Rationing

Rationing.  Is it ever acceptable?

As has been pointed out before, we ration every day in the health care system--even if we don't call it rationing.  The market rations by having prices that some people cannot afford.  Private managed care plans ration when they deny claims.  Public plans like Medicare ration care when they make policy decisions on what to cover and what not to cover.  Despite this, Medicare generally is viewed as a program that people who are already enrolled do not want to lose.  So, it seems like existing rationing (even by the government) is accepted despite the fact that "rationing" has been given a very bad name in the debate over health care that is ongoing at present.

Even more interesting is that there may be "new rationing" that is still not directly called "rationing" but that would be viewed as acceptable.  The New York Times had a July 29 article that talked about prioritizing for swine flu vaccine.  This article clearly pointed out who would be given priority for the swine flu vaccine--health care workers, people with high risks of complications, and people caring for infants who cannot receive the vaccination.  The last group would be those over age 65 despite the fact that this group is one of the most important groups to vaccinate against the typical flu.

The New York Times article  pointed out how much the committee that made these recommendations struggled.  However, there was no uproar immediately afterwards. The fact that there are some people who are more at risk is accepted.  The fact that there are some people whose benefit affect others--like those caring for young infants--is accepted.  In other words, given the fact that the price of the vaccine is the same for all, we could say that it is more cost-effective to vaccinate some people than others.

This is interesting given the general outrage over the idea of rationing and the idea of making resource allocation decisions guided by cost-effectiveness.