Nike, Barney Frank, and Health Care Rationing

Every society rations health care. Even in a country as wealthy as the U.S. there are more good things that could be done than we are prepared to pay for. As important as health care is, it is not the only important social good. Limits must be set. The ethically relevant issue is how a society conducts the process. The U.S. rations by leaving 48 million without insurance and by asking our complex mix of public and private insurers to find ways to set limits, preferably without acknowledging that they are doing so.

Two recent New York Times articles sharpened my sense of why honesty about rationing is so difficult in the United States.

Direct to consumer (DTC) advertising via traditional media – largely television and print – is already highly effective in driving consumer demand for costly branded products. “The New Advertising Outlet: Your Life” describes how Nike and other companies use the Internet for sophisticated targeting of individuals in relation to their specific interests. DTC is showing up in Second Life and other cyber fantasy spaces. The new techniques will drive ever more consumer demand.

More consumer demand will require more supple ways of setting limits, but “Liberal Base Proves Trying to Democrats” tells a bizarre story about how our political process is going in the opposite direction. Congressman Barney Frank, a leading liberal and gay activist, is being attacked by gay rights organizations for removing “gender identity” from the Employment Non-Discrimination Act. Barney (disclosure: I am a yellow dog Barney Frank supporter) has done this to gather more support for protection of working rights for gay men and lesbians. He concluded that whatever chance the bill has for garnering support would be undone by making it cover transsexuals and transgendered individuals.

To set limits a society must be able to conduct vigorous debate and accept disappointing conclusions. The Barney Frank story, like the preposterous political grandstanding that marred the end of Terri Schiavo’s ordeal, shows how much we have to learn to be able to set and accept limits chosen in a fair and thoughtful manner.

Barney Frank summarized the problem this way – “There is a tendency in American politics for the people who feel most passionately about an issue, particularly ones that focus on a single issue, to be unrealistic in what a democratic political system can deliver, and that can be self-defeating.”