Peter Singer on Rationing Health Care

The third rail of any health care debate is the topic of rationing. The fact is that health care is rationed every day by consumers, doctors and payers. The buzzwords in medicine are 'best practices' and 'evidence-based' to determine the optimal interventions. When do you order a head CT for someone with headaches? When is hysterectomy warranted for dysfunctional bleeding? These are decisions made every day and while any individual decision is hardly going to break the bank, the total allocation of the health cae budget, not to mention risk to the patient, for any intervention muat be weighed against the potential benefit.

Peter Singer has an excellent discussion in the New York Times on rationing health care. He notes that at present health care is rationed, but now it is not necessarily based on any applicable standard, only the whim of a particular insurance payer. Standards on such things exist and he elucidates the mechanism very well.

We all relish the thought that WE can decide what is the best practice: what is best for us in a particular situation. WE want to be the captain of our ship. Granted, nobody enjoys abiding by the dictates of a large bureaucracy, but the goal of a health care "system" is to provide the optimal care for the greatest number of people, and the problem in the US is that we lack a "system" and health care is too often doled out by whim. In every publicly administered health system-- Britain, Canada, Australia, France, etc.-- there exists a provision for individuals to purchase additional insurance and care as they desire. The United States would be no different, but provision of tha basic health care is necessary.