NYT’s David Leonhardt Debunks “Rationing” Scare Stories

David Leonhardt has an excellent column explaining “why the case against rationing isn’t really a substantive argument” but instead “a clever set of buzzwords that tries to hide the fact that societies must make choices.” He concludes:

[F]lat-out opposition to comparative effectiveness is, in the end, opposition to making good choices. And all the noise about rationing is not really a courageous stand against less medical care. It’s a utopian stand against better medical care.

As he argues, there’s no way to create an infinite quantity of medical resources. At its most basic, there are only so many trained doctors and nurses in the country, and they only work so many hours and thus can only do a certain amount of work. Blocking the use of serious medical and public health research doesn’t expand the quantity of resources available. Instead, it undermines the efficacy with which the resources are deployed. Right now, instead of decisions being guided by considerations about results, they’re essentially guided by considerations about what will enhance the profits of key stakeholders. Primary care and prevention get shortchanged, generic drugs get shortchanged, people who don’t have insurance get shortchanged, error-prevention gets shortchanged. Meanwhile, people who do have generous insurance plans wind up over-treated by specialists—subjected to procedures that aren’t necessary and expose people to health risks. This is because the actors in the delivery system are orienting themselves around what they can get paid for, rather than what will promote health. You get paid for treatment, you don’t get paid for prevention. You get paid for giving a well-insured person a test he doesn’t need, but you don’t get paid for giving an uninsured person a test he does need.