MELISSA BLOCK, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.
In the debate over how to fix the nation's health care system, one big worry is rationing.
Here's Senate Republican leader Mitch McConnell on CBS' "Face the Nation."
(Soundbite of TV program, "Face the Nation")
Senator MITCH McCONNELL (Republican, Kentucky; Minority Leader): I don't think many Americans want to start having to, you know, wait in line and start getting government permission for procedures. We need to be very careful about taking the wrong steps.
BLOCK: To those worried about having to wait in line for their care, some doctors and economists argue the U.S. is already, in effect, rationing in the most unproductive ways.
NPR's Scott Horsley reports.
SCOTT HORSLEY: Dr. Arthur Kellerman still remembers the patient, a mother of two in her mid 30's. She showed up in his emergency room with a hemorrhagic stroke.
Dr. ARTHUR KELLERMAN (Emergency Medicine, Emory University School of Public Health): We worked for 90 minutes to save her life. But basically, she had burst a blood vessel in her head. She didn't have a chance. When I broke the news to her sisters, they told me that she was a working mom but she had no health insurance. And when the money got tight, she had to make a choice: either she was going to buy groceries for her kids or she was going to buy her three blood pressure medicines that she had to take every day.
HORSLEY: Sadly, Kellerman says, for less than the cost of that futile 90-minute effort in the E.R., the woman could have had all the blood pressure medication she needed for the rest of her life.
It wasn't a government bureaucrat who decided she should forego treatment until it was too late, it was her lack of health insurance.
Dr. KELLERMAN: In America, we strictly ration health care. We've done it for years. But in contrast to other wealthy countries, we don't ration medical care on the basis of need or anticipated benefit. In this country, we mainly ration on the basis of ability to pay. And that is especially evident when you examine the plight of the uninsured in the United States.
HORSLEY: A few years ago, Kellerman co-chaired an Institute of Medicine committee that looked at the kind of care people get when they don't have health insurance. On average, he found they get only about half the care that people with insurance do. And they tend to wait longer and get sicker before seeing a doctor.
Dr. KELLERMAN: The cost of staying at home and feeling a lump grow in your breast, to feel a squeezing sensation become more and more evident with shorter and shorter walks every day, or less and less effort at work, hoping that somehow, hoping beyond hope it'll go away. That's an incredibly expensive choice to make when, had you been able to get the care you needed early, it could have been quickly, easily and simply taken care of.
HORSLEY: And it's not just the uninsured who are affected. Dr. Elliott Fisher of Dartmouth tracks variations in health care around the country. He says Americans who do have health insurance tend to get a lot of procedures after they're sick not because bureaucrats dictate that, but because that's what insurance and Medicare pay for.
Dr. ELLIOTT S. FISHER (Medicine and Community and Family Medicine, Dartmouth Medical School): We do lots of joint replacements, back surgery, cardiovascular procedures, imaging procedures, and we do lots of those because they're well remunerated.
HORSLEY: Fisher says those high cost services are not necessarily the most valuable when it comes to improving people's health. And as the cost of providing them goes up and up, insurance companies often cut the very primary care that could keep people healthier.
Dr. FISHER: I think there's a very real sense that we are rationing payments to primary care and what that leads is to poor care. You know, it leads to the five-minute visits that many patients are experiencing. Many primary care physicians feel like hamsters running on a wheel, and they have to run harder each time Medicare or the private payers cut their fees.
HORSLEY: And rationing is not limited to the health care industry. No other country devotes as much of its economy to health care as the United States. And while we might not think of that as a choice, it means we have less to spend on everything else.
Harvard economist Katherine Baicker says government payments for health care come at the expense of schools, roads and other services. And the extra money that employers have to pay for rising health insurance premiums is money they can't put into workers' paychecks.
Professor KATHERINE BAICKER (Health Economics, Harvard School of Public Health): No worker gets to say, you know what? Make my premium $1,000 lower by getting me a more efficient health insurance package. And, at the same time, give me $1,000 in take home pay.
HORSLEY: So while there is no government rationing board handing out coupon books for heart surgeries, more and more of the nation's resources are being gobbled up by health care, often with little choice for the individual and often, in ways, that no sensible person would choose.
Scott Horsley, NPR News, Washington.
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