The Covert Rationing Blog

Why We’re Rationing Covertly

May 30th, 2007 by DrRich

We have seen that rationing healthcare is a fundamental economic imperative, and that we’re long past the point of asking whether we should (or must) ration. The real question is: How should we ration?

Our society has answered this question, too - at least implicitly and at least for now. That answer derives from a second fundamental imperative under which we labor, this one being a cultural imperative instead of an economic one.

DrRich calls it “the culture of no limits.” Unlike the economic imperative to ration healthcare, which is nearly universal in Western countries, our deeply-held culture of no limits is uniquely American. The culture of no limits can be stated thusly:

In America we have and will continue to have the best healthcare in the world, the best doctors, the best hospitals, and the best technology. Since one cannot place a price on human life, everything that can be done for a sick person must be done, as long as there is some small hope of a beneficial outcome. Finally, every disease is potentially curable, and as a matter of policy we will strive to learn how to cure every disease, death itself being merely a manifestation of insufficient technology. In summary, where healthcare is concerned there are and can be no limits.

So, at the same time we find ourselves up against inherent spending limitations that require rationing, we find that there can be no limits.

We can see right away that these two fundamental tenets shaping our healthcare system – the economic need to ration and the culture of no limits – are in their essence completely incompatible with one another. And our need to simultaneously hold onto these two incompatible but necessary imperatives demands that we conduct the unavoidable rationing without acknowledging it.

The only choice we have it to establish a healthcare system that allows us to conduct the unavoidable rationing while maintaining the fiction that no rationing is necessary, that allows us to ration while declaring that there are no limits, and to deny that any rationing is occurring at all. We can ration secretly. We can ration deceptively. We can ration covertly.

And, having no other obvious choice, that is what we are doing.

Posted in An Introduction to Covert Rationing

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