Democrats are against health care rationing if it's done by insurance companies. Republicans are against it if it's done by government.
What neither side will admit is that medical rationing is part of the future. We can't afford a system where everybody gets whatever care they want regardless of cost and effectiveness. The only question is whether we'll ration intelligently and fairly. Or not.
We ration health care today. Medicare fully pays for only three weeks of rehab after a hospital stay. That's rationing.
When your insurance company covers only 30 days of inpatient psychiatric treatment, that's rationing. When Medicaid covers people making a certain portion of poverty-level income but rejects those making slightly more - ditto.
"We don't have unlimited resources to spend on health care," says Dr. Sean Tunis, head of the Center for Medical Technology Policy in Baltimore. "And we're already neglecting other important social needs because there's simply not enough money."
Republicans are supposed to get this. They're supposed to be the party that understands waste, limits, cost/benefit trade-offs and what happens when you let people (patients and doctors) spend somebody else's money (insurance companies' and taxpayers').
These days they sound like their own caricature of a Democrat, pretending that resources are endless, that everybody gets what they want and that measuring efficiency is the same as euthanasia.
Tunis is in the middle of all this because he's helping lead the parade on "comparative effectiveness," the long-overdue effort to find out why the United States spends roughly 70 percent more on health care (as a portion of its economy) than other developed countries but gets worse results.
Until 2005, he was chief medical officer at the Centers for Medicare and Medicaid Services in Woodlawn, overseeing quality and clinical standards for the huge government programs. He founded the Center for Medical Technology Policy to help doctors and patients learn which new procedures and pills work best. In February he was appointed to a federal committee on comparative effectiveness created by the stimulus bill.
But even he doesn't sound very optimistic that what he's doing will affect policy or practice any time soon. He does what he does, he says, "based on the faith that somewhere in the near future there will be a market for the information."
