That’s why Medicare needs the Independent Payment Advisory Board. Setting a cap on spending is the first step of rationing. The next is deciding who gets what medical care.

“Limited resources require decisions about who will have access to care and the extent of their coverage.” (Berwick, 1999)

As physician-blogger Dr. Richard Fogoros puts it: we can either ration overtly or covertly (“with our eyes open” or closed) — but ration we must.

The only way to escape the need for centralized rationing is to recognize that health care expenditures are not a national phenomenon, but an individual one. We have to stop thinking of medical care in collectivist terms, such as a “national resource” available for dispersal through political wrangling. Medical care is of, for, and by private individuals.

The proper alternative to the increasingly top-down, coercive central planning integral to our current system is restoring to each of us the right and responsibility for making our own rationing decisions.

Go ahead and vilify Dr. Berwick. There’s plenty not to like.

But if you support Medicare, Medicaid, the ACA or any other variation of government-run medical care, then plan on handing your wallet to the federal government, while Dr. Berwick and the central planners tell you what medical care you can have.

*(This is not to imply that markets or prices ration. They do not. Markets are simply a mechanism of exchange. Free markets signal through prices the scarcity of items based on supply relative to demand. Markets and prices don’t ration. People ration — either voluntarily as individuals, or coercively through government.)