Rationing health care


Now that so many more people are going to be eligible and able to afford health insurance, there’s a big worry. There won’t be enough doctors, enough nurses, enough clinics and hospitals. There will be long waits for an appointment with a doctor, long waits at clinics, waiting lists for surgeries, shortages of drugs and medical equipment. It’s going to be a disaster. There’s going to have to be rationing of health care.

As if there weren’t rationing now. The rich and those lucky enough to have a good health insurance policy can get treatment, can get their cancer treated, their back operated on, their pneumonia stopped with drugs, their children vaccinated and seen every year. The rest, those who can’t afford insurance, who are unemployed or work for an employer that makes sure they work too few hours to qualify for health insurance, they get sick and they stay sick. If they’re lucky, they recover. If not, they get sicker and sicker until they go to an emergency room. By then it’s often too late.

They’re not like you and me: selfish. They’ve got good health care, and they want it to stay that way. They don’t want to wait in lines for doctors, for surgery, for medical equipment, for drugs. They don’t even see that they’re selfish; they think they deserve good health care because they’ve worked hard and have a good job or are rich. After all, life isn’t fair. But come the day when they lose their job, when their home is foreclosed, when they can’t afford health insurance, then by their own standards they no longer deserve health care. Maybe life isn’t fair, but that cruel it need not be.

I have a close friend in Brazil. She had surgery to repair a torn diaphragm — all paid for by her government health insurance. They found she has tumors on her lungs, she who never smoked, who never worked in a polluted place. She saw a doctor, she’s being given chemotherapy which she’ll have to continue for years, and she’s surviving, all possible due to the cheap government health insurance she has. Yet if she’d lived here, supporting herself and her children making handicrafts, just getting by, she’d never have been able to pay for health insurance, never been able to pay for years of chemotherapy, and she would have died.

There, in Brazil, I sat at her side waiting to see her doctor for the results of the first chemotherapy treatment. We got to the clinic in a hospital at 7:30 a.m., and we saw her doctor at 12:30 p.m. Those who were most ill went first. The doctor was overworked but good, kind, compassionate and competent. He wasn’t rich, the clinic was run down, there were many poor people. And it gave me hope. It is possible for all.

With so many people now able to get health care, it’s finally clear that we need more doctors, more nurses, more clinics, more hospitals. We can afford those easily, easily. Expand the size and number of medical schools. Give full scholarships to all students who enter college to study to be a doctor or nurse. Place limits on the profits that drug companies can make. Train more physician’s assistants to take over all but the most crucial of medical diagnoses and prescriptions. And we can pay for all this easily, easily. We can take the money we spend to kill people, money for tanks and battleships and missiles and artillery and training, training, training to kill people and direct it to make a better world for all of us, one where the sick are tended, the hungry are fed, where the shortages won’t be because we follow the way of death.

Arf, formerly known as Dr. Richard L. Epstein, is the author and publisher of books on reasoning and is head of the Advanced Reasoning Forum in Socorro.