'The United States primarily rations healthcare through market forces, with access largely determined by ability to pay. This results in a system where individuals with private insurance, often through employment, or those who can afford high out-of-pocket costs receive care, while those without insurance or sufficient funds are often unable to access necessary services. This form of rationing is evident in the high number of uninsured Americans, with nearly 46 million lacking coverage in 2009, and the fact that many people forgo needed care due to cost.
Private health insurance companies play a significant role in rationing by setting coverage limits, creating complex claims processes that delay or deny care, and establishing drug formularies that restrict access to certain medications based on cost and effectiveness. These insurers often deny coverage for pre-existing conditions or impose higher premiums and waiting periods, effectively rationing care based on health status. The Affordable Care Act aimed to reduce some of these practices by prohibiting denial of coverage based on pre-existing conditions and eliminating lifetime and annual coverage caps.'
The question today is not whether to start rationing healthcare. We are already rationing, based in large part on the ability to pay. The question is how to alter the terms in a way that balances fairness and efficiency.
www.carnegiecouncil.org