Healthcare rationing in the United States

Healthcare rationing in the United States exists in various forms. Access to private health insurance is rationed based on price and ability to pay. Those not able to afford a health insurance policy are unable to acquire one, and sometimes insurance companies pre-screen applicants for pre-existing medical conditions and either decline to cover the applicant or apply additional price and medical coverage conditions. Access to state Medicaid programs is restricted by income and asset limits via a means-test, and to other federal and state eligibility regulations. Health maintenance organizations (HMOs) that commonly cover the bulk of the population, restrict access to treatment via financial and clinical access limits.

The Patient Protection and Affordable Care Act passed in March 2010 will prohibit insurers from limiting coverage to people with preexisting conditions beginning in 2014, which will alleviate this type of rationing.

Some in the media and academia have advocated rationing of care to limit the overall costs in the U.S. Medicare and Medicaid programs, arguing that a proper rationing mechanism is more equitable and cost-effective. The Congressional Budget Office (CBO) has argued that healthcare costs are the primary driver of government spending over the long-term.

Peter Singer wrote for the New York Times Magazine in July 2009 that healthcare is rationed in the United States:

"Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals."

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