A fear in the United States is that moving toward a universal healthcare system would mean that we would have to ration care. At this point, our doctors and nurses are already overwhelmed by the number of patients under their care. They already have packed waiting rooms and some specialties are booking out months and months in advance. Big cities have primary care providers with full practices, and rural towns don’t have enough doctors, especially specialists, for their population. Opening up the healthcare system to make sure everyone has affordable access means that the system will become even more backlogged, and care will have to be rationed to prevent it from being overwhelmed by a sudden flood of people scheduling appointments.
However, Dave Chase points out, in his book The Opioid Crisis Wake-Up Call, that we are already rationing care. He writes, “While some worry about rationing care, the volume-driven reimbursement system has always rationed choices by pushing us toward costly, invasive treatment options.”
In other words, we are already doing a poor job of allocating healthcare resources, and we are already rationing our healthcare in an inequitable manner. We are rationing it by price, shutting out those who cannot afford treatment and over-prescribing unnecessary treatment to those with the means to pay for it.
I think a big hesitation around universal healthcare in the United States is that we tie everything into deservingness. We have ideas of who deserves a raise, who deserves to have a nice car or a fancy office, and who deserves help and who doesn’t. Healthcare fits into that same system of deservingness, and giving healthcare to people for free means that we won’t be rationing care by the same system of deservingness. Suddenly, people who are wealthy who have been telling themselves and others how much they deserve their wealth and the things it brings would not be prioritized by the healthcare system, and priority would maybe be given to those with the most serious need or who had the greatest likelihood to benefit from medical intervention. This doesn’t seem to fit with our American story, and that is where the fears of rationing care may stem from. Like Chase said however, we are already rationing care, but not in the most effective and equitable manner.
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