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Do-it-yourself rationing


By David May
Posted: February 4, 2012 - 12:01 am ET
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Has the nation reached a ‘new normal' in how much care we can afford?

At least several times during the past couple of weeks, it sure felt as if the nation had been transported back in time to the late 1960s.

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We saw headlines about manned exploration of the moon—in fact, this time the idea floated was lunar colonization, with possible statehood! At the same time, we heard reports from the front lines of a war zone decrying the latest “carpet bombing” campaign.

Of course these weren't flashbacks to the Apollo space program or dispatches from Vietnam. All the headlines came courtesy of the latest round of debates and stumping in the campaign to select the 2012 Republican nominee for the presidency.

Late-night comics had some fun with the space-base proposal from former House Speaker Newt Gingrich, but residents of Florida could not have found much humor in the nonstop aerial attacks of negative political advertising they had to endure. Apparently, it was a fusillade for the ages.

Meanwhile, something former Massachusetts Gov. Mitt Romney mentioned during a debate a few weeks back also drew some media interest—the concept of illegal aliens “self-deporting.” (Here, by the way, we're talking about human beings, not some alien life forms that might have their sights set on Gingrich's moon colony.) The idea is to make it so difficult for illegal immigrants to find employment in the U.S. that they'll voluntarily leave the country. Will this work? That's a topic for another editorial.

We have a different question for all the presidential candidates, including the incumbent: What about the already prevalent problem of “self-rationing” when it comes to vital healthcare services?

Just about every attempt at reforming our healthcare system over the years has drawn fire from critics about what they say will be the ultimate objective of cost-cutters: reducing spending by limiting access to necessary care. But it's been the fraying safety net and a troubled economy that have increasingly led us down the path to self-imposed rationing.

The essential words in this discussion are “necessary care.” All of us should agree on the need to avoid unnecessary healthcare spending, whether it's choosing a generic drug over the brand name or making an appointment with an urgent-care clinic rather than racing to the ER. In many cases, we're talking more about budgeting than rationing.

But far too many Americans are being forced to make painful choices when it comes to how much healthcare they can afford. The Great Recession did heavy damage, and our recovering, yet weak, economy continues to pinch our resources, individually and at all levels of government.

Just last week, Modern Healthcare reporter Melanie Evans presented new data on this topic in a Jan. 27 post on her “Of Interest” blog. Citing a survey by the Centers for Disease Control and Prevention, Evans shares data on how high unemployment has affected access to healthcare. “Not only were the unemployed more likely to be uninsured, but they were also more likely to report serious psychological distress and fair-to-poor health,” Evans writes. “Unsurprisingly, the unemployed also reported more difficulty paying for needed medical care and prescriptions. Among the unemployed and uninsured, 41.2% said they put off or did not seek care because of cost.”

In the Jan. 30 issue of Modern Healthcare, reporter Jaimy Lee reported on the lagging comeback in elective surgeries that also suffered during the economic slump. While some observers are expecting a resurgence, citing pent-up demand for procedures such as hip and knee implants, others aren't so sure. One analyst says the low numbers actually could represent healthcare's “new normal.”

Given all these trends, efforts to energize our economy might be the best place to shoot for the moon.


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