There is a rumor going around that health care will be rationed under any of the proposed health care reform bills currently before Congress. For those of us in the spinal cord injury and disability community, my question is… so, what’s new?
To be clear, rationing occurs whenever any third party (i.e. your insurance company, Medicare, Medicaid) decides whether or not to pay for something that your health care provider has prescribed for you. Depending on your point of view, rationing can look very differently. You may see rationing as coverage that’s being denied by your health care insurance company. From the insurance company’s perspective, they may believe that they can justifiably deny paying for something that’s not included under your health insurance policy.
The truth is… no health care reform is going to cover all people for all of the services that they may want over the course of a lifetime. We believe however, that all people should be able to get the care that’s necessary in the opinion of their health care provider.
The problem with that is that medical providers’ opinions may vary radically about what’s “necessary.” This gets into “comparative effectiveness”, which I will get into in a separate post.
In the SCI/D community, we witness rationing everywhere. Have any of you been told to boil and re-use catheters because you’ll only get so many per month? That’s rationing. Has anyone ever been told that their wheelchair cannot be replaced for five years? That’s rationing. Medicare’s “in-the-home” rule… rationing. Annual or lifetime caps on coverage… rationing. It goes on and on.
The reality is that rationing will forever be present as long as you’re asking a third party to pay for your care. No one, not even the United States Government, will be able to pay for everything without limits to coverage.
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