Editor's Letter: Privatizing Medicaire

last updated 8 January 2015

Rationing. Such a harsh-sounding word—flinty-eyed, hard of heart, impervious to pleas for mercy. We heard a lot about rationing, and “death panels,” when the Democrats made their attempt to bring Medicare and health-care costs into line last year. And now rationing is back in a new guise. Rep. Paul Ryan’s proposal to privatize Medicare would also impose limits on how much care seniors would get. Rather than rely on government panels of health experts and “outcome’’ studies, Ryan would rely on the “free market”—that is, insurance companies and their most elderly customers. Let’s say you’re 78 and very sick, and want a new cancer drug that costs $12,000 a month. Your insurance company might say, “Sorry, no”—too expensive, too unproven. The government isn’t involved, but that’s rationing. You might consider paying for the treatment yourself, but decide not to exhaust the savings you’d planned to leave your heirs. That’s rationing, too.

Rationing is not inherently evil. If there’s a finite amount of money to spend on health care, we’ll need a system of values and rules to divvy up that money humanely and effectively. Whatever system we ultimately choose, someone will have to say no to expensive treatments of dubious value; we may have to reconsider spending a quarter of the entire Medicare budget keeping people tethered to machines in the last months of life. We could, of course, continue to operate as if there’s an infinite amount of money available. But how’s that working out? For Americans to stop spending trillions we don’t have, we’ll have to accept limits on personal choice. We’ll even have to accept our own mortality. No wonder rationing is such a bitter pill to swallow.