The Wall Street Journal (subscription required) this weekend had a story about the United Network for Organ Sharing is revising its kidney transplant policies — favoring young patients over old, rather than the length of time on a waiting list.
This change in how kidneys are currently rationed, naturally, has stirred up the age-old debate over whose life should hold more value; who deserves to live and who will die waiting for care?
What’s interesting to me, is that without this suggested policy change, there has been virtually no furor over medical rationing in the U.S. Fear of rationing occurs in discussions over “socialized systems” such as those in Canada or the U.K. that will result in lines and rationing.
But we DO have medical rationing in the U.S. And people die at the rate of 18,000 a year because health care is rationed, according to the Institute of Medicine, making uninsurance the sixth leading cause of death in the United States.
The United States’ method of rationing, however, is largely invisible to the middle and upper classes, because they have insurance.
The U.S. medical system current rations care based on who can afford to pay. If you can afford to pay, you see a doctor. If you can’t afford to pay, you wait, you get sicker. You might see a doctor — at an exhorbitant price — and you are 25 percent more likely to die because of the lack of care you receive.
That’s not to say other systems are perfect. In the U.K, for instance, waiting times for elective procedures (such as hip replacements) can be long. On the flip side, waits to see a primary care physician can be shorter than the waits in the U.S., according to an analysis of four countries’ health systems.
The United Network for Organ Sharing is heading into a ideological and emotional storm and all new policies must be approved by the U.S. Department of Health and Human Services. These are difficult decisions to make and one could argue that none of us is qualified to judge who is deserving of life or not.
But let’s not kid ourselves, just because our policies don’t explicitly make those judgements, that rationing is happening today, and it’s happening in the U.S.