One of the biggest areas of debate in the health insurance reform is the idea of "rationing". It could be perhaps the most overused and misunderstood term in the debate. For example, Megan McCardle points out the now-predictable threat of "granny and a pacemaker".
But there is also a real difference between having something rationed by a process and having it rationed by a person. That is, in fact, why progressives are so fond of rules. They don't want to tell grandma to take morphine instead of getting a pacemaker. It's much nicer if you create a mathematical formula that makes some doctor tell grandma to take morphine instead of getting a pacemaker. Then the doctor can disclaim responsibility too, because after all, no one really has any agency here--we're all just in the grips of an impersonal force.
But this won't do. If you design a formula to deny granny a pacemaker, knowing that this is the intent of the formula, then you've killed granny just as surely as if you'd ordered the doctor to do it directly. That's the intuition behind the conservative resistance to switching from price rationing to fiat rationing. Using the government's coercive power to decide the price of something, or who ought to get it, is qualitatively different from the same outcome arising out of voluntary actions in the marketplace. Even if you don't share the value judgement, it's not irrational, except in the sense that all human decisions have an element of intuition and emotion baked into them. [More]
This is not my understanding of most of the proposals being considered - even the Republican ones - which back comparative effectiveness research (CER). Many critics hold CER as the thin end of the wedge leading to rationing. However, rationing as Megan describes only occurs if you prevent people from buying more coverage on the private market. Several other commentators point out this logical flaw.
Guaranteed minimum healthcare doesn’t forbid anyone to seek more on the private market – paying out of pocket, extra insurance. No more so than a guaranteed minimum income would forbid you to get a job to earn more than the minimum. So guaranteed minimal healthcare doesn’t ensure its minimum by positively forbidding anyone to get more. So it isn’t really rationing. (Is any of this getting through?) To put it another way: rationing is a response to scarcity. But the scarce item in the healthcare case isn’t healthcare, it’s money. (If you want to accuse the goverment of rationing taxpayer money, that would be closer to the truth, but still a weird way to talk, I say.) There just isn’t going to be any attempt by the government to ration healthcare, as opposed to its own spending of taxpayer money. Because: why would there be? [More]The rationing debate is one of the ways this debate is being waged in our fears. Given the uncertainty of the times, it could be an effective strategy for those who have oppose any changes. But if the campaign to stop reform actually stops it rather than helps shape it, what will they have won? David Frum points out some flaws in that strategy.
The problem is that if we do that… we’ll still have the present healthcare system. Meaning that we’ll have (1) flat-lining wages, (2) exploding Medicaid and Medicare costs and thus immense pressure for future tax increases, (3) small businesses and self-employed individuals priced out of the insurance market, and (4) a lot of uninsured or underinsured people imposing costs on hospitals and local governments.The health reform proposals a typically ugly pieces of legislative work. Not unlike the farm bill - heard any of the angry comments about ACRE recently? But those issues won't be ironed out with loaded language and misinformation.
We’ll have entrenched and perpetuated some of the most irrational features of a hugely costly and under-performing system, at the expense of entrepreneurs and risk-takers, exactly the people the Republican party exists to champion.
Not a good outcome.
Even worse will be the way this fight is won: basically by convincing older Americans already covered by a government health program, Medicare, that Obama’s reform plans will reduce their coverage. In other words, we’ll have sent a powerful message to the entire political system to avoid at all hazards any tinkering with Medicare except to make it more generous for the already covered.
If we win, we’ll trumpet the success as a great triumph for liberty and individualism. Really though it will be a triumph for inertia. To the extent that anybody in the conservative world still aspires to any kind of future reform and improvement of America’s ossified government, that should be a very ashy victory indeed. [More]
There is at least one reason to push the process too. Farmers know dang well you only have a tiny window of non-campaign mode before business in Washington devolves back to tracking polls against your primary opponent(s). It controlled the flow of the Farm Bill, and does so with most major legislation.
Right now the feeling is reform may run out of steam. I don't know, because too many on all sides of the issue want to see at least some things changed in the way we provide health insurance. And the more times we see seniors ranting about keeping "government hands off my Medicare!", the more times it sinks in who is getting the best of our current system.