HealthCare Rationing Through Rationalization

People spending more of their own money on routine healthcare would make the system more competitive and transparent and restore the confidence between the patients and doctors without government rationing.

Benjamin Carson, MD,  Neurosurgeon,  Johns Hopkins

If you believe that healthcare is a public good to be guaranteed by the state, then a single-payer system is the next best alternative.  Unfortunately it is fiscally unsustainable without rationing.

Charles Krauthammer, MD,  Psychiatrist turned political commentator

While rationalization at the individual level is a plea for more autonomy, at the social level it is often a claim of power to stifle the autonomy of others.

Thomas Sowell,  Senior Fellow,  Hoover Institute

In political circles,  the word “rationing” is a no-no.   Rationing evokes thoughts of  sacrifice of personal freedoms.  That thought  does not play well in  America,  the land  of freedom and abundance. 

But present healthcare costs, particularly of Medicare, are  unsustainable.   Therefore, in one way or another,  you  must be rational.   You  must “rationalize” – make your case rational or conformable to reason be removing unreasonable alternatives.

If you believe in personal freedoms without rationing,  you argue that the marketplace is the best way of distributing healthcare goods.  Here, consumer cost sensitivities or incentives  are the mechanism for  rationing care.  You do not need to use that awful word “rationing.”   You let price become your rationing tool.

If you believe the state should play the dominant  or exclusive role in distributing and paying for healthcare,  you take different tacks.  

One, you can make it difficult to order, perform, or receive a test or a procedure by creating paperwork that must be waded through or complied with  before the test or procedure can be done.   This  approach leads to delays or obstacles or denials of care, and goes under the headings of  “Rationing by Bureaucracy,” or “Rationing by Waiting.”

Two,   you can control costs by making physicians wards of the state or wards of organizations.    Since physicians do not like  to be considered state employees,  you take the second choice.  You pass a law that creates regulations where physicians need to become hospital employees to have access to capital, resources, and technologies to fight or avoid those regulations.  Or you  create organizations that make physicians “accountable” and create “savings” for the government.   You can call these approaches, “Rationing by Consolidation,” or “Rationing by Accountable Organizaitions.”

Three,   you  can rationalize care by paying only for that care or those procedures or tests that produce  favorable outcomes compared to other forms of care or other procedures and tests.     This is done by  compiling massive amounts of data comparing  one approach to the other under the cover of “outcomes research,” or “paying-for-performance” for those healthcare institutions or individuals who achieve the best results.  This approach is completely rational and is understood by healthcare managers with MBAs and healthcare policy makers with MPHs. Indeed, “”Rationing by Outcomes,”  or  “Rationing by Objectives.”

Tweet:    To make healthcare costs sustainable,  you must “ratio “care by “rationalizing”  care in a way that fits one’s political philosophy.