As a postprandial no-show affords a little time for reflection after a hectic morning, I think about all the folks I see in this clinic, one after another until they become a blur, who are indigent, unemployed, and unable to obtain Medicaid or Medicare. This is rationing. We already ration health care, and this is how we do it, by the vicissitudes of finances and the job market.
Yes, they are seeing me, but they are very limited in their access to medications, psychotherapy, and other specialized services, such as psychological testing or substance abuse treatment. This is rationing, merely done haphazardly.
I suppose the health care mess boils down to two issues: social justice, and living within our means. Part of social justice is protecting the minority against the majority, always a challenge, by definition, in a democracy. Word is that resistance to reforming health care is growing, and Obama may fail in this as Clinton did. Why? Because most people still have health insurance and are more or less content with their coverage; they don't want to risk this in order to cover the uninsured. They enjoy seeing doctors who can bar no expense in arranging for testing and treatment. Social justice?
The perpetual refrain these days, from economists and myriad other experts, is that we can't go on this way, that is, spending a massive amount of GDP for medical results that, while spectacular in isolated cases, are merely mediocre on average. But if we are spending medically beyond our means, it appears that the public is not willing to stop yet. Perhaps we have not yet hit rock bottom; perhaps the system is rotting but not yet rotten enough. Perhaps reform is not possible until one or more of three things happens: the majority of people are actually uninsured, the majority of people are personally dissatisfied with the system, or the out-of-control medical-industrial complex really does throw the general economy into chaos.
I'm not an expert, so hopefully I'm wrong.