Conservative columnist Charles Krauthammer’s negative assessment of President Barack Obama’s healthcare reform package is based on his belief that the plan is economically feasible only if that care is rationed.

To quote Krauthammer:  “Rationing is not quite as alien to America as we think.  We already ration kidneys and hearts for transplant according to survivability criteria, as well as by queuing.  A nationalized health insurance system would ration everything from MRIs to intensive care by myriad similar criteria.”

Krauthammer’s personal preference is “for a highly competitive, privatized health insurance system with a government-subsidized transition to portability, breaking the absurd and ruinous link between health insurance and employment.  But if you believe healthcare is a public good to be guaranteed by the state, then a single-payer system is the next best alternative.  Unfortunately, it is fiscally unsustainable without rationing.”

Krauthammer is wrong!  In the United States, healthcare is rationed but it is according to your income and insurance status.  And for the 47 million Americans who don’t have insurance, we ARE already rationing everything, “from MRIs to intensive care (to use Krauthammer’s examples)”.  We have to accept that no matter what the system is that we adopt, that rationing will occur.  The issue is rationing that is unethical and doesn’t meet the mission of healthcare.  The way to mitigate rationing in a nationalized system may be to do what the British Medical Association has suggested, which is to define a set of core services – cardiac care, for example – -which may fall under the rubric of life threatening.  These would never be rationed regardless of who you are.  More elective procedures or non life-threatening procedures, on the other hand, would be rationed.  We can’t expect our health system to do it all and this seems a modest proposal.