Do we ration health care? Without doubt


For those who fear the government is about to start rationing health care in America, there many examples of how we already do.

Here’s one.

Each year, about 115 high school athletes across the U.S. die from undetected abnormal heart rhythms.

And, for years, some have argued that an electrocardiogram, or ECG, could, if administered to all student athletes, prevent many of these deaths.


However, after studying the issue in 2007, the American Heart Association concluded it would cost about $2 billion to screen and evaluate ECG results for the 10 million students competing in high school and middle school sports.

That means it would cost about $17 million per life saved, if indeed every death could be prevented.

What’s more, trying to screen every student in the U.S. would put a tremendous burden on the health care system. Some questioned whether there are even enough physicians, technicians and machines in the U.S. to handle the load.

Then there is the issue of false positives. About 16 percent of the tests show a problem where there is none, so those students would have to undergo expensive retesting and evaluation.

So, a national testing program has not been adopted.

While it seems callous to say so, the medical community applied a cost/benefit ratio to the problem and decided that 115 deaths is acceptable compared to the massive cost and difficulty of testing every young athlete.

That implies there is a point — a dollar value — at which a life, even a young life, is not worth saving.

But that point isn’t fixed forever. As the result of its own research, Harvard University, has decided to give ECGs to student athletes, according to a story in Monday’s Boston Globe. Italy also tests all competitive athletes between 12 and 35.

And a new Stanford University study says the cost is actually less than previously estimated, perhaps as little as $43,000 per life saved, according to the Globe.

Now, is $43,000 worth saving a single young life? That’s now in the same range as mammograms and pap smears.

But, as you can see, this is sort of rationing at work. At one price, the procedure seems outrageously expensive and it is not performed. At another price it seems like a bargain.

We are simply choosing among various alternatives in order to spend our health-care dollars as effectively as possible?

The real question is who sets these standards and makes the decisions, particularly when it comes to publicly funded programs.

Right now, insurance companies decide which drugs and procedures are available to those with insurance.

The federal government decides for older citizens.

And the uninsured have their health care severly rationed. If they can’t pay for it, they don’t get it.

In some countries, like Canada and England, public panels of scientists, researchers, doctors, patients make the decisions based on established criteria. Of course, those would be labeled “death panels” here.

Still, as health care costs mount, and pressure to contain them grows, we will need some rational way to making these difficult choices.