We keep hearing a lot about how any health care reform will necessarily involve some form of "rationing". The Whigs, I mean Republican Party, would have us believe that Obamacare will lead to Soviet bread line-style rationing of health care. Just you wait; you'll be standing in serpentine Disneyland-type lines jagging back and forth with a bunch of other people with appendicitis waiting to get surgery, so they imply.
I hate this kind of garbage. "Rationing" is such a loaded word that carries collectivist connotations of delayed care and loss of autonomy. We hear about rationed health care and everyone wants to march against the tsar. But we have a disturbing tendency nowadays to overuse and/or misuse terminology in our political/cultural discourses. Sotomayor is a racist. Obama is a socialist. Iran is evil. It's ridiculous. These are important words with very specific meanings and contexts. Throwing them around while ad libbing on a Fox News pundit panel is just irresponsible and intellectually dishonest.
There's a difference between rationing and intelligent use of healthcare resources. No one is talking about making patients wait 6 months for a heart bypass. Obama isn't going to deny your laparoscopic cholecystectomy if you come into the ER with acute cholecystitis. At issue is the overutilization of expensive, limited resources. Should a 90 year old demented patient be kept on a vent in the ICU with every other day dialysis? Does every morbidly obese 55 year old with cranky knees (but is still ambulatory and able to work) need bilateral titanium knee replacements? Does every woman with breast cancer need a breast MRI? Do we need $5 million DaVinci robots in every hospital?
We're not talking about rationing the staples of health care provision (preventative care, emergency/oncologic surgery, etc). What needs to be trimmed are the extraneous goodies that coincidentally tend to make the most money for hospitals and providers. Not everyone admitted to the hospital with indigestion needs upper and lower endoscopy. Not every chest pain needs a heart catheterization. Not everyone with aymptomatic gallstones needs a lap chole.
There's a difference between trimming excess fat and limiting basic necessities. True rationing (food in wartime, gasoline in an oil shock) forces us to cut back on the basic stock we depend on for subsistence. Cutting back on luxury items is not rationing; it's just smart economic behavior. We need to do an honest accounting of what is truly necessary in medicine. It won't be easy. Tough decisions lay ahead. But calling any form of healthcare cost containment "rationing" or "social medicine" is just ridiculous political grandstanding.