1. The health care system is not nearly organized enough to ration care. It has taken over a decade, multiple committees, and significant financial incentives and disincentives for items as simple as core measures to take hold nationwide–and these are very simple rules aka ‘never events’
2. There is an art to the practice of medicine that no statistics or government mandates will ever be able to harness or fully regulate. Sometimes doing nothing is the right thing to do, and not because of costs or available resources.
3. Medicine is not homogeneous enough to follow simple rules or algorithms across the board. When people ask if an 80 year old with cancer will be ignored to treat a 40 year old with cancer, it fails to recognize that there are different forms of cancer with different stages and different prognosis, as well as different treatments. Even if one decided to prioritize a 40 y/o with pancreatic cancer over and 80 year old with lymphoma the medications one uses to treat are different. Even if we threw the kitchen sink at the 40 y/o he or she is still unlikely to survive for even 5 years.
4. Sometimes too much ‘health care’ can actually be detrimental to one’s health, especially the current care received by most geriatric patients when cared for by non-geriatricians.
5. Every rule ever created in medicine can be side-stepped by practitioners who find them inappropriate, for a medically justified reason. For example, a patient with an aspirin allergy will not receive aspirin when having a heart attack despite the core measure requirements.
6. Obama would not ‘ration’ care or allow that to happen.
7. Rush, and the other right wing watch dogs would shine a light so bright on any occurrence of rationing it would not be sustainable
8. We currently ration health care, under various guises–pre-existing conditions, medical futility, experimental treatment, out of area resident, elective procedures, etc.
9. Bad doctors can not be counted on to do the right thing regardless of the health care paradigm in effect.
10. Good doctors will do the right thing regardless of governmental regulations and financial incentives.