More thoughts on rationing

Anyone still interested in the discussion of whether we have health care without rationing in the United States should consider reading a piece by Peter Singer (a professor of bioethics). It is long, but worth the read. The main point he makes is that every system rations in some way. The system we have right now primarily rations by price--if you can't afford care you won't get it. Regardless of the reform that is adopted, our system almost certainly will continue to ration by price (at least in part) as people who cannot afford certain types of care will not receive it and those who can will.

What I find most useful about Professor Singer's discussion is the following quote:

"Will Americans allow their government...to decide which treatments are sufficiently cost-effective to be provided at public expense and which are not? They might, under two conditions: first, that the option of private health insurance remains available, and second, that they are able to see, in their own pocket, the full cost of not rationing health care."

This is one thing that individuals on all sides of the political debate may be able to agree. People who can afford to buy more than whatever public option is made available should be able to do so. In fact, we probably couldn't prevent it even if we tried. However, people who want more coverage should have to purchase it on their own. Think of what this would achieve. Everyone would have a minimum. The burden to society of the minimum might be controllable. Everyone who had more could buy more if they wanted; and everyone who bought more would be completely responsible for it themselves. Yes, that would create a two-tiered system. But, as I and others have stated before, it is already the case that people get vastly different health care in the United States now as a result of their income or insurance.

And, that last point, is the one thing that no reform is likely ever to change.