Rationing of Health Care in the United States An Inevitable Consequence of Increasing Health Care Costs

“The modern era of medicine began in the 1960s. Health care coverage expanded with the passage of Medicare and Medicaid and the increasing availability of employee-based health insurance. Scientific and clinical advances began to occur at a far more rapid pace. Physicians became more specialized and began to focus on acute care dominated by cardiovascular disease, diabetes, and cancer rather than infectious diseases, and there was increasing recognition of the importance of chronic diseases,” Howard Bauchner, M.D., writes in an editorial over at JAMA Network. “With more data available, it became possible to measure variation in the delivery and quality of care, along with disparities and rationing in the provision of care. Health care costs per person more than doubled between 1960 and 1970, beginning their 5-decade increase.

“Rationing and cost of care are inextricably linked, although measuring the amount and extent of rationing and defining rationing is difficult. There are many types of rationing, including rationing by access (type of insurance), by cost (out-of-pocket expenses), by restriction (the service is not available or paid for by a third party), or by long waits (Canada and parts of the United States). Broadly, rationing refers to approaches that are used to allocate resources and potentially restrict access to effective therapies. Rationing is linked to poverty, race, and ethnicity, and it inevitably leads to differences in the care that certain groups of individuals receive….

He concludes: “For the United States to prosper in the 21st century, controlling health care costs is critical—indeed, it is the single most important challenge facing health care. Greater rationing of care is inevitable if health care costs continue to increase. Controlling health care costs is the only way to ensure appropriate investment in other areas, such as education, the environment, and infrastructure, and to provide a more equitable, just, and fair distribution of the remarkable health care advances that have been achieved with even more on the horizon. It has been said many times that in the richest country in the world, in which many of the greatest scientific and medical advances are developed, it is a blight on the US soul that each of its residents does not fully benefit from available health care.” Howard Bauchner, M.D., “Rationing of Health Care in the United States An Inevitable Consequence of Increasing Health Care Costs,” JAMA Network.