Should health care rationing be binary or analog?

Massachusetts has won a Medicaid waiver to finance its Commonwealth Care plan for another three years, assuring something approaching universal health care in that state.

The state saved 40% on its bill for uncompensated care under the plan, it reported in August, as three-fourths of the state's 650,000 uninsured found some coverage.

Critics call this a bailout. Even so the state is under enormous financial pressure as the recession comes on. (A Republican posted this photo of Massachusetts Gov. Deval Patrick.)

If times stay tough the state may have to redefine what it means by care, rationing what it pays for across all citizens. This is what happens in Europe. Hard times mean less coverage, longer waits, fewer staff.

In contrast to this "analog rationing" the normal American cure is to cut the unemployed off from all but emergency care. I call this "binary rationing." You either have insurance or you don't.

In past recessions binary rationing just transferred the burden to charity hospitals, but many of those are being closed, or are being transformed so they can turn people away.

This gets to the heart of the American health debate at any time. But it becomes more urgent during hard times.

When you put everyone on the same plan those on the best plans lose some benefits. This is analog rationing. When you tie care to employment those without get nothing. This is binary rationing.

So how should health care be rationed?[poll id=27]