Rationing Health Care in the United States and Canada

Abstract

Any health care system should be grounded in the ethical principle of fairness in access to services and the economic principle of efficiency in allocating resources. In this paper, I explore the relationship between ethics and economics in possible two-tiered rationing schemes in American and Canadian systems. In the US, rationing through managed care occurs in the form of constraints on the type and number of services doctors perform. In Canada, rationing occurs in the form of queuing, with comparatively long periods of waiting time for surgery and other treatments. Managed care organizations in the US have temporarily increased efficiency in the delivery of care by reducing waste and unnecessary services, but not fairness, as evidenced by the 44 million uninsured and underinsured. I consider whether adopting a universal model along the lines of the Oregon Basic Health Services Act might ensure both fairness and efficiency. On this model, guaranteeing that all Americans had a decent basic minimum of health care would mean excluding some expensive treatments from health plans, though people with the ability to pay for these treatments might have them. Such a two-tiered system would be fair provided that the lower tier entailed a decent minimum that met people’s basic health care needs. Tiering in the Canadian system would involve allowing those with the ability to pay for expedited care to jump the queue and thereby cut their waiting time. This might ameliorate the problem of waiting for people who cannot afford to jump the queue because they are unable to pay for expedited care.