Will We Ration Health Care? The Coming Public Policy Debate
Tuesday, February 15th, 2011The passage of the Affordable Care Act has generated concerns that the government will ration valuable health care services. But what exactly is rationing, and how does the U.S. health care system allocate scarce resources today? In this podcast, University of Virginia Professor Eric Patashnik discusses his research on the politics of evidence-based medicine and why rationing has emerged as a major public policy issue. He covers the role of doctors, political leaders, and public opinion in shaping the context in which the debate over rationing is playing out.
Eric Patashnik is Associate Dean and Professor of Politics and Public Policy at the Frank Batten School of Leadership and Public Policy. He is also Nonresident Senior Fellow at the Brookings Institution and Fellow of the National Academy of Public Administration. Patashnik received both his MPP and PhD (political science) from the University of California, Berkeley. He previously held faculty positions at Yale University and UCLA. Patashnik’s latest book is Reforms at Risk: What Happens After Major Policy Changes Are Enacted (Princeton University Press, 2008), which received the 2009 Louis Brownlow Book Award given by the National Academy of Public Administration. His two other books are Promoting the General Welfare: New Perspectives on Government Performance (co-editor with Alan S. Gerber, Brookings Institution Press, 2006), and Putting Trust in the U.S. Budget: Federal Trust Funds and the Politics of Commitment (Cambridge University Press, 2000). His essays have appeared in Political Science Quarterly, Governance, Journal of Health Politics, Policy & Law, Social Service Review, and in many edited volumes. His current major research project, with Alan Gerber of Yale University, explores the politics of evidence-based medicine in the United States and is supported by grants from the Smith Richardson and the Robert Wood Johnson Foundations.
Mr. Patashnik spoke at the February 9, 2011 meeting of the Senior Statesmen of Virginia. The meeting was held at The Charlottesville Senior Center. Following the presentation, questions were taken from the audience. The program was moderated by SSV board member Bob McGrath.
Program Summary
At the February 9 SSV meeting, Eric Patashnik, Associate Dean and Professor of Politics and Public Policy at the Frank Batten School of Leadership and Public Policy, addressed the issue of, “Will We Ration Health Care? The Coming Public Policy Debate.” Rationing is simply the process of allocating scarce resources, anything from 50 yard line tickets at Redskin games to health care. We ration medical care implicitly and obliquely, and in contrast to other wealthy countries we mainly ration on the ability to pay rather than on the basis of need or anticipated benefit.
“The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open.” But explicit rationing is upsetting to many: Oregon’s attempt in the 1990s to ration Medicaid services unraveled under constituent pressure and provider gaming; explicit rationing might mean that some people who are accustomed to getting pretty much whatever care they want would be denied care or would have to pay more to get certain services; explicit rationing could increase the role of government, and most Americans don’t trust government to make good decisions
The US spends almost twice as much per capita ($7,290) as the next country (Canada $3,895), and yet in 10 out of 12 measures such as quality, access, efficiency, long health productive lives, the US is in the bottom tier. Within the US, there are huge variations in medical spending, and the areas that spend more on health care per capita do not necessarily get better results. Medicare spent more than $71,000 per end-stage patient in Miami, and only $33,000 in Green Bay. Hospital stays in Green Bay were 25 percent shorter than national average yet had no worse outcomes.
Popular treatments may not work as advertised. A common surgical procedure, arthroscopy for osteoarthritis of the knee, was found to be no more effective than a fake operation in which the surgeon merely pretended to operate.
Comparative effectiveness research (CER): recent legislation (health reform law, stimulus bill) have established funding and infrastructure for research on what works best: use research to establish practice guidelines that doctors should follow. Although the public grasps there is a problem, it is very skeptical of anything they believe will reduce choice or interfere with patient doctor relationship.


David John Marotta, CFP®, AIF®, is president of 
Steve Williams was appointed executive director of the Thomas Jefferson Planning District Commission and the Charlottesville-Albemarle Metropolitan Planning Organization (MPO) in Charlottesville in May 2009. Under his leadership the Charlottesville-Albemarle MPO has been focusing on planning based on performance measurement, land use-transportation coordination, expansion of the region’s transit systems and bike and pedestrian transportation.
Since 1998, Saunders Midyette has served as vice president and national sales director for the St. Clair Group, Inc., and President, Jackson Group, L.L.C., in Charlottesville. In the three decades previous to that he held the positions of vice president and chief financial officer with the Sisters of Providence Health System in Springfield, Massachusetts (1996-1997); senior associate with The Hunter Group in St. Petersburg (1995-1996); vice president and chief operating officer for the Greater Southeast Healthcare System in Washington, DC (1994-1995); chief operating officer with the University of Virginia Medical Center (1991-1994); associate director and administrator with the University of Michigan Hospitals (1987-1991); associate director and chief financial officer with the University of Michigan Hospitals (1979-1987); associate administrator and chief financial officer with the University of Utah Hospital in Salt Lake City (1976-1979); and controller and chief financial officer with the Hospital of University of Pennsylvania (1966-1976).
James E. Haden was named president and chief executive officer of Martha Jefferson Health Services in 1993. Mr. Haden received a master’s degree in Public Health/Health Services Management from UCLA in 1971. He completed his administrative residency at Scripps Hospital in LaJolla, California, and received the 1988 Alumni of the Year Award from the UCLA Health Services Management Alumni Association. Mr. Haden served as president / CEO of Queen of the Valley Health Services in West Covina, California (1986-1993). Prior to that, he served as chief operating officer of Hoag Memorial Hospital Presbyterian in Newport Beach, California (1978-1986). He served as associate administrator at Huntington Memorial Hospital in Pasadena, California (1976-1978). In 1992, Mr. Haden was chairperson of the California Association of Catholic Hospitals and was a member of the Hospital Council of Southern California (1988-1993).
Carol Huston Craig was appointed government relations specialist at the University of Virginia Medical Center in April 2010. In this position she is responsible for tracking state and federal legislation impacting the Medical Center; preparing advice statements on legislative and regulatory issues impacting the Medical Center; planning and organizing on-site educational programs for legislative guests and off-site visits to legislators; assisting in the preparation and submission of COPN applications; and assisting in the review of Medical Center policies.
Congressman Tom Perriello was sworn into office on January 6, 2009, and is proud to represent the 5th District of Virginia. He serves on the House Transportation & Infrastructure Committee and the House Veterans’ Affairs Committee. During his short time in Congress, he has already successfully passed into law a $2,500 tuition tax credit for college and community college education; worked to extend job training benefits for veterans; and supported economic recovery efforts in Congress.
Jeffrey A. Clark was born and raised in the tide-water area of Virginia. After high School he joined the U.S. Army and served 4 years. He was stationed for two years in Germany and the remaining two in Texas. While in Germany Jeff traveled to other European countries and he took advantage of college classes offered to soldiers. Jeff met his wife Gerri of 25 years while stationed in Texas. They have four adult children and three grandchildren.

Virginia has 11 Congressional Districts that are heavily gerrymandered. Of the 11, six have Democratic incumbents and five Republican, which is a switch from 2008 with seven Republicans and four Democrats. All five Republican seats are safe (Rob Wittman, 1stDistrict; Randy Forbes, 4th; Bob Goodlatte, 6th; Eric Cantor, 7th; and Frank Wolf, 10th). Of the Democrats, only Bobby Scott (3rd District) and Jim Moran (8th) are safe. The four that are competitive—all currently Democratic but in pretty Republican Districts–are Glenn Nye (2nd), Tom Perriello (5th, comprised of Charlottesville, Albemarle and down to the North Carolina border), Rick Boucher (9th), and Gerry Connolly (11th). Freshman Glenn Nye is not yet entrenched and therefore vulnerable. Incumbents have a large advantage, but not so much for freshmen members. An exception to the campaign financing law is that although contributions are limited to $2,000 per donor, a candidate can donate an unlimited amount of his own funds, so party leaders are looking for wealthy businessmen who can finance their own elections. Nye’s district voted 50% for Obama, and McCain performed well here. Rick Boucher served about three decades, but he voted in favor of the cap and trade bill—very unpopular in coal mining country. Morgan Griffith, the Republican leader of the House of Delegates resides just outside of the 9thdistrict, but there is no law that you have to live in the district (or the state, for that matter). The Crystal Ball still sees this very narrowly as likely Democratic win. Northern Virginian Jerry Connelly won election with 55 % of the vote in an open seat race last year, and will be running again against Keith Fimian again if Fimian wins the Republican primary.
Rob Bell
David Toscano
