Section 8 - Fixing our health care system

               A case for open rationing - Answering the arguments

Those who insist that open rationing can only be disastrous have used four major arguments. 

1. Rationing is unfair

This argument implies that we have a choice about whether to ration health care at all.  We don’t.  We’re rationing right now, and as I have tried to make plain, covert rationing is as unfair as it gets.  What we’ve got today is an “every man for himself” mentality, with every faction within the health care system in a mad scramble that rivals the great Oklahoma Land Rush in its desperate grab for turf.  Patients, meanwhile, are left at the starting line with nothing but empty assurances.

Open rationing, of course, also has the potential to be unfair.  But it presents us with an opportunity to devise, openly and publicly, a health care system that strives for fairness – as opposed to a secretive system of covert rationing, that systematizes unfairness.

2. We shouldn’t ration until we’ve eliminated all the waste and inefficiency

This is a typical response when the issue of health care rationing is raised. It rests, first of all, on the fallacy that eliminating waste and inefficiency would allow us to avoid rationing.  As we have seen (in Section 2), it wouldn’t. 

Further, open rationing itself will become a powerful motivator – possibly the ultimate motivator – for identifying and eliminating inefficiencies within the health care system (and also outside the health care system, since waste within all social programs will impact on the health care budget). With open rationing, in fact, we should be able to achieve a level of efficiency we could never achieve without it.

3. Open rationing means the Clintonians will win in the end

It may seem as if our discussion so far has implied that a single-payer, government-run (i.e., Clintonian) rationing plan will be the only viable option for developing a system of open rationing.  Fortunately, this is not the case.

Indeed, according to Principle 3, an optimal rationing plan will minimize the amount of rationing that must be “imposed” by third-party bureaucrats, and instead will maximize the amount of rationing done “voluntarily,” by the patients who are directly affected by rationing decisions.  Such a system of open rationing can be founded on changes in governmental policies that eliminate the bizarre incentives that exist today, that empower individuals and provide them with incentives to consider for themselves the cost/benefit ratio of optional medical services, and that encourage the health insurance industry to provide new, fairer and more efficient products.  The details of how this can be accomplished is discussed in the Appendix.  Suffice to say here that open rationing does not have to represent an ultimate victory for the Clintonian school, and indeed, if we adhere to Principle 3, it cannot. 

4. Open rationing will be too disruptive to society

It’s difficult to make a definitive statement refuting this one.  There is no doubt that any debate on how to do open rationing will be painful and difficult.  And any process that requires abandoning basic premises (such as the American health care myth) tends to be disruptive.

But the choice here is not between open rationing and no rationing at all.  It’s between open rationing and the covert rationing we’re already doing.  We’ve seen how covert rationing does many things that are destructive to us as a society and as individuals.  It is difficult to visualize any way in which covert rationing can be made significantly less so.

Open rationing, on the other hand, at least has the potential of becoming a force for good.  It is inherently honest instead of inherently dishonest.  It openly acknowledges a limitation that truly exists, and places trust in our citizens to find a way of dealing with that limitation fairly and equitably. Accomplishing a just system of open rationing will require us to acknowledge our duty to one another.  It will require us to reaffirm the importance of the individual, but at the same time to acknowledge that our own freedoms, rights and well-being are interconnected and dependent on the freedoms, rights and well-being of the other individuals in our society.  It will require us to re-articulate our basic principles and to re-establish communal priorities.

Goaded on by the reality of having to acknowledge rationing, we may even find that we can actually improve the level of health within our society. Open rationing will require us to enfranchise those who are now disenfranchised from the health care system.  It will require us to work together to assure that the money we have available to spend is, to the fullest extent possible, used to deliver effective and efficient medical services to patients who need them.  With single-minded efforts to this end, we may even find that beneficial health care services will actually not be restricted nearly as much as we may think.  By acknowledging rationing, we will actually be able to minimize rationing.  If we can figure out how to do it well, open rationing may lead us to become a stronger people, and a healthier people, than we are today.

Next: Six guiding principles for open health care rationing

Return to YourDoctorintheFamily.com home page