If you wade through the various arguments made in opposition to governmental involvement in health care, you will soon find that it all boils down to one thing: rationing. People may speak of things like “socialized medicine” or “death panels” and make appeals to the free market as they bemoan the loss of personal freedom that they see as inherent in any health care system with almost any level of governmental involvement. What they are really saying is that they are worried that the government will make decisions for them and that they may not agree with the decisions that are made on their behalf. They are chiefly worried about rationing, which they define as the government refusing to pay for a health care good or service that the person anticipates they might benefit from some day. In fact, they often seem to think that the government will literally prohibit them from seeking the care they anticipate needing at some point in the future.
I will grant them that if such things were true, they would be terrifying. Thankfully, they aren’t true at all. What’s perhaps more alarming is how some people’s definition of rationing has grown so limited. Compare people’s concerns with the present reality: They are worried that government will make decisions on their behalf, which they may not agree with. Why then are they not equally as worried about all of the decisions already being made on their behalf by the employee benefits managers at the places where they work or by the claims specialists at their insurance companies? It seems to me that both situations violate the principal that individuals should be free to make their own decisions. People are also worried that the government will “ration” by preventing them from getting the care they need. The reality is that the government has no such authority and that money talks.
Here we are introduced to the true meaning of rationing, where prices dictate the exchange of goods and services. Today, anyone with enough financial resources can make an appointment with any doctor they choose, get any services they need, and so on. They don’t need insurance. They can, in effect, self-insure, and no health reform will change that. If the “Big Brother Plan” doesn’t cover something they need, they can simply pay out-of-pocket and get whatever care they want.
The flip-side of this is that those without the financial resources to do so cannot be assured of getting the care they need. Today, there are people who go without. Why? Because we ration care based on the ability to pay for it, and not everyone is able to do so. Health reform is designed to help these people gain access to basic medical care. Many of us, it seems, are unwilling to believe that this is rationing. Others surely understand the current system, and simply fear that in a world where rationing is inevitable, giving to those who have not will necessitate taking from those who have. To some extent they are right. However, the impact of that transition can be lessened by capitalizing on the reduction of systemic inefficiencies. Moreover, none of us can be certain that we will not fall catastrophically ill in the future, and if such a fate should befall us, I imagine that we will hope desperately for a system to come to our aid, rather than resign ourselves to suffer as victims of a system motivated by unabashed self-interest.