The Historical Truth
The United States has had rationed access to medical services since before World War II. The medical association and the dental association met together and decided to limit the public's access to care in order to drive up prices and raise the incomes of doctors and dentists. Milton Friedman, the Nobel Prize winning economist, wrote his doctoral thesis on the technical aspects of how the groups decided to implement this project.
Since that time, we have had rationed care, with vigorous attacks by "the establishment" on various alternatives. There are significant court decisions regarding some of the attacks (ask your local chiropractor about them).
The issue before the public is not rationing. The medical establishment has already created rationed care in order to enrich itself.
The issue before the public is _ scientific _ care.
Medicine is often described as "an art, not a science." Medicine is often approached like religion, with blind faith, instead of being approached like a science. As a result, Medicine currently takes a tithe, 10%, of the American Economy.
The truth is that for most of history, medicine has been bad art.
Before the year 1987, people were more likely to be hurt by a visit to the doctor than helped.
For years doctors told heart attack victims to assume a sedentary lifestyle -- the worst possible treatment for cardiac patients.
For years, doctors treated back strains with drugs and bed rest -- a course of treatment we now know results in it taking longer for a person to get better -- and a course of treatment that results in more long term pain and permanent impairment.
For years, doctors treated weight gain with strict diets -- something we now know causes rebound weight gain, and is the number one cause of obesity in the United States.
The list goes on. In general, when someone could guess which way to treat a problem, doctors treated it the wrong way, from insisting that it was safe not to wash hands when delivering babies (creating a mortality rate close to 90% in France at one time) to current doctors failing to clean their stethoscopes ...
The following conclusions come from the facts:
No doctor who practiced for any substantial time prior to 1987 has any moral authority. Such a doctor was a part of a conspiracy that gained in wealth by persuading the public to consume a good (medical care) that the conspiracy knew, or should have known, caused more harm than good. All the AMA truly did was enrich doctors (compare doctors net incomes, adjusted for infarction, from 1950 to the present).
Doctors as a class are not competent to determine, and to prescribe, what medical care is appropriate to illness, disease or bad health. Consider, before 1987 they were prescribing themselves.
Statistical tools exist to validate and clarify what is therapeutic and what is not. From these tools, the following facts have become evident.
One, over ten percent of all tax dollars are spent on futile treatments for chronically ill people in the last ninety days of life. (Medicare/Medicaid are _ that _ large of a part of the national health system and heroic efforts to stop death when it can no longer be avoided take up that substantial a part of Medicare/Medicaid).
Two, over five percent of all tax dollars are spent on care for which there is no medical treatment or need (e.g. children's colds being seen in emergency rooms, etc.).
Three, outside of trauma care (setting bones after accidents, treating people who are in the midst of myocardial infarctions, etc.), nurses provide better care (e.g. those treated by nurses instead of Md.'s are healthier at the end of treatment) for less expense. See above for attacks by the AMA on competing avenues of health care and efforts of the AMA to take over health care provision by other groups.
Four, specialists make better gatekeepers than generalists (e.g. if someone is in an automobile accident and they are sent to a protocol limited Orthopod for referral to Chiropractic care or for tests and pre-surgical treatment, they recover faster, with less expense, than those who see GPs and physical therapists) -- at least for things nurses are not competent to handle (trauma care).
How do we get to an intelligent health care system, with reasonable costs.
First, the public needs to understand that we already have rationed care.
Second, the public needs to understand that much of what they believe about limited access to "real doctors" is the result of a long standing program of disinformation (not that I would trust Chiropractors to prescribe themselves -- read Consumer Reports interesting study).
Third, the public needs to appreciate statistical protocols and that there are conditions (e.g. colds) for which hand holding (the only care one will get from a doctor) or routine treatment (e.g. the administration of inoculations) is better provided by inexpensive sources with computers (LVNs can do both just fine, as long as the computer keeps them from forgetting something -- they'll do better than Md.s acting without computers) than by expensive ones (e.g. Md.'s).
The best way to approach this seems to be by combining the statistics on health (and what health services have benefited people) with the economic information on just how much doctors have profited from misleading the American people (the comparative economic statistics from 1950 to now).