Health Care Rationing Explained

The Syracuse Post-Standard dares to widen the debate

By now, most media accounts of the health proposals of John McCain and Barack Obama have grown stale and, frankly, boring. The stories I’ve seen lack both spark and originality, and rarely get beyond dry recitations of the stale rhetoric coming from health policy establishment types and the two candidates. For some reason, other voices rarely have been heard. So we were pleased to see the Syracuse Post-Standard open its pages to Trisha Torrey, a contributing columnist and the patient empowerment expert at

During the campaign, various candidates have mentioned the R word—rationing, which would prevent middle class voters from getting every treatment they demanded when they demanded it. But I have seen few stories addressing the extensive rationing that already goes on in the U.S. health care system—that is, until the Post-Standard published Torrey’s column on Tuesday. While Torrey did not point out that, in America, care is rationed to the poor because they simply can’t pay for it, (we’ve chosen to provide care, for the most part, based on ability to pay), she clearly showed how rationing affects those who have insurance.

In a sense, she pointed out, everyone rations care by choosing not to go to the doctor at times, a strategy that’s effective until an expensive illness strikes. Government programs like Medicare and Medicaid create elaborate formulas to determine which treatments they will cover, sometimes based on evidence of effectiveness and cost. But sometimes these programs pay for certain treatments based on health industry lobbyists’ recommendations, rather than any valid assessment of their true worth. One treatment might win out over another; hence a type of rationing occurs.

Health insurers also ration care when they deny treatments, Torrey says. Most middle class insurance holders have experienced this sort of rationing when their carrier says they can have procedure X but not procedure Y. Here’s a clear example I came across recently: One of the big insurers refused to pay for a pap smear for the daughter because the mom had just had a pap smear, and the policy said it would cover only one per family each year. Torrey notes that “thousands of different plans ration care in thousands of different ways.” Indeed they do, and it’s hard for people to know this in advance, or to choose their carriers based on which ones are least likely to ration needed care. That’s important to remember now that annual open enrollment (when employees choose their insurance for the next year) is upon us.

Every country rations health care in some way. So as the effort to reform health care moves forward during the next several months, reporters looking for a fresh story might consider Torrey’s comments and build from there.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.