Wednesday, September 09, 2009

Rationing is the wrong word

In the ongoing debate over Obamacare, conservatives keep saying that the plan will lead to rationing of care, as too many people compete for too few doctors and services, and as the costs of Obamacare face the reality of exploding federal deficits.  But rationing is the wrong word to describe the process that Obamacare will subject us to.  The correct word is very familiar to emergency room doctors and the military-triage.

Ration is defined by Websters as 'a food allowance for one day' or 'a share, especially as determined by supply'.  Clearly, medical care is not in short supply in the US.  Compared to other countries, the US has more doctors and medical supplies per person.  Even a small town like Owatonna has a half dozen choices for purchasing prescription medication.  When we use the word 'rationing' to describe the likely effects of Obamacare, we are conjuring images of the last few major outbreaks of rationing in the US-the oil embargo in the 70's and the war shortages of WWII.  Neither one of these is a proper comparison to Obamacare.  In WWII and during the 70's, the nation faced an actual shortage of materiel, and what little there was was allocated to each person equally.  The only priority given was to those directly involved with the war effort.  The government divided the limited supply equally among citizens.

But Obamacare wont directly reduce the supply of health care in America, it will artificially reduce demand.  By introducing government control into health care, the Obama plan will allow the government to regulate demand for health care by determining what it will pay for.  Eventually, a lack of demand will mean a smaller supply, but that will be a ways down the road.

So what Obamacare is really going to do is not ration the supply of health care, instead it will triage the demand for it

Triage is defined as
1 a : the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors b : the sorting of patients (as in an emergency room) according to the urgency of their need for care
 In the army, we use a simple color code to triage patients.  Green for minor wounds, red for life threatening, and black for those not likely to survive.  Green patients are given routine care or encouraged to care for themselves until they can be evacuated.  Red patients are given heroic life saving care by medics and doctors and are given priority over everyone else.  Black patients are separated from everyone else and made as comfortable as possible.

 In order to extend health insurance to those who currently don't have it, and still be revenue neutral (or save money, which is what the Democrats still claim), Obamacare will have to cut services somewhere.  The easiest way to do that is to move patients from red to black.  Even moving the line between red and black just a little bit could mean thousands of people who are no longer eligible for life saving care.  President Obama suggested this himself, "maybe you're better off not having the surgery, just taking painkillers".  But Obama's notion that this would be a suggestion is laughable.  The entire point of Obamacare would be to establish government oversight over health care, and what procedures are justifiable at what point in a patient's care.

So when supporters of this health care reform tell you that there will not be any rationing, they are technically correct.  Rationing would actually be better than what we will get if this bill passes.

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