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    Ethical Considerations of Healthcare Rationing in PPACA World

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    The Patient Protection and Affordable Care Act (PPACA) promises great changes in the health care system. Coupled with the rapidly aging Boomer generation, this change may lead to an increased demand for services without an accompanying supply of providers. Do you think that rationing will be part of the post-PPACA future? How can you justify rationing in a universal health care environment?

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    There are two issues to consider in discussing the concept of rationing. One is the conscious limiting of access to services; what most people think of as "rationing." The other is the unavailability of services due to inadequate supply. These are clearly two different situations, both of which may be described as rationing. Let's consider the first one.

    Rationing of healthcare has been with us forever. Even in systems like Canada and the UK where there is universal healthcare, there is a rationing aspect. The well-off individuals can obtain any level of care they desire in these systems since there is the allowance for a "pay as you go" kind of care, i.e., those who have the resources to pay in cold, hard cash, can avail themselves of any level of care they desire at any time. The rest of the population has to wait, depending on circumstances, until care is available. Certainly, these systems allow for emergent care, but for non-emergent medical treatment such as the arthritic hip joint that needs to be replaced, a waiting list is the standard. ...

    Solution Summary

    Rationing occurs in the setting of consciously limiting access or that of inadequate resources. Post-PPACA we will move from the first to the second situation. The question is practical; how do we as a society determine the allocation of existing healthcare resources that may not be sufficient to meet demand? We can make practical choices based on what we know about healthcare usage, or choose not to engage and force the Government to make those choices. In either event, healthcare resources will remain limited in the face of increasing demand and some way of allocating those resources will be required.