Rationing Health Care

HEALTH care, 1989, will likely cost the United States more than $600 billion, or about 12 percent of the gross national product. This year Americans will spend about 50 percent more, on a per capita basis, on health care than Canadians, the second-highest spenders. Despite the great money drain, the US ranks 16th in the world in life expectancy. Minorities especially suffer from health problems. Blacks, on the average, suffer rates of infant deaths, neonatal deaths, and postnatal deaths that are twice as high as those for whites. Out-of-control health-care costs are driving millions of Americans out of the health market. At present, an estimated 37 million Americans are not covered by health insurance. And rising costs may further threaten the 160 million Americans dependent on employer-sponsored health-insurance coverage.

It is not surprising that emergency measures, including ``rationing'' of care, are being considered. In Oregon, for instance, a new law is intended to provide basic health services for a larger number of people on Medicaid while cutting back medical services judged to be less necessary. The law creates a health-services commission that will establish priorities for medical services. The commission, comprised of health-care providers as well as consumer representatives, will make decisions based on clinical information.

Many people instinctively react to this type of ``rationing'' arrangement as being somehow un-American and fundamentally unfair, because it targets the nation's poor. But Americans must accept the sobering reality that the sky is not the limit when it comes to health-care spending. If a poor person receives ``free'' health care, the care is free only to that person, not to society. Businesses that insure their workers, in effect, pay twice for health care: for their own workers, and again - because of inflated health-insurance premiums and higher taxes - for the employees of businesses not insuring their workers. At least some employers are experiencing health-care-cost increases of 20 to 30 percent annually. And from 1980 to 1987 federal health-care spending doubled.

The crisis may mean that rationing will increasingly be viewed as a sensible way to allocate scarce resources. Alameda County, in California, is apparently following the path cleared by Oregon as it proceeds with plans to ration health care for the country's poor. A large number of indigent-care initiatives are presently being considered in state legislatures and Congress.

One way or another, the country has to come to grips with the distressing problem of enormous health-care costs and the resulting inaccessibility of the health-care system to millions of Americans. Other industrialized nations have been able to keep health-care spending, as a percentage of gross national product, from blazing out of control. The US must do the same. Many of the industrial nations have constructed a national health-insurance system. In the US, however, this approach would represent a considerable reshaping of the present health-care structure. Another broad approach to the crisis is to expand governmental programs such as Medicare and Medicaid. Whether this is politically feasible, given the current budget crunch, is highly questionable.

There aren't any ``magic bullets'' here. The nation, instead, should prepare itself for what will probably be a slow, difficult, but much needed process of major reform of the US's present health-care system.

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