Health Care Rationing and Insured Access: Does the Catholic Tradition Have Anything to Say?
In a recent article in The New England Journal of Medicine, Arnold Reiman began by saying: "Suddenly everyone is talking about rationing."· Indeed, the debate over the restructuring of the Medicaid plan in Oregon has ignited a national discussion about rationing health care services. What reasops are there to even enter into discussion about "rationing" health care? To "ration" something means to have an allotment, or share of something. It implies limits to what one can have. In a broad sense, limiting health care to what one can purchase is a form of rationing: market rationing. However, "rationing" is more usually employed to identify some constraints, set by others, upon one's access to resources. Here, in particular, the focus is upon limitations on the amount of health care resources one can demand from physicians, health care providers, or third party payers. In particular, fueled by concerns about the rising cost of health care, a national debate is emerging about whether there should be limits to public health care resources and, if so, how such limits should be shaped. We need to be very clear that we are not talking about rationing health care as, for example, basic staples were rationed in the United States during the Second World War. In the Oregon discussions, we are talking about rationing the public resources that will be expended for health care. People will continue to be free to use their resources to obtain health care beyond the basic level. There are three factors that provoke the present dilemma in health care which has, in turn, provoked discussion of rationing. First, there are the questions which arise as we face difficult decisions in making macroallocational choices about the use of our nation's financial resources. Each time we make such allocation choices about defense or education we are