The two schools of covert rationing
School of thought number 1 - the Wonkonians
Governmental regulators, politicians, public health officials, political liberals, and policy mavens (wonks, in other words) espouse the Wonkonian school of thought.
Wonkonians believe that the root cause of the problems in our healthcare system lies in human weakness (specifically in too many greedy doctors using too much expensive technology). The fix for these problems therefore rests in setting policy and promulgating regulations to hold that greed in check. Philosophically, Wonkonians believe in original sin, in the essential evil of man - if you give a fellow too much freedom, he’ll probably do something bad.
That the traditional (Tooth Fairy) Quadrant IV healthcare system institutionalized the natural human greed of physicians supports the Wonkonians’ argument. Under that Quadrant IV system, the more technology doctors use, and the more procedures they perform, the more money they make. This system fosters profligacy, waste, and the overuse of expensive resources.
According to the Wonkonian school, the greed inherent in our healthcare system is confirmed by the fact that millions of Americans are shut out of the system (or at least shut out of health insurance). Where is the cry of outrage from our “compassionate” physicians over the high number of uninsured? The greed is further reflected by a lack of quality in our present healthcare system - consider the high infant mortality rate and lagging life-expectancy in the U.S. as compared with rates in other developed countries. Again, where is the professional outrage? Clearly there is a fundamental problem with our healthcare system, a problem that stems from the misguided incentives and maladjusted motivations of healthcare practitioners and other profiteers.
Politicians and policymakers gravitate toward this school of thought because its basic premise is that the problem with healthcare results from misguided incentives coupled with human greed. This premise places the solution in the hands of policymakers, who can do the job with stricter regulations and more enforcement muscle.
