By Any Other Name, It's Rationing

If you’re a word person, as I am, you think words matter.

And if you listen to words being spoken and words being written, and insults being hurled, you know it’s all about rationing.

As it has to be. The supply of health care is a limited resource, and the demand in an aging population is unlimited. Health care money and professionals don’t grow on trees. It requires human and physical capital, and those resources are in short supply. No matter how hard you try, you can’t repeal the laws of supply and demand. You might be able to innovate your way out of rationing, but not with the current web of private and public regulations.

If you’re on the private side, which covers 253 million Americans, you ration through “co-payments,” “pre-authorization”, “costly premiums,” “individuals and small group payments,” “pre-existing illness,” high cost individual cancellations”, and other maneuvers and tactics to cut costs.

If you’re on the public side, i.e. Medicare and Medicaid, which covers 86 million citizens, or you’re pushing for Obamacare, you unfurl and deploy words or phrases like “public option,””health-cooperatives,” “leveling the playing field,” “honest competition,” “high-cost-low value trade-offs,” “evidence-based medicine,” “ outcome based care,“ implementing a set of performance measures that all providers must adopt, “ standardization,” "pay-for-performance," "quality metrics," “directly targeting individual providers and high-end outliers,” “limiting services to health care that works,” “comparative effectiveness research,” “QALY – Quality Adjusted Life Years.”

On the federal side, it’s about somehow stopping the financial hemorrhage of federal health programs, and it’s about what to do when you run out of other people’s money. And that means it’s about rationing.

On the private side, it’s about staying in business, and that means rationing.

And on the personal side, it’s about knowing what things cost, spending one’s own money, staying healthy, and self-restraint, self-reliance, and self-responsibility. And that means rationing one’s behavior.