I’d love to just steal David Leonhardt’s excellent analysis in the New York Times today, ‘Limits in a System That’s Sick’ and paste the whole thing here. It’s hard to pick and choose when the whole essay is full of new perspectives.

Leonhardt points out the obvious–we are already rationing health care, and not in a fair or sensible way. Everyone who has to deal with the system, as a worker or a patient, knows that some people are getting meds and tests that they don’t even need, for profit and liability reasons– and others are suffering for lack of basic, effective, preventive health care that is proven to work.

But not all the costs are seen in the hospital—

There are three main ways that the health care system already imposes rationing on us. The first is the most counterintuitive, because it doesn’t involve denying medical care. It involves denying just about everything else.

The rapid rise in medical costs has put many employers in a tough spot. They have had to pay much higher insurance premiums, which have increased their labor costs. To make up for these increases, many have given meager pay raises.

Anyone who works for a small business knows how true this is. Leonhardt compares the US with other countries and explains why Americans pay more for less. A chart in the article shows survival rates in several countries. If you are diagnosed with breast cancer, stay here. If you need a kidney transplant, better go to Canada. I think I know why.

We are good at catastrophic care–doing the surgery. We are not good at the basic preventive care that your transplant patient will need for all the years of his life. If we could put the money where it will do the most good, we could have the best of high tech, and keep the need for it to a minimum.