by Bob Maschi

The right is squawking (same tune, different subject) about 'rationed health care.' The claim goes that the plans currently being discussed include a system of 'rationing' health care. Some people (fans of low-budget science fiction flicks, no doubt) go so far as to claim that 'death panels' will be set up to select those who live and those who die.

Lost in the nonsense is an important fact. Our health care is already rationed! Actually, every health-care system on the planet rations care. No place provides every test, every injection or every examination available to every patient. Of course, health-care systems choose how to ration that care in different ways.

The Need to Ration Health Care

Health care is an investment. Not only is it an investment by the individual, but it is a social investment as well. The individual (usually) wants to live a long life, a life uncomplicated by serious medical conditions. A society might choose the same thing, encouraging longer periods where people can be productive, and then to set positive examples of how one should strive to enjoy their retirement.

But health care can also be expensive. It takes an incredible amount of education, training, more education and experience for a person to become a competent doctor. Their support people, the nurses, EMT's, anesthetists, pharmacists and others, also require a significant amount of training and education. Add in the cost of their equipment; those monsters with all kinds of wires and dials and bleeps and blips. More, add on the costs of developing tests and cures and any society that takes the medical profession seriously must find a way to invest an incredible amount of money.

There is no limit to the amount of health care a person or people could get. Imagine a society where everyone got a daily dental and eye exam, an MRI every other week, a different vaccination every couple hours and an experience doctor (in a chauffeured ambulance) tailing them closely in case they should suddenly suffer a heart attack or car crash. It can't be done. So, health care must be rationed.

How to Ration Health Care?

Since we will always have a limited amount of health care available, how do we distribute it? Who should get health care? More, how much health care should people receive? And then who decides?

In the United States this is all decided by our economic system - capitalism. Generally speaking, those who can afford health care, get it. Those who cannot afford it, do not. Of course, we have some social safety nets set up including Medicaid for the poor, Medicare for the elderly, Veterans Hospitals and an occasional free clinic (but I can't recall any time in the last few decades when these programs weren't under financial attack by one or both of the corporate-controlled parties). A lot of the programs for the poor lack even basic coverage. For example, given the moods in Washington, poor people with dental problems, metal-health issues or failing eyesight may have very limited options. Likewise, often only stabilizing care will be provided. If a poor person breaks a limb in a car crash it might be mended at the local emergency room, but physical therapy to get that limb moving correctly again may not be offered.

A financial step up from the poor are working people and their families. Many of these people have health insurance, often through their employers. There are several problems with this. First, this is actually a temporary form of insurance, in that if one loses their job, they also lose the employer's contribution toward this insurance. In addition, this insurance is usually quite limited. It often has high deductibles and even when it begins to pay, it only pays a percentage of medical costs. It is not hard to imagine a hard-working person who has a 'good' insurance plan through their employer needing some expensive operation and being forced into bankruptcy because of the costs not covered.

On the other end from the poor and working we have a small but very powerful group of extremely wealthy individuals who can afford all of the medical treatment they want. While a homeless person can suffer in pain for years with a toothache, the rich can afford nose jobs. As a non-union construction worker slowly goes blind for lack of care, the wealthy can get tummy tucks, Botox injections and have their asses bleached. The rich are denied no care at all. They not only get what they need, they can get whatever they desire. No doctor or hospital will turn them away.

This is how health care is currently rationed in this country. The more wealth you accumulate, the more (and the better) care you get.

Is There a Better Way?

Is there a better way to ration health care? Should the size of one's bank account be the only real factor in the quality of care one receives? The current system generally rewards a person born into a wealthy family along with the associated crooks and schemers who did nothing more for society than develop a way to steal an unfair share of its wealth. Are these really among the few people in our society who should get consistent and quality health care?

Another way of distributing health care would be a system based on need. The people who need health care get that health care (note that this route does not prevent people, wealthy or otherwise, from buying medical care above what is guaranteed). Would such a system also be rationed? Of course! There will always be more people needing transplants than natural organs available for transplanting. There will always be too few doctors and nurses within an area hit by a natural disaster. But we can do a lot better.

This is, primarily, a moral issue. We have to ask ourselves a simple question: What form of society allows so many of its members to suffer unnecessarily while so many others get silver-spoon care? Is it really good for society for so many to be worried about not being able to afford health care for themselves and their children? Isn't it interesting that many of the people so concerned with 'life' are the same ones opposed to guaranteed health care?

This is an economic issue as well. Delayed medical care often results in much bigger, and much more expensive, medical problems later on. Investing in people's health early on saves money by preventing situations from becoming more serious and leading to loss of sleep, loss of work and even loss of life. We aren't only talking about prevention here _ eating right, exercising, etc. We are talking about preventing generally minor medical issues from worsening over time by affording early treatment. Further, healthy people don't spread diseases to others, thereby lessening the need for more care going to more people later on.

Unfortunately, the moral and economic benefits of providing care to all are overshadowed by the political aspects. As people suffer, the two corporate parties play games.

First, we need to distribute the health care we have available around more equitably. Much more equitably. Then, we need to increase that health care for everyone. We have to financially help people who want to serve humanity by becoming doctors or other medical professionals. We need to reign in the ridiculous profits of the drug and insurance companies. And then we have to stop building more prisons and start building more hospitals.

In brief, we need to spread the health.
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