June 9, 2010 Liz Borkowski, MPH 7Comment

President Obama has nominated Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services, and he sounds like a great guy for the job. Julie Rovner reported for Morning Edition earlier today that Republicans are stalling his nomination, which isn’t out of the ordinary these days. But the part of her story that really pissed me off was this snippet from Senator Pat Roberts (R-Kansas), who said, “Dr. Berwick is the perfect nominee for a president whose aim has always been to save money by rationing health care.”

I would really, really like it if everyone who gets involved in the US healthcare debate could acknowledge one thing:


We may not have an explicit healthcare-rationing policy on the books, but we already ration healthcare based on insurance status and ability to pay.

If you’re in the 15% of the population without health insurance coverage, you’ll have a hard time getting the healthcare you need when you need it (unless you’re a millionaire or you never get sick). Even if you do have good health insurance coverage, you’ll face limits on how much and what type of care you can get – for instance, your plan probably limits how many physical therapy visits you can get each year. And many people who have insurance miss getting recommended care because they can’t afford the deductibles or co-payments.

Whenever I hear politicians or pundits trotting out the “rationing” talking point, they imply that it’s something we have to stave off because it threatens the system we already have. That’s misleading, and doesn’t do anything to advance the much-needed national discussion about how we’re going to get the growth of healthcare costs under control.

7 thoughts on “Time to Retire the “Rationing” Talking Point

  1. This was my biggest disappointment with the healthcare bill and the surrounding debate – there was no attempt to force the American public to confront the necessary hard choices. I thought that of all public officials, Obama would have been the one to finally “own” the rationing claim in public debate and respond to the incoherent claims of the opposition.

  2. from today’s email by Tony Perkins, honcho of the “Family Research Council” –

    Rationing Health Care? You Bet Your Life!

    The White House can plan all the health care PR it wants, but if it keeps nominating people like Dr. Donald Berwick to run the system, then the President is wasting his time. … As Sen. John Barrasso (R-Wy.) said, “President Obama didn’t mention that the new Medicare director, someone he’s recently named… is planning to ration care.” Or, as Berwick has said, “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open.”

    If you thought all the talk about “death panels” was conservative hogwash, think again. An anti-market socialist, Berwick once decried the U.S. health system as “trapped in the darkness of private enterprise.” With Berwick at the helm, Medicare and Medicaid programs are expected to cut billions of dollars in services. And why not? According to the socialist model that Berwick admires, it’s much cheaper to let sick people die.

    Perkins is quite useless as a source of facts, but he’s a very reliable weathervane for the hyperchristian faction of the Republican Party.

  3. You mean you want everyone involved in the health care debate to acknowledge the obvious truth? Yeah, good luck with that… Next you’ll be calling for them to debate rationally on the basis of measurable outcomes!

  4. Those of us who are sick, uninsurable and uninsured would welcome rationed healthcare or any kind of healthcare at all.
    I work hard just like everyone else and it is not right that I have had to go without my medicine or seeing a doctor for the past 2 years. Do you know how frustrating it is to see yourself deteriorate everyday from lack of medicine when you were in very good shape on the medicine? I paid for insurance just like you until I could not afford the COBRA premiums anymore.

  5. The sheer chutzpah of that triple claim — that Obama wants to ration healthcare (stated) while Republicans don’t (implied) and the existing system isn’t already rationed (implied) — is enough to make me feel ill.

    Republicans need to rediscover shame.

  6. Well, here we go again. Yes, agreed, rightwing objections to Obama’s health reform plans as “rationing” avoid recognizing the very real and vicious healthcare rationing we already have. To base much of one’s reform plan, however, on the Orzag et al. interpretation of the Dartmouth studies as if Dartmouth compared not only costs but outcomes–that is, to base one’s plan on a cost/benefit analysis that somehow dropped out the benefit considerations–quite arguably can lead to rationing, in this case primarily among Medicare patients. To some, it seems as if, rather than cut healthcare costs and extend access by removing the terribly high expenses of the “middleman”–health insurance companies with their dividends, high CEO salaries, marketing expenses, etc.–the reform plan simply shifts the rationing to a somewhat different cohort and to somewhat different areas. Policy makers now must strive to assure a somewhat better resolution.

  7. Paula: Seems to me that any form of healthcare is going to involve rationing of its “free” component, as doctors and medical materiel will always be (for the foreseeable future, anyway) a limited resource.

    Do we agree that Obamacare (even as flawed and industry-friendly as it is) will involve substantially less rationing than the present system, or are you suggesting that it just shuffles things around a bit?


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