To get back to the subject of my last post, anyone who tells you that public health care plans do not ration care or that ObamaCare will not is misinformed.
If someone tells you that health care is currently rationed, he would be right. Under the current system health care is rationed by market exchange. You - whether individually or through your employer through premiums and forgone wages - buy only so much coverage. Your choice is, of course, constrained by a variety of circumstances. You don't have unlimited amounts of money. You have other needs that must be provided for. Regulations require that your coverage be the same as others in your plan (at least within a limited group of largely equivalent choices) - at least if it is to be tax exempt - so you may not be able get precisely what you want.
For those without coverage, care is rationed by the willingness of the state and providers to offer care. The latter choice is, of course, affected by anti-patient dumping laws.
The end result is that whatever rationing exists is the result of a decentralized process that, within a fairly intrusive regulatory framework, responds to choice and ability to pay. Its advantages are that it does not require anyone to be omniscient. It does not set up a single "honest broker" to decide what care is and is not worthwhile. It allows those decisions to be made from the bottom up, rather than the top down. Although it is far from an unfettered market, it provides incentives to innovation and the results, in the development of breakthrough procedures, technology and pharmaceuticals have been spectacular. American medicine is the engine that drives the improvement of care around the world and that fact is not unrelated to the existence of our limited free market for health care.
But we should not be surprised that this comes at a price. We live in a fallen - and therefore - paradoxical world. Sweet and sour tends to be the way of things. Our system is not as egalitarian as we want it to be. Poor people don't get the same quality care. The market agreements that ration care are affected by the distribution of wealth. The provision of care through employment is an historical accident and a source of economic inefficiency.
And - this is the thing that neither side of the debate wants to talk about - it doesn't ration much care. The reason that we pay so much for health care is the very "problem" identified by President Obama and cited in the last post. We spend enormous amounts of money on care for persons in their twilight years and for the chronically ill. You are, to be sure, more likely to receive this care if you are insured or a person of means, but remember the overwhelming majority of Americans are insured and Medicare and Medicaid do the exact same thing, albeit not quite as generously.
It turns out that - given the choice - we want that hip replacement even though we have cancer. We want a pacemaker even if we are 83. We buy coverage - again often through our employers - that provide for it and we pressure government programs to provide the same thing (although they tend to shift the cost to private payers).
This is one of the reasons that statistics tend to show that American health care (measured by the success of medical interventions such as cancer treatment or bypass surgery) is better than what is on offer anywhere else in the world, yet Americans don't have longer (and may have shorter) life expectancies. We are a rich country and we pay an awful lot for a little more - or a little better - life. But, as a statistical matter, this may be overcome by impacts that are not much related to medical care and that may be side effects of our wealth or our relatively individualistic and libertine culture.
The "public option" takes dead aim at this. And that's the subject of the next post.