Health care rationed in U.S., HSPH ethicist says

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Daniel Wikler, Mary B. Saltonstall Professor of Population Ethics and professor of ethics and population health, was interviewed Dec. 17, 2010, on Public Radio International’s “The World,” about health care rationing. The interview was part of a week-long series, “Rationing Health,” which looked at the issue in the United States, South Africa, United Kingdom, Zambia and India. Wikler, who has served as an ethicist with the World Health Organization and has been involved in international efforts to ensure equitable health rationing, also led an online discussion on the topic with Sheri Fink, a Pulitzer Prize-winning journalist and physician.

Rationing is the shortfall between what a health system provides for its citizens and what it could provide if the money were used more efficiently and fairly, Wikler told “The World.” In the U.S., there’s “implicit rationing” that’s often not recognized because the people subjected to it “don’t have much of a voice,” he said.

“The number of people who die because they don’t have health insurance or they have inadequate health insurance is staggering,” Wikler said. Many lacking coverage will forgo a lifesaving treatment or a preventive service or go to a community center or emergency room where they cue up and are likely turned away, he said. Later they get sick and end up in the hospital where they may die because, by then, they’re “just too sick,” he said.

Most people think of health rationing as “God committees that say ‘yes’ to this patient and ‘no’ to that patient when actually those committees are quite rare,” Wikler said. “But we should be asking if people are getting the care they need … If the answer is no, then there’s rationing,” he said. “It’s just not the death squad rationing that is booted about in the political debates but it’s rationing.”