Moving leftward

Two powerful forces are moving us leftward within the healthcare universe:

1) Individual patients (and their doctors) do not take the needs of society into account when they decide how much of society's money to spend on their own healthcare. Thus, society has a strong incentive to take those spending decisions out of the hands of individuals and place them in the hands of some central authority.

2) We have a growing conviction that healthcare is an entitlement for all Americans. This conviction itself is at least partly a result of latter-day Quadrant IV healthcare, where exploding healthcare costs (fueled by exploding expectations) have outstripped the ability of individuals to pay for their own care.

Declaring healthcare to be an entitlement forces the centralization of healthcare, as any large entitlement requires the redistribution of wealth, which is possible only with a powerful central authority. If there were no such authority (but, of course, there is), a healthcare entitlement would necessitate creating one.

So: both the need to curb the profligacy of individuals and the entitlement mentality have driven the American healthcare system leftward in the healthcare landscape, toward the centralization of medical decision-making. Such centralization enjoys, if not popular support, at least popular resignation.

Given this strong move to the left within our healthcare landscape, it is now time to introduce the First Corollary of the GUTH:

    First Corollary of the GUTH: Left = Rationing

When any healthcare system is operating in either of the two left-hand quadrants of the healthcare universe, whether Quadrant I or Quadrant III, it is necessarily operating under a system of rationing.

Why is the First Corollary true? Why is it that any healthcare system operating on the left half of healthcare landscape must necessarily employ rationing? It is because centralized decision-making means that some central authority is controlling a pool of money, created by society, from which healthcare costs are to be paid.  Because there will always be limits to how much money can be placed into such a pool, while there will never be limits on what can potentially be spent on healthcare, whenever the healthcare system is operating in one of the two left quadrants, rationing is occurring.  A fuller discussion of just why rationing is an economic imperative in the two left quadrants of the healthcare landscape can be found in the Understanding It section of this website, and in my book. 

The American healthcare system is not just moving leftward within the healthcare landscape, however; it is moving downward, away from Quadrant I and toward Quadrant III.