One patient I took care of wanted to try a treatment that was not on the approved list of his insurer. It wasn’t monkey glands or anything. It wasn’t brand new and unproven, either. He and his family had good reason to believe it would help him.

It is helping him. The family is digging deep into their own funds, doing everything to keep the treatment going. Friends help, and the community donates.

This patient is well insured, with a good plan and government money filling in the gaps.

We are already rationing health care for the insured. Each separate health insurance company gets to decide the terms of the rationing, within government constraints that are in place because citizens demanded some protection. The insurance companies have to ensure that after everyone pays their premiums, and care is distributed, there is a good hunk of money left over for the corporation and its stockholders. This is not evil, it’s business.

For the uninsured the rationing is dire. Lack of basic care when it is needed leads to disability and death that could have been prevented. President Bush vetoed a re-authorization of SChip— state children’s health insurance. Was that a whim, or rationing?

Single payer would cut out the middleman, the companies that need to skim off a profit from what we spend nationally for health care. A public option would offer affordable insurance to many people who cannot now afford it, and expose insurance companies to real competition.

Rationing is unavoidable. Next time you see some poster up in the market advertising a fundraiser for a needy family with a disabled child you are looking at it. Government is a mess. Do you trust the corporations more?