Rational Maybe, Moral Never : Health-care shortages vividly illustrate the heartbreaking dilemma

The imaginative effort and the predictable failure of Alameda County to devise a rational rationing of public- health services provides a lesson for every county in the state. More than anything else, the failure measures the inadequacy nationwide of basic health services, an inadequacy that is at once dangerous in health terms and costly in fiscal terms.

Rationing of health care for the poor and uninsured already is a fact, imposed by endless lines at clinics, the unavailability of specialists, the limited access to diagnostic services and hospitals, and the enduring squeeze on public-health budgets.

Alameda County decided to do by design what was being done by chance, and in the process make more effective use of health-care dollars. Oregon’s experiment along similar lines was a model. Oregon made an open decision to focus limited funds on primary care, thus ensuring such services as prenatal care, the most cost-effective medical investment, but denying organ transplants. It was a decision as honest as it was controversial. But the Alameda County study quickly discovered that “The health care system for the poor and uninsured in Alameda County is already stretched so thin that . . . rationing, prioritizing . . . specific services or procedures relative to target populations or diagnostic categories are impractical and morally indefensible.”

The same conclusions apply to most of the counties, probably all of the states. California has 5.2 million without health insurance, many of them children. The most recent evidence of the failed health-safety net is the outbreak of measles, accompanied by a record death toll, at a time when immunization can provide protection.

At a time when artificial budget restraints dominate politics, it apparently has been easier for legislators to postpone providing adequate health funds even though they certainly know that postponement extracts a staggering increase in the cost. That must change.