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Health Care Will Always Be Rationed

It's a triumph of outstanding journalism.

A couple of days ago the Guardian published the results of a survey it commissioned which found that the UK National Health Service was rationing care. Wow! What a discovery. Well done the Guardian for letting us in on this secret. Dr Mark Porter, leader of the British Medical Association, chimed in with his own spectacular insight: "The NHS is being forced to choose between which patients to treat, with some facing delays in treatment and others being denied some treatments entirely."

In spite of the screaming headlines, this is hardly news.

The NHS - like every other health care system in the world - rations care. It has done so from the days of its foundation and will continue to do so forever. Health care is a service for which there is infinite demand and finite resources. Choices therefore have to be made as to what it can provide and what it can not. The only question that is worth debating is the basis on which such rationing is best done. Some systems ration by ability to pay. Most ration by making judgments as to what care will be provided free at the point of delivery and what will not.

Of course there is no perfect system for rationing care - and very many have been tried. Whatever system is chosen, some people will feel discriminated against, some doctors will feel aggrieved that their particular area of care is not treated with the respect it deserves and health care managers, union leaders and politicians who happen to be in opposition at the time will complain ceaselessly about the scandal of health care rationing - the last only to change their tune once faced with the reality of being in government.

The current manufactured news story continued its pantomime when health minister David Prior reportedly stated "Treatment decisions should only be made by doctors based on a patient's individual clinical needs". The honourable minister chose not to clarify how such a statement can be squared with an inevitably capped NHS budget. Other trite clichés like 'postcode lottery' are once again making their tiresome appearance.

It is time that the debate about the NHS in the UK grew up into an adult one. There are many issues that should be subject to public debate but whether there is rationing or not is not one of them. Most doctors seem to understand this. The survey reports that "Three-quarters (74%) [of doctors] believe that the NHS is right to be rationing treatments either because that helps the NHS survive financially, or because not all treatments should be funded by the service or because free NHS services can be abused by patients."

If only those few who blag publicly about these issues were as adult as most doctors seem to be, we would have a chance of improving how the NHS spends taxpayers' money.

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