I’ll Never Ration. Not Me. Not I.

Opposition to health-care rationing is a little like opposition to growing up. It sounds great. It’s just not very practical.

A society’s resources are always limited. So we have to make choices about what we can afford and what we can’t. Not everyone can afford to own a vacation home — which means vacation homes are rationed. Not everyone can afford to live in towns with excellent public schools — which means that good public education is rationed.

Similarly, we can’t afford to try every feasible medical treatment on every patient. Instead, we make choices. The most obvious form of rationing is the millions of Americans who lack health insurance today. Most of them get less medical care than they need and, in the process, keep down the nation’s total medical bill.

But even those with health insurance experience rationing. How? In many ways.

This country has not spent the money to install computerized medical records, and we suffer more medical errors than many other countries. We underpay primary care doctors, relative to specialists, and we’re left stewing in waiting rooms while our primary-care doctors try to see as many patients as possible. Specialists are usually not paid for time they spend collaborating with doctors in other specialties, and many hard-to-diagnose conditions go untreated. Nurses are usually not paid to counsel people on how to improve their diets or remember to take their pills, and manageable cases of diabetes and heart disease become fatal.

“Just because there isn’t some government agency specifically telling you which treatments you can have based on cost-effectiveness,” as Dr. Mark McClellan, head of Medicare in the Bush administration, has said, “that doesn’t mean you aren’t getting some treatments.”

Norman Ornstein of the American Enterprise Institute had an op-ed article Saturday in The Washington Post on a new form of rationing. He wrote about states, including Arizona and Indiana, that have begun refusing to cover the costs of some life-saving treatments for Medicaid patients:

    These are real death panels. They are far from the Affordable Care Act’s provision for end-of-life counseling for families to enable them to make rational decisions about their loved ones outside of the awful stress in a hospital or hospice. But these decisions are not being made by evil people reveling in the anguish of patients on Medicaid; they are the result of painful choices made by state governments struggling with a sluggish economy, balanced budget requirements and soaring Medicaid costs. States have to react, and one solution to their constraints is rationing care.

    In other words, the nightmares of conservatives bitterly opposed to health reform are coming true on two fronts, but with zero relation to the reform bill they opposed….

    This is not a future scenario. The dilemmas of state governments are here now. The same kinds of pressures have been building for years in nearly all public- and private-sector health programs as rising costs have to be met by measures to contain them, which means some form of rationing, whether done by employers, health insurers or others. The Affordable Care Act was spurred by these mounting pressures and included, in one form or another, nearly every idea for containing costs without resorting to the blunt instruments Arizona and Indiana are using. Those cost-retarding programs and vehicles are near the top of the incoming House Republicans’ hit list for the health-reform legislation. They may want to rethink their repeal efforts even as their counterparts in states are rationing up a storm.