From an American perspective, Germany’s health care system represents a nettlesome challenge. Americans now spend 14 percent of their gross domestic product (GDP) on health care, while Germany spends less than 10 percent. Yet, for all that heavier spending, the U.S. health care system has never managed to provide all Americans with secure, portable health insurance. Evidently, for many low-income Americans without health insurance, the system now rations health care by income and ability to pay.
By contrast, Germans of all ages have long enjoyed fully portable health insurance that provides what is effectively first-dollar coverage for a very comprehensive package of benefits. Furthermore, unlike U.S. patients, who increasingly find their choice of doctor and hospital limited through the technique of managed competition, German patients still enjoy completely free choice of provider at the time illness strikes. In cross-national opinion surveys conducted by the Louis Harris organization in conjunction with the Harvard School of Public Health, both German patients and physicians express relatively greater satisfaction with their health care system than their American counterparts express with their system.
The relatively low level of health spending in Germany is all the more remarkable, because Germany’s population is so much older than America’s: 15.5 percent of the German population is age sixty--five or older, compared with 12.2 percent of Americans. In fact, the United States will attain Germany’s current age structure only in the year 2020 [Uwe E. Reinhardt, "Germany's Health Care System: It's Not the American Way," Health Affairs, 13(4) Fall 1994].
Catch that date: 1994. Little has changed in national differences since then. When Linda and fellow conservatives trot out the word rationing as a reason to oppose health coverage reform, they might as well be arguing that health coverage reform will make morphine addictive and cough medicine taste bad. The United States already rations care. It's been happening since well before Reinhardt's 1994 article. Americans seem to accept rationing completely... as long as it happens to lower-income people, who obviously don't deserve health care if they're poor, since lacking money evidently indicates some punishment-worthy character flaw.
By the way, Reinhardt points out in a 2003 paper that the United States' ration-by-income scheme appears to restrict care even more severely than any of the supposedly socialist dystopias across the pond. According to that paper, Europeans go to the doctor more and get more treatments than Americans do. Compared to the OECD median, the United States has fewer acute care beds available per 1000 population, fewer hospitalizations per 1000 population, shorter hospital stays, and fewer acute care days per capita. In other words, we get less health care than over half of the industrialized world. (Yet we keep spending more.)
This data shows that America already restricts care more than most industrialized countries with public health coverage do. If you're really worried about rationing, you should be clamoring for a European-style health coverage system. After all, spending less and getting more is perfectly... rational.