More On Rationing Health Care: Does The US Ration Other Important Services?

After I posted my last entry (FYI: An Important Newspaper Article About The US Health Care Mess), I got to thinking about the concept of rationing health care- that is, providing health care for some problems and not for others.  It really boils down to money; if one has a health care budget and if the demands cost more than the budget and if one is not willing to allow deficit spending (by either printing more money or borrowing it) some health care demands will not be paid by whomever writes the checks.  Of course, that does not mean a person whose health care service request was denied cannot go out and buy the service on their own, unless such an approach is not permitted.  The idea that someone somewhere will be making life and death decisions about access to health care services makes most people uncomfortable.  But maybe we need to think about rationing in a much broader context?

How much is a human life worth?

Our society already rations many services that put a price tag on how much a human life is worth and seem to  we accept the approach.  For example, private citizens, industry, and the government (federal and state) already determine how much to spend on transportation safety.

In building roads and in setting rules for transportation, governments look at costs and then try to strike a balance between the most safe possible solution and a downright dangerous one.  Having limited access roads, long merge lanes, dedicated lanes for large trucks, etc. makes for safer roads and fewer traffic accidents.  Unfortunately, such roads cost much more to build than roads without such features.

We could build the safest possible roads everywhere except that highway departments have finite budgets and must decide on how best to spend their money.  The decisions are often based on statistical information regarding the likelihood of motor vehicle accidents leading to injuries or deaths given the volume of traffic, speed, etc.  Often historical data are used to help make decisions whether or not to make road improvements, such as adding a traffic light to a certain intersection- only after so many injury motor vehicle accidents at the intersection in question is it “worth” spending  the money.

Individual decisions that balance safety vs. costs

When people shop for cars, they usually have a pretty good idea how much they can afford to spend.  Once they pick out the brand and model they are interested in, they usually then decide which options to purchase, including safety features (thank goodness more and more, vehicle manufacturers are including important safety features as standard equipment, such as multiple air bags and stabilization control) which are known to save lives in the event of an accident.  If money were no object, most people would get the safest vehicle possible.   But costs do matter to people and they routinely make personal safety decisions based on their cost analyses.

Rules that balance safety vs. convenience and personal freedoms

Let me give you  one last set of examples to illustrate the fact that health care rationing is not all that different from  rationing we already do in other areas.  It is well known that using  seat belts save lives, yet the US has moved very slowly to make seat belt use mandatory (and even when mandatory, the consequences for not wearing a seat belt are minimal).  It is also clear that lowering speed limits on roads saves lives, yet we as a society are reluctant to impose major restrictions on individual freedoms.   It’s the same for states that do not have helmet laws for motorcycle riders.  I could go on and on.  I am not saying that the government should or shouldn’t be able to limit individual freedoms if certain rules can save lives but only that we already make many decisions in our society that truly have life and death consequences.

So, in many ways our society does put a price tag on how much a human life is worth.  Of course we do not have a single well accepted formula for calculating the value of a human life and there is no consistency in the approach from issue to issue.  That’s what makes the notion of rationing health care so difficult to come to grips with, yet we must find a way to do that if we are to improve US health care in the end.  I am quite confident that we can control costs and attain universal health care access.  I’ll try to persuade you in subsequent entries.

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