Health care now rationed by ability to pay

By Bill Roy
Topeka Capital-Journal
March 13, 2009

Some claim universal medical care would open the floodgates of use and cost of medical care, and the government would soon be in the business of overtly rationing care. That's pretty frightening unless we look objectively at how we are now rationing medical care, and how badly our results compare with nations with universal coverage.

Today, only America among advanced nations rations medical care by ability to pay. And the results are horrendous except for rich Americans, many of whom are trying to scare you out of universal medical care provided on the basis of need, not price. They like what they have.

No one disputes that this nation spends at least 1 1/2 times per capita more for medical care than any other nation. Some studies indicate we do not get more medical care, we just pay more for what we get.

It's hard to have missed the numbers: $8,000 per capita this year; $15,000 a year for a family policy that may include deductibles and co-pays; annual increases usually twice the rate of increase of the gross domestic product; and government expenditures similar to nations with universal medical care.

Today, one of $6 goes for medical care and salaries of for-profit health insurance executives.

Our system of rationing medical care by ability to pay costs us money and lives. No other civilized nation requires a ransom to access medical care.

A 2002 study by the Institute of Medicine of the National Academy of Science estimates conservatively that 18,000 people died in 2000 because they did not have health insurance. The IOM further concluded "137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006."

Rationing medical care by price is deadly for the poor, but not for the rich. Health and Human Services studies indicate the rich live on average 4½ years longer than the poor in America. This difference is widening as incomes have widened more rapidly since Reagan and the rich won America's class war.

Our nation, which is the only industrial nation in the world that rations medical care by price, ranks 41st in the world in life expectancy. We lose more young lives too.

America lags in newborn mortality and children who die before age 5. Forty-four nations have lower death rates before age 5 than we do.

One can only conclude our medical care rationing system is both very costly and very deadly, especially for poorer Americans. It would be difficult not to do better with any universal care system that does not ration care by ability to pay.

Nations where individual states plan and administer medical care systems can work well, and could approach utopia if they had as much money as we spend. Federal Medicare worked very well until Republicans and their fellow treasury-raiders legislated Medicare D and Medicare Advantage, programs set up to favor for-profit providers, not patients or taxpayers.

How well and at what price states could deliver medical care will depend on how well-structured their delivery systems are and the availability of proper personnel. With resources now available in America, waiting lines or delayed services would be the exception.

No medical care system can do everything for everyone everywhere.

Services are and will be available in Topeka that are not available in Hays, and services will be available in Hays that are not available in Goodland. But movement through the system, whether physical or administrative, can be planned, facilitated, and markedly superior to our present non-system.

In sum, we can have a rational system and use it to its optimum as needed. Any covert rationing would come about because of limitations of personnel or physical facilities, which at current expenditure rates would be highly unlikely.

Beware of those who feign fear of medical care rationing in any universal system, but seem unaware of the death-dealing results we have in our present system of rationing by ability to pay.

Dr. Bill Roy is a retired physician and former member of Congress. He has a law degree and lives in Topeka. He may be reached at