FORTUNE — Let’s ban the word “rationing” from the health care debate.
It’s everywhere. Sen. Pat Roberts (R-Kan.) Earlier this month introduced the “Repeal Rationing in Support of Life Act,” which would remove four provisions of the Affordable Care Act (a.k.a. Obamacare) that restrict spending. A recent front-page article in the New York Times, headed “Treatment Cost Could Influence Doctors’ Advice,” noted that some critics call such a practice rationing. Accusations and denials of rationing have filled discussions of the ACA since before its enactment four years ago.
So let’s be clear on two big facts about rationing. First, as the term has long been used, we don’t have rationing of health care under the ACA. Rationing is what we had in World War II. The government imposed strict limits on how much sugar, gasoline, rubber, and other goods you could buy, and you could not legally buy more than that, no matter how much you were willing to pay. We don’t have that with respect to health care. So long as you’re willing to pay the doctor or hospital directly with your own money, you can buy all the health care you want.
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Remember that fact when you read statements like this one from Sen. Roberts: “Under Obamacare, Washington bureaucrats can dictate one uniform standard of health care that is designed to limit what private citizens are allowed to spend, with our own money, to save our own lives.” Obviously that isn’t correct. Sen. Roberts is actually criticizing — quite rightly, in my view — a provision of the ACA that restricts how much people can spend on health insurance. But you don’t need health insurance to get as much health care as you want. You just need money.
The second big fact about “rationing” concerns what people really mean when they misuse the word. They mean that in some patients’ cases some procedures or products or medications won’t get paid for because they cost too much. Those people are absolutely right. We’ve had that situation for years with private insurance, and we’ll have it much more under the ACA. It’s just that in every other area of our lives, we don’t call it rationing, we call it budgeting. Who will do it is the great question, because a ton of it will need doing.
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Total U.S. Health care spending by all parties rose at a 5.6% annual rate in last year’s fourth quarter, and the government expects it to increase 6.1% this year. Even when the rate of increase was subsiding, health care spending consistently grew faster than GDP, and now it’s growing much faster. Obviously that cannot go on. The rate of increase in health care spending is going to come down because it must.
There’s a vital debate to be had over the role of the federal government and regulations vs. The role of individuals and markets in managing that tightening. Let’s have that debate. And let’s do it without invoking one particular, inaccurate, freak-out-inducing word.
