Rationed and Restricted Care: The Inevitable Outcome of Government-Run Health Care

Vox wasn’t supposed to say this part out loud. But in a 2020 piece celebrating Britain’s National Health Service, Vox co-founder Ezra Klein explained that the NHS is forced to ration care.

“It has embraced the idea we fear most: rationing,” he wrote. “There is, in the UK, a government agency that decides which treatments are worth covering, and for whom. It is an agency that has even decided, from the government’s perspective, how much a life is worth in hard currency.”

Americans should bear this in mind as the reconciliation bill moves forward. The bill includes a massive Medicaid expansion. Government-run health care systems make a promise to patients: affordable, accessible, and equitable care for all. Too often, this promise falls short, as inadequate resources and efforts to cut costs leave patients waiting for the care they need and place unnecessary burdens on physicians.

The unnecessary rationing of absolutely necessary health care services is an inevitable outcome of an underfunded, mismanaged government-run health care system.

Those in favor of expanding government control over health care say it will cut costs. But when they don’t, policymakers and administrators turn to a less optimal solution—rationing care, or the regulation of access to drugs and health care services. This naturally leads to worse health outcomes overall. The necessary “one-size-fits-all” restrictions neglect a patient’s individual and unique issues, needs, and preferences.

As Vox demonstrated, rationing is just a part of government-run health care.

In the United Kingdom, services such as cataract surgery are labeled as “low priority procedures.” Access to these such procedures has been limited to those who qualify based on an assessment determining whether the patient meets a specified clinical threshold that mandates care. These patients are subjected to excessive wait times and reduced quality of life while they wait for care. At least 95 CCGs have also classified hernia repair as a “low priority procedure.” Seventy-five CCGs classify hip and knee replacements as procedures of limited value. Even more alarming, a dozen CCGs restrict diabetics’ access to continuous glucose monitoring^. The value of these services and procedures is in no way limited to those patients who need them, and their access to necessary care must be prioritized in policy decisions.

Germany and France’s government-run health care systems operate through excessive bureaucracy explicitly meant to delay the adoption of new medical products and services to cut costs. In France, people in some more rural areas reside in “medical deserts,” where their government health care coverage plan does little to curb excessive wait times, correct the physician shortage, or expand access to treatment and care^.

Group consultations, which are appointments delivered by a clinician to a group of patients (up to 12 people) with similar health issues, is another favored method of rationing care. Despite proponents’ claims, group consultations are a way of cutting costs and mitigating the unintentional delays that place limitations on a provider’s ability to develop and implement personalized care regimes for unique individuals and diminish patient privacy.

The rationing of care is already happening within the existing Medicaid system.

“According to the 2018 Physicians Foundation Survey, more than 1 in 5 physicians either limit the number of Medicare patients they see or refuse to see them at all,” the Heritage Foundation reports. “For Medicaid, the number is almost 1 in 3.”

Proponents of Medicaid expansion will often reference the success of the Scandinavian government-run health care model as evidence supporting their position. This model won’t work in the United States, where more diverse demographics and corresponding health issues complicate a desire to implement universal, generic coverage. In fact, those Scandinavian systems are moving closer to private health care. Also, moving all U.S. health care into the public sector will inhibit the indispensable medical innovation and research happening in the U.S. private sector.

As Britain has seen, and as Vox happily acknowledges, rationing is simply the reality with government-run health care.

“No system can say yes to every desired treatment, in every context, at any price,” Klein wrote. “All systems have to tell somebody no: Either providers cannot charge what they want, or patients cannot have what they want, or taxes are going to be much higher than anyone wants.”

That’s the real promise here.