Tuesday, August 18, 2009


Philip Stephens, Financial Times:

Beneath the transatlantic waves lies an awkward truth; one that politicians of all shapes and sizes – conservative and progressive, European and American – would prefer not to discuss. Healthcare is rationed everywhere.

Some countries, of course, choose to spend more on health than others, just as they set different priorities for education or defence .... But all the models, the American included, share one characteristic. They ration access, while pretending otherwise. In Britain, the state imposes the limits; in the US the market does much the same job. What separates them are questions of efficiency and equity.

"Rationing" appears as a pejorative in the US health debate only as it relates to rich people not getting what they want instantly because they can pay for it. Perhaps they will have to "wait in line," and so on; a grievous infringement of their liberty, etc.

Of course, in any system where large numbers of people go without care altogether, this is a special use of the term. That it is the dominant usage tells us something about who speaks loudest in an unequal society.

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