All of the sudden, health care rationing is the big issue related to a national health care program. The opponents of the program have stated that rationing will lead to “death panels” who will decide which citizens live and which will die. Proponents of the program refuse to acknowledge aloud that rationing exists as a concept, let alone that we need to do more of it to manage health care costs.
If anybody is truly interested in how scarce health care resources might best be rationed - whether it be a limited number of transplant organs, vaccines, or meds in an emergency setting - I recommend reading Ezekiel Emmanuel’s article in the January 31st issue of the Lancet. Basically, this article recommends that scarce resources be allocated related to several criteria - age, number of expected lives saved, patient prognosis. If this is still not enough differentiation, random chance (lottery, if you will) is the final determinant.
Most importantly, and directly refuting the argument made in the link above, the article recommends that resources only be allocated based on the value of an individual to society in a public health emergency. For example, if providing immediate care to a nurse might in turn provide care to an additional 20 people, that nurse should be a priority for care.
Of course, the system we have now rations care almost exclusively by this “instrumental value” criterion, measured simply by income potential. In other words, care is allocated to people who can afford it. People who can’t afford care are treated through overburdened public institutions and often after they develop emergent problems.
Medical ethics is a tricky business, and a complicated conversation. To see this conversation treated in such a shabby manner in the political world is both disappointing and unsurprising.