| Description |
The acknowledgment that we can not meet all society's health care desires, or even needs, is a necessary precursor to meaningful health system reform. Like any other situation where resources are limited and demands are not, some form of rationing must be utilized to distribute benefits. This paper argues that an explicit rationing system is more morally just and practically effective than the implicit rationing that currently exists in American health care. It is also, I believe, an integral component of comprehensive health care reform. I suggest a political framework for implementing such an overt rationing scheme as a part of a larger reform package. One of the gravest problems facing this approach is the pejorative meaning that has come to be attached to the word rationing. The complications that ideology create for my suggested process is explored through the use of Murray Edelman's concept of symbolic politics: politics that is emotional rather than rational in basis. In developing my framework, a literature review was conducted into research on the current state of the American health care system, the public policy making process, and critiques of rationing by both proponents and opponents of the concept. The practical implications of developing a rationing system were evaluated by a comparative study of the experiences of the United Kingdom's National Health Service and the proposed Oregon Medicaid initiative. I suggest that the political process leading to the implementation of an explicit rationing scheme must have several essential factors. All major health care stake holders must be involved reserving an especially important role for the American public, the consumers of the final product of the process. There must be some type of "escape valve": an intrinsic means for consumers to express disagreement with proffered treatment options without questioning the legitimacy of the entire rationing scheme. And finally, rationing should only be applied in conjunction with, never as an alternative to, other vital reforms in the health care system. |
