Rationing

by digby

We do it. But we ration the American way, which is by winners and losers. If you are rich, no problema. If you’re poor, well —

A recent article in the journal of Clinical and Investigative Medicine finds that a move to Canadian-style wait times might actually be an improvement for the United States. The study, by Kevin Gorey and colleagues, compared wait times for breast cancer treatment in the United States with those in Canada, and found that low socioeconomic status was a major factor in creating long wait times for patients in the U.S., whereas it played no role in determining wait times in Canada.

On the whole, there were not group differences in wait times between the U.S. and Canada. The authors note that high-income Americans had shorter waits than the average Canadian, but that low-income Americans had longer waits than the average Canadian. Most notably, while Canadians might face slightly longer waits than wealthy Americans, they were all able to receive the treatment that they needed. By contrast, in the United States, many of the least well-off were subject to what the authors term “the longest wait of all.” That is, they received no treatment at all.

What does this tell us? Primarily that the Canadian system is far more equitable than the highly inequitable system observed in the United States, characterized by the polarized groups of people at the extremes of an income distribution. This is evidence, first and foremost, that we already ration care in the United States, not on the basis of need, but on the basis of price. The study also demonstrates that on the whole, the increased waits that would be experienced by a few of the wealthiest Americans would be more than offset by the decreased waits experienced by those less well-off.

The question is: How selfish are we?

That’s probably not the right question. I think most people, certainly Americans, are pretty selfish.

The question is, how sure are you that you won’t get sick, lose everything you have and then be one of those losers who have to wait for health care? It happens every day to people who used to be middle class workers and who are now living in a nightmare from which they can’t awaken.

Everyone but the very wealthy in this country are just one illness away from being at the back of the line. That’s the kind of stress that people in other countries don’t have and it allows them to take risks and live happier lives.

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