a unfeeling and faceless bureaucratic doctor that they can’t get the procedure for a few years.

The argument is purposely misleading and rationing of health care isn’t reform’s basic tool. The approach is about being rational not rationing.

Reorienting how we spend health care dollars efficiently does involve choices that the opposition will do everything possible to twist into a rationing nightmare. However very rational informed choices about what tests when, what drugs why and similar sound evaluations can help target heath care drive cost efficiency. When this rational approach uses information from well managed complete heath care personal records and navigates reasonably through the waters of defensive medicine, good medical outcomes can result. And positive outcomes are a critical goal to pursue. More focus on preventative medicine may well result in a decline of some procedures or prescriptions. Of course those rational declines will be cited as evidence of rationing!

This morning’s KJ had an interesting piece from the Washington Post by Michael Kinsley. It makes some rational observations on the myths about rationing.

The greatest myth ignored in this argument is that we already have severe rationing and that is what reform can help reduce. Having a profit focused system has rationed out to Americans as a whole an inferior, unequal, and inadequate system. HMOs feature rationing. Small businesses unable to offer health care plans represents a form of rationing. Pre-existing conditions discrimination and unfair claim denials are a form of rationing. Cherry picking and choosing who is insured is rationing. Large deductibles ensure rationing health care based on income. And non-universal access to reasonable care is definitely rationing.

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