By Ezra Klein
August 28, 2009 Washington Post
"Look at Canada," says Charles Krauthammer. "Look at Britain. They got hooked; now they ration. So will we."
So do we. This is not an arguable proposition. It is not a difference of opinion, or a conversation about semantics. We ration. We ration without discussion, remorse or concern. We ration health care the way we ration other goods: We make it too expensive for everyone to afford.
I've used these numbers before, but let's repeat them. A 2001 survey by the policy journal Health Affairs found that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent. This, Americans will tell you, is the true measure of our system's performance. We have our problems. But at least we don't sit in some European purgatory languishing without our treatments. That's rationing.
There is, however, a flip side to that. The very same survey also looked at cost problems among residents of different countries: 24 percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22 percent said they didn't get a test or treatment. In Britain and Canada, only about 6 percent of respondents reported that costs had limited their access to care.
The numbers are almost mirror images of each other. Twenty-seven percent of Canadians wait more than four months for treatment, versus only four percent of Americans. Twenty-four percent of Americans can't afford medical care at all, versus only 6 percent of Canadians. And the American numbers are understated because if you can't afford your first appointment, you never learn you couldn't afford the medicine or test that the doctor would have prescribed.
We ration. And if the numbers and the surveys don't convince you of the point, this is what it looks like when we ration.