Thursday, June 12, 2014

Fear of Health Care Rationing

A quick note on something that the reader will have understood from the start, but which has just become apparent to me. Sometimes I'm slow.

Rationing of health care has long been a huge bugaboo. I remember that my father said, “Why are people so stupid to talk about the evils of rationing? We already have rationing, we have to!” He thought people were just being stupid.

Well, they weren't being stupid, just a bit disingenuous. Yes, of course we have rationing. My Dad was thinking about what doctors do in guiding patients to one path or another. They ration. But much more importantly, as long as there is any element of the market in health care, we ration care as we do any other good or service, by price. It's clear that the poor get less than the rich, and the in-between – the working poor, those just above the Medicaid eligibility line – get less than anyone.

So, when someone says, “We don't want rationing!” (think, Sarah Palin), what are they really saying? What they are saying is that they don't want to get less than they are already getting. Don't take something away from me and give it to the poor or anyone else – that's the real message. They can't say that directly most of the time, but “don't ration” is code for “don't take it away from me.” And don't give it away to my most feared competitor, those right under me.

As always, those most threatened are those just above the poor, or those just above the working poor. They are the most conservative elements, usually, except for the superrich. (And what is it with them? Are they really just selfish pigs, or do they unconsciously believe that they have no right to what they have, and so are all the more and very insistent on their right to have what they have and more, in a kind of reaction formation?) “What's the Matter with Kansas” investigated why that group of working class voted against their own economic interests, and found that they were diverted toward social conservative ideas by the class above them that really stood to benefit from the conservative economic policies pursued by conservative politicians. But I think the key is, don't take away from me what I already have and give it to those below.

I remember a staff member at Bayside who came from a labor union family. We asked her why she wasn't for the Clinton health plan. She said that everyone having the same plan would mean that she, and everyone else, would have the equivalent of Medicaid. In other words, her take would be downgraded. We were amazed she didn't have our optimistic outlook, but in looking back, I can't blame her. Maybe she actually had it right. After all, even strictly socialistic health care systems have parallel private systems. So, even if you even things up, the upper wealth sectors will have private systems available. It will be the currently strongly insured who have their resources diluted, because they will have to share strictly with the newly enfranchised, while they upper crust won't.

So, as I said, I bet 90% of people understand this, but I didn't really, and now I think I do.

budd shenkin

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