Europe may offer lessons for health care rationing debate

Fears about rationing are a hot-button issue in the health care debate, but some health experts argue that the U.S. system already faces rationing. Others point out that the U.S. may look to Europe for examples of how private-market systems can cost less without raising concerns of rationing care.

"New guidelines calling for women to get less frequent mammograms are a strong indication that Americans will face more rationing of health care in the future, critics of the congressional health care overhaul say," The Detroit Free Press reports. "... many Americans fear that faceless bureaucrats and studies will dictate how decisions about health care policies and insurance reimbursement are made."

"The Obama administration and others say health reforms will eliminate arbitrary decisions by insurers to deny or limit care and that studies will focus on what works, to give incentives to the best, proven treatments. The mammography flap shows that 'most people have been led to believe that rationing is not part of health care right now,' said Leonard Fleck, professor of philosophy and medical ethics at Michigan State University. ... He supports reforms for many reasons, including the fact that government decisions must be public, rather than those adopted quietly by insurance companies" (Anstett, 11/28).

The San Francisco Chronicle reports on the health care systems in the Netherlands, Switzerland and Germany. "Holland and Switzerland rely exclusively on private insurance, and all three rely on private doctors. The three European nations deliver universal coverage and world-class quality at a fraction of what Americans spend." These three countries, "far from leading to poor quality and rationing … outperform the United States on many quality measures. These are not just broad measures such as life expectancy that could reflect higher U.S. poverty or obesity. Even Britain, much maligned by opponents of government-run health care in America, has made greater strides in preventive care."

In part, this is because "Americans often confuse intensive care with quality, said Beth Docteur, a consultant and former health official at the Organization for Economic Cooperation and Development, a group of 30 industrialized countries. U.S. doctors face powerful economic incentives to do more ... The Germans apply especially rigorous scientific analysis to determine which medical procedures work and which don't" (Lochhead, 11/29).