Feature

Facing up to the realities of rationing

“As demand increases relative to supply, many doctors are likely to turn away patients whose coverage would pay the lower rates,” said Tyler Cowen in The New York Times.

Tyler CowenThe New York Times

Uncle Sam is going to ration health care, say opponents of the Affordable Care Act of 2010, better known as “Obamacare,” said Tyler Cowen. What they don’t mention is that well before that legislation was enacted in March, we were on our way to “rationing on a scale that is unprecedented here.”

The problem stems from the different levels of reimbursement paid to physicians from health insurers. Private-insurance plans pay doctors the most, followed by Medicare (for seniors), and then, far behind, Medicaid (for the poor). “As demand increases relative to supply, many doctors are likely to turn away patients whose coverage would pay the lower rates.” It’s already happening to Medicaid beneficiaries, whose publicly funded care is also targeted by cash-strapped states; Arizona recently rationed “transplant coverage for Medicaid patients.” But even Medicare patients are getting the bum’s rush “as doctors increasingly prefer patients with private insurance.”

Without efforts to equalize reimbursement rates, wealthier people will simply “jump the line by paying more,” a situation the Affordable Care Act will only exacerbate by offering subsidies for private insurance.

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