ind it difficult to obtain health care services."
The problem is especially apparent in view of the fact that "the United States is the only industrialized country other than South America in which the public (government-financed) sector share of health care is less than 60 percent . . . health care is, in fact, a very big business--the nation's third largest industry." Instead of offering blanket coverage on the basis of citizenship, "the United States offers access to health services mainly on the basis of age, income, and employment."
The issue of rationing medical care is significant as part of the overall view that medical resources are finite. The issue is not whether or not we ration, but rather how we allocate available resources. Rationing occurs whenever health care resources are insufficient to make them available to all who might benefit. "Rationing is not a new concept; in the United States, people are denied benefits or services on the basis of ability to pay (as in fee-for-service), age (as in Medicare), residence (as in urban or rural), ethnic identity (as in Indian Health Service, a part of the U.S. Health Service), gender (as in inequalities in use), and other characteristics."
The Canadian medical establishment has accepted rationing as a necessary consequence of universal care. In his chapter on Canada's National Health Insurance System, Laurence A. Graig quotes the former president of the Ontario Medical Association as stating that "rationing is inevitable in today's economy." He further distinguishes between the American and Canadian systems by pointing to Canada's willingness to use explicit rationing to address the finite resources for health care. Graig notes that "one observer of the two systems observes that Americans shrink from the notion that care must be rationed; Canadians don't. It's not a question of whether either country must ration . . . but rather how it's done."
The pro...