Section 2 - The truth about health care rationing 

     Part a) Why we have to ration

Let’s be clear, first of all, on what we mean by rationing health care.  Many definitions have been used, and most talk blandly about such things as the allocation of scarce resources, or the fair distribution of available benefits or goods or commodities. In fact, some experts reject the term “rationing” altogether (in favor of something more insipid, like “resource allocation”), because it has such negative connotations.

I object to such definitions on precisely the grounds that they are misleadingly soothing. There is nothing pretty about rationing health care. Rationing is bad, and if we’ve got to do it we might as well keep that in mind. It might keep us more honest

So here’s the definition I like. To ration health care is to withhold at least some medical services from at least some individuals who would probably benefit from them, because we have decided not to buy those services for everybody who needs them.

This definition has the virtue of being straightforward.  Also, it puts the onus on us (since we’re the ones deciding not to buy the services) instead of on those nasty “scarce resources” themselves. That makes it more difficult for us to dance around the real issue, which is, if we decide we’ve got no choice but to ration health care, then we ought to feel obligated to do it in the least harmful way possible.

Another advantage of this definition is that it gives us a starting point upon which we all can agree: The rationing of health care is undesirable, and so it should be undertaken only if there is no other alternative.

We need to agree on one additional point – that medical care is not free.  Somebody (even if it is not the patient, or the patient’s family, or even if it is not anybody alive today) must pay for it. But nonetheless, as long as the funds are available to do everything for everybody, there should be no rationing.

Thus, the central issue becomes whether sufficient financial resources are available to allow us to avoid rationing.  In considering this issue, we should ask the most difficult question first – is there a limit to what we should be willing to spend on health care?

Next: Why there are limits to what we can spend on health care

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