Thursday, December 25, 2014

Coming soon to a state near you: Health care rationing

No one wants the government to ration health care. Least of all, many of health reform's staunchest opponents. They warned that Obamacare is a veiled attempt to let bureaucrats decide what treatments our doctors can give us.

Coming soon to a state near you: Health care rationing

No one wants the government to ration health care. Least of all, many of health reform’s staunchest opponents. They warned that Obamacare is a veiled attempt to let bureaucrats decide what treatments our doctors can give us.

As it turns out, we didn’t have to wait for Obamacare to take effect to see government rationing in action. States across the country have started using it to control spending, and there is more to come.

The rationing is taking place in state Medicaid and similar programs that provide benefits to the poor. The most dramatic initiative took effect last fall, when Arizona’s Medicaid program stopped paying for many kinds of organ transplants. The state claimed they are not worth the cost.

At the time, there were indications that the legislature would reverse the action. But when it reconvened in January, it failed to act. To the contrary, Republican Governor Jan Brewer is now looking to cut Medicaid even further.

Other state cutbacks are less dramatic but still significant. California eliminated most Medicaid dental coverage. Illinois is delaying Medicaid payments to pharmacies, forcing some to stop participating in the program. And 19 states have cut back programs that provide free HIV medications.

Opponents of rationing warn that it will cost human lives. In Arizona, they appear to be right. Since the cutbacks took effect, two Medicaid patients needing transplants have died. One of the deaths has been directly tied to the coverage restriction.

Where have the rationing opponents been while this has been taking place? Their silence has been deafening.

What’s more, some of the politicians most strongly behind Medicaid rationing are the same ones lambasting Obamacare for allegedly trying to do the same thing.

Either rationing is a legitimate cost control technique or it is not. How can it be acceptable to use it for the poor but not for everyone else? The value of your life should not depend on your income.

Many experts predict that, whether we like it or not, some form of rationing may eventually have to be considered as a way to save the health care system from financial collapse. Do health reform’s more strident opponents wish to promote a reasoned public debate concerning it? If so, they must first decide which side they are on and stick to it.


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About this blog
Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
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