The Rationing Canard

| Fri Aug. 28, 2009 1:24 PM EDT

Ezra Klein takes a bat to Charles Krauthammer's claim that national healthcare inevitably leads to rationing:

A 2001 survey by the policy journal Health Affairs found that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent....There is, however, a flip side to that. The very same survey also looked at cost problems among residents of different countries: 24 percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22 percent said they didn't get a test or treatment. In Britain and Canada, only about 6 percent of respondents reported that costs had limited their access to care.

The problem, of course, is that the U.S. rations by denying healthcare to poor people, and the Krauthammers of the world don't really care much about that.  What's more, for all that we like to think of ourselves as nice people, most middle class Americans don't care much about it either.

In any case, Krauthammer also violates two of my standard rules for figuring out when someone is completely full of it when they talk about healthcare.  #1: the old hip replacement canard.  Run for the hills when you hear it.  Krauthammer, as Ezra points out, is implicitly talking about elective surgeries like hip replacements, but there's a reason these procedures are called "elective": it's because these are the procedures that can be most effectively triaged.  We do the same thing in emergency rooms all the time, and we do it every time you have to wait a few weeks for a doctor's appointment because you're not keeling over on the street.  Every system triages something, and in some countries that something is hip replacements that can be easily monitored and scheduled.  In others — like ours — it's things like basic dental care.

#2: Krauthammer is careful to name check only Britain and Canada, which have more problems than most other national healthcare systems — and are conveniently English-speaking, which makes it easy to lazily Google complaints about care.  But he couldn't make his rationing statement at all if he'd chosen France and Germany (or Sweden or Japan) instead.  The plain fact is that universal care doesn't inevitably mean longer waits for care than in the U.S.  As any honest observer knows, plenty of actual, existing countries have proven just that.  We should emulate them.

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