One of the largest boogeymen raised by opponents of single payer health care is that your health care will be rationed. There will only be so much money, so someone will end up being denied the health care they need. To some degree this is true. I do expect that people will have to postpone elective procedures until a fiscal year passes. This can sound terrifically scary.
Except your health care is already rationed, and to a frightening degree.
I used to sell insurance, and when it came to health insurance, I had to know the plans and their limitations quite well, at least for Washington State. However, we have a fairly active insurance commissioner, and our laws are generally better for the consumer than many other states. That being said, the limits you have on coverage might as well be rationing.
Probably the greatest limitation is that most individual plans do not cover pregnancy. Pregnancy is expensive. There are a lot of doctor's visits, trips to specialists, and the delivery, plus at least two days in the hospital are pricey as hell. And given the rising number of c-sections, you then have to start paying surgeons and anesthesiologists as well. So, the easiest thing to do is exclude it. When you decide that with your limited resources, you will cover one thing, and exclude others due to expense, what are you doing but rationing? Washington State requires that mental health care be covered. Previous to this law taking effect, mental health care was excluded from most plans.
The majority of plans limit the number of visits you can have to doctors each year. Specialists are even more limited, and despite the proven medical benefit of chiropractors and massage therapists (both of whom help put me back into place after many hours of martial arts each week), the former is generally limited to ten or fewer visits each year, and if the latter is covered all, you should kiss the feet of whomever got you that sweet deal.
Drug coverage is rationed as well, at anywhere from $1,500 to $3,000 per year. I'm on one common medication that without insurance is $2,400/year. I'm on the generic. I better hope that I don't need anything beyond antibiotics and then thank God that I'm not allergic to penicillin or amoxycillin. I also better be happy that I don't need something for which no generic is currently available. This last part comes as an unhappy surprise to many, many people in the last quarter of the year when they receive a bill from the insurance company for the last couple months, demanding hundreds of dollars.
Most plans limit the amount they'll pay for an organ transplant, anywhere between $200,000-$250,000. Here's a list of the range and average costs:
Heart $50,000 - $287,000 $148,000
Kidney $25,000 - $130,000 $51,000
Liver $66,000 - $367,000 $235,000
Pancreas $51,000 - $135,000 $70,000
Heart/Lung $135,000 - $250,000 $210,000
So, in other words, better hope you're average or below, particularly if you're looking at a liver transplant. Oh, and better hope that your plan either doesn't have a waiting period, or that you're past it. Otherwise, not covered.
And finally, there is a $2 million lifetime limit. That sounds like a lot, and during the prime of your life, provided you're decently healthy, will be plenty. It's at the end of your life that this will cease being sufficient. End of life care is incredibly expensive. Spend a month comatose, or with doctors taking heroic measures to keep you alive for another couple days, every couple days, and you'll blow through that $2 million limit in a hurry.
Now, hospitals, being run by rational people, will decide it is not in their interest to spend their resources on prolonging your life by a minuscule amount. The doctor will have to come in and talk with your family about there being no hope, and making you comfortable while you wait. Sure, keeping the bed filled is expensive, but the saline and morphine drip aren't gonna put them out of business. And you will die, because your health care has been rationed, and you're out of rations.
So, health care will be rationed either way. Now I ask you, who do you want determining the rations? A corporation is legally beholden to do best by the stockholders. Unless you're a pension or mutual fund, or run a university endowment, you do not have enough influence over a health insurance company to make them change their policies. I can kick a politician's ass out of office, a Congressman every other year, and at least every four years, one of my Senators is up for reelection. The good parts of Washington State's health care have been mandated by politicians in response to public anger. I'd much rather they have direct leverage over who's doing the rationing.