I think one of the problems in conducting the health-care debate — shoot, in conducting almost any debate, regardless of the subject these days — is the absence of common ground and common understanding.
So as an experiment, let’s take just one piece of the issue and see if we have an agreement on the facts:
Does everyone understand and accept that health care is rationed today, right now, for almost everyone who doesn’t have access to tens fo millions of dollars they could spend if necessary on medical bills?
When an insurance company denies coverage because of a pre-existing condition, it is rationing health care. When it “rescinds” coverage — telling a client with a serious, expensive medical issue that it is canceling his or her policy — it is rationing health care. When an insurance company refuses to pay for a particular procedure or medicine, it is rationing health care. When uninsured people are turned away from hospitals and doctors’ offices, health care is being rationed. (And if anybody thinks that doesn’t happen, remember those long lines in Los Angeles when doctors offered free care to the uninsured. That was a lot of suppressed demand for health care that people could not acquire through other means.)
Once we accept that health care is being rationed at every turn in the current system, we can talk honestly about the fact that it would also be rationed under the system proposed by President Obama. Some current means of rationing would be abolished as counterproductive — you couldn’t be denied coverage for pre-existing conditions, and coverage couldn’t be withdrawn or rescinded if you actually got sick.
Other means of rationing would be enhanced. Medical data would be aggregated and studied to determine which procedures produced the best outcomes, and which do not. That’s a cost-control and efficiency method practiced in one version or another in almost every major industry, and was endorsed by a lot of conservatives until Obama incorporated it into his plan, at which point it became evidence of — gasp! — rationing.
Health care is rationed today, and it will always be rationed. The issue is whether it will be rationed rationally, so to speak.