In “Rationing Health Care” and “More on Rationing Health Care” I describe why employer provided health care how employer provided health care was created as a response to the price and wage controls imposed during WWII. Employers could not raise wages but the government permitted them to offer health care benefits to employees in addition to wages. New laws made health care expense deductible for the employers and did not count the health care benefits as taxable income for the employees. Because health care payments paid with the employees wages were taxable, both the employer and the employee had a financial motive to push more medical employee paid health care expenses onto the group plan paid by the employer.
The law created a tragedy of the commons and the common resource was the group plan. Health care is over consumed because the employees have no incentive to control expenditures but all pay for the increasing costs because the cost of the group plan has increased. There are basically two ways to control rising costs. Employees must be again be exposed to market prices or the employer through the group provider must ration health care.
Medicare and Medicaid have created similar tragedies of the commons. The elderly and the poor get benefits paid for largely by taxpayers, and consequently have little incentive to control consumption. President Obama’s health care reform would ration health care benefits through expert committees. A couple of articles describe the impact of government rationing in the Tennessee and the United Kingdom (“Patients to wait longer for care under new health law, think tank says,” “Cataracts, hips, knees and tonsils: NHS begins rationing operations”).
In Tennessee, approximately 700,000 citizens will gain health coverage (demand expands from D0 to D1), most will be younger men with low incomes who will become eligible for Medicaid. The remainder are people who qualify for subsidies to buy insurance though newly created state health exchanges. As demand expands without a corresponding increase in health care providers, the price of health care increases as does the quantity of health care provided (the increase in demand has caused a change in quantity demanded along the original supply curve and equilibrium has shifted from A to B). More health care will be demanded at a higher price. Somebody has to pay. Sources cited in the article suggest that taxpayers and healthy young adults that do not qualify for subsidies will subsidize the poor and infirm.
The second article explains that the National Health Service will ration hip replacements, cataract surgery and tonsil removal as well as other operations to control burgeoning budgets.
Society cannot afford to provide all the health care that people desire. As health care becomes more effective and more expensive, people will not be able to afford all beneficial care. Public payment for health care has or will hit the same ceiling. We as individuals or collectively cannot afford everything we want. Resources are scarce. It seems cruel to force a dying person to examine their financial records to determine if they wish to spend their remaining wealth on a procedure that might be effective. Many will not have the resources to pay. It also seems cruel to tell a dying patient that she does not meet the cost benefit criteria for a procedure that might extend her life.