Thursday, December 23, 2010

Rational Rationing

This is the night the adults take over Christmas.  Parents all over America will put the kids to bed, break out all the hidden presents for all their little kiddies, ask tough questions and make some tough choices.  Are the piles even?  Did we spend equally on each child?  Did we hit enough marks on their Santa lists to meet expectations?  Are the stocking stuffers adequate to fill the entire stocking?  Should we shift some generic, non-gender specific items from one recipient to another?  It’s the last day to make adjustments! 
This is the dark underbelly of the decision-making in Santa’s workshop.  The children won’t want to know about the messy process of separating the booty based on criteria other than the omnipotent “naughty/nice” list, but it is what happens.  We don’t think of this ritual as the “rationing” of the presents, particularly in this country where it is more likely that we’ll just buy more to even the gift distribution.  We are a people of wealth, abundance, boundless credit, and dare I say, gluttony.  We don’t like to think about limits, especially during the holidays.  But on this night 2 days before Christmas, limits are on the table.  Rationing is as American as apple pie on this eve of Christmas Eve.

This rationing of children’s presents is not as painful or inconvenient as some of the events traditionally associated with rationing in history.  Noah only had room for two of each, and choices had to be made.  George Bailey enforced strict rationing in Bedford Falls during WWII.  I personally waited in long lines on even numbered calendar days for overpriced $0.75 per gallon gasoline in the 70s (outrageous!).  Noah, George Bailey and I recognized that, however inconvenient shared sacrifice was, it was required for the benefit of all.  We could have cheated.  Noah could have slipped an extra kangaroo onto the ark in its mother’s pouch.  I could have switched my license plates to ‘odd’ on odd days, ‘even’ on even days (kids, ask your parents what I am talking about…or google “1970s odd-even rationing”).  We didn’t.  Rationing, however painful, helped save the animal kingdom, win the Second World War, and insure enough gas was available for emergency needs in the late 1970s.

The concept of rationing, however, has been dragged through the mud over the past year or so.  Critics of health care reform freely tossed the word “rationing” into every debate on the topic, hoping that it would ignite a firestorm of revolt.  For the most part, it did.  Discussions of rationing centered around dictatorial, shadowy committees who sole purpose was to disrupt the natural purifying force of the Invisible Hand.  Darwin was heresy and should not be taught in school, they said, but his concepts were spot on when it came to the health care markets.  No one dared mention that it was the beloved Noah who was at the head of history’s first “Death Panel”.

I read a piece in The Week recently that drove home the health care rationing dilemma in stark terms.  There is a new drug called Provenge, a treatment for advanced prostate cancer.  Studies have shown that it can extend the life of a patient on average 4 months.  A decision is pending on whether this treatment will be covered by Medicare and Medicaid.  If that’s your life, those 4 months are pretty darn important.  The cost of the treatment, however, is $90,000.  So for 30,000 patients in a year, that’s almost $2.7 billion, and this is just one drug for one condition.  The numbers can add up quickly for a nation concerned about its balance sheet.

So there are 3 choices – cover the costs, and the budget be damned; don’t cover the costs, and some lives end sooner; cover some of the costs, and allow those with enough private money to live while others of less means do not.  If we don’t cover the costs, or only cover part of the costs, we are “rationing” between rich and poor.  If we cover all of the costs, we are on a fast track to bankruptcy, and acting more like the socialist regimes our far right loves to compare us to.  This is before we begin to include the availability of competent health care in the rationing debate.  When resources are scarce, rationing occurs, whether it is managed or allowed to just ‘happen’.  The argument should not be whether or not to ration health care; we already do.  It should be about the best way to ration.

On Saturday morning, the children may scream and cry that they didn’t get enough presents, or presents of equal or greater value than their siblings.  The left and right will scream and cry that everything is covered by Medicare, or nothing is covered by Medicare.  Tough choices require tough decisions, and these decisions need to be made by adults, in an adult manner.  We need grown-ups to make choices that children cannot or will not.  We could throw all the presents into a big pile under the tree, and let the strongest kid enjoy the spoils while the youngest and weakest cry in the corner, plotting retribution.  That may not be the best solution for anyone involved, so the adults step up.

The truth is that we ration limited resources every day, and sometimes it even stings a little.  When we make our daily decisions and difficult choices out to be evil and un-American, it demeans us all, and drives adults away from the necessary conversation.  It’s Christmas time.  We can act better than that.

So here’s an eggnog toast to the adults who have to decide.  Let’s hope all the kids are happy when they see what limited resources Santa has wrapped under the tree. 
“It is logical.  The needs of the many outweigh the needs of the few…or the one.” – Spock, Star Trek II: The Wrath of Khan.  And remember, he was a Vulcan.  You can’t get more adult than that.

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