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Fixing American Healthcare: The Problem of Covert Rationing

Dr. Richard Fogoros wrote a fascinating book called Fixing American Healthcare: Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare. In the first two thirds of the book, he explains why our healthcare system is broken, and describes its dysfunction with exasperating accuracy.

One of the most important concepts in his book is that of “covert rationing.” As Dr. Rich explains, we Americans cling to two fundamental beliefs:

1. Everything that can be done for a sick person must be done, as long as there’s some small hope of beneficial outcome. (The belief in no spending limits).

2. Healthcare is an entitlement for all Americans. (The belief in universal access).

Since science and technology have provided us with incredible (and expensive) advances over the last several decades, doing all that’s possible for all who are sick is simply not financially possible. However, Americans are fundamentally opposed to rationing care, so the rationing occurs covertly, including cost-savings achieved by people being uninsured, by certain chemo drugs not being covered by Medicare, by physicians being coerced by HMOs to ration care, and countless other subtle and capricious ways.

Covert rationing is a little recognized but fundamental flaw of the current healthcare system, and it results in untold inequities in care. Dr. Rich believes that a fair system requires open rationing of resources, with rules agreed upon by tax payers. Would you agree?

In my next post I’ll discuss Dr. Rich’s thoughts on what’s really driving up healthcare costs…This post originally appeared on Dr. Val’s blog at

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5 Responses to “Fixing American Healthcare: The Problem of Covert Rationing”

  1. Dr. Scherger says:

    I could not agree more about the covert rationing.  Most aurthorities now state that we in American ration health care to our citizens, economically, than any other developed country in the world. 

    I look forward to your next post.  I do believe that basic health care needs are an entitlement that we can afford in this country, and makes good sense from both a public health and civil society perspective.

  2. PearlsAndDreams says:

    Just dropping by to say HI … been without a computer for a couple of weeks.

    back on line.

  3. C Coleman Brown MD says:

    I have to agree that open rationing is a necessity that the American people will have a hard time swallowing. That being said, it’s time may have come. We all know about the cost of the “first and last years” of life and how hard it might be, but that is the reality of providing universal access.

  4. RH Host Melissa says:

    I would have to agree as well.  I look forward to your next post on this book.  Thanks!

  5. PearlsAndDreams says:

    As someone who has already had people tell me “wouldn’t it be easier on your family and society if you just let nature take it’s coarse?” …yes, to my face they have said that

    I find the idea of rationing rather frightening … knowing I’d be amoung the many that would be first targeted in that rationing.

    In many ways, it’s already began … treatments available to me a few years ago, no longer covered by medicare/medicaid unless it’s a crisis situation.

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