Why It's a Good Idea for the Well-Off to Share Their Health Care with the Rest of Us

In the din of voices arrayed against health care reform, one word has come to symbolize the presumed evil of the reformers' plans: rationing.

Falling for the argument framed by their adversaries, advocates of health care reform have pooh-poohed the claim rather than address the truth that, in certain circumstances, "rationing" at the end of life is a good thing, preventing endless suffering endured by patients with terminal conditions who are subjected to treatments they never wanted in the first place.

Americans lucky enough to have good health insurance are overtested, overmedicated and overtreated. Republicans have tried to tie overtreatment to malpractice reform, suggesting that doctors today practice "defensive medicine" in order to prevent lawsuits. The Republicans' only solution to the problem of excessive spending is to limit malpractice lawsuits, but this ignores the medical industry's primary motivation: revenue.

To the anxious health care consumer, pharmaceutical companies market newly minted afflictions, and medical equipment manufacturers aggressively press physicians to add elaborate screening equipment and laboratory facilities to their practices, building in a profit motive for both the doctor and his or her supplier for the overprescription of tests and screenings.

Yet despite all this testing, medicating and screening, health care is already rationed in the U.S. "by ability to pay," Peter Singer, professor of bioethics at Princeton University, writes in the New York Times Magazine.

Singer offers a list of staggering statistics to prove his point: An estimated 20,000 people die each year because the U.S. does not have universal health care (13,000 in the 55 to 64 age group); millions of insured Americans can't afford drug or treatment co-payments; more than 60 percent of bankruptcies are caused by illness; a full 54 percent of Americans report not visiting a doctor when sick and not filling a prescription because of cost.

Because resources are finite, rationing will always be a part of any health care system, whether overseen by insurance companies or the government; and frankly, always should be -- but not like this.

According to a 2-year-old study by Consumer Reports, about 40 percent of the U.S. population has inadequate access to health care, all but ensuring an early death to those among the un- and under-insured who have a life-threatening condition. Among the remaining 60 percent, many receive far more health resources than they need or want, more than is even good for them.

Excessive medication, tests and treatments are not only costly; they do little to improve the nation's health (PDF). If this abundance of treatment and testing truly reaped a bonanza in national well-being, the U.S. brand of health care would have a higher rating among nations than the pitiful ranking of 37 awarded the U.S. health care system by the World Health Organization.

Among the most overtreated are people on Medicare, those with other comprehensive insurance coverage who have terminal diseases, or those who are among the very, very old. Nearly a third of Medicare spending, $67 billion, is spent on patients in the last two years of life, reports the Times' Timothy Egan, whether that life is ending from a terminal disease or old age.

Billed as prolonging life, too often the treatments to which these patients are subjected serve only to prolong their deaths, often in painful or traumatic ways. And many would choose to forgo such overtreatment, if only they had an option to do so.

Attempts to discuss the inevitable and complicated need for end-of-life rationing are rarely rewarded with reasonable debate, despite the topic's importance to the future of our medical system.