When is rationing not rationing, a mandate not a mandate and price-fixing not price fixing?
When the government says so.
Supporters of the ACA react to the opposition’s charges of rationing by pointing out that the law expressly forbids it: “[Cost-reduction proposals] shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums…increase Medicare beneficiary costsharing…or otherwise restrict benefits...” (Pub. L. 111-148, § 3403)
But if the government takes your money to fund Medicare and then in any way limits your access to the benefits of that program, that's rationing. Since in addition to rationing the law also prohibits benefit restriction and increased cost sharing, the only effective way left to achieve mandatory spending cuts is to lower payments to doctors and hospitals. If you end up with less access to medical care because the government pays less, that’s rationing. No matter how much you deny it, or what you call it, a rose is a rose...and government restricted access to health care is rationing.
The same people who say the ACA will not ration will also tell you that markets ration through prices. This is an erroneous portrayal of the role of prices in a free market. Free market prices are simply a signal. Prices do not ration any more than a bathroom scale makes you fat or thin. Free market prices reflect the relative scarcity of resources and then allow you to decide how to allocate your own private resources. Free market prices are what people voluntarily pay; government rationing is an act of force. It's a fundamentally different kind of interaction when the government forcibly determines how your resources must be allocated—either by expropriating them first, as in the case of Medicare, or by mandating how you must spend them, as in the case of the individual mandate to purchase health insurance.
Speaking of mandates—in the legal challenges to the ACA, the U.S. Solicitor General argues that the law’s “requirement to maintain minimal essential coverage” is not a mandate to buy coverage; it just regulates how we pay for health care. This is a distinction without a difference. Lawyers are adept at word games, but if you look at the actual effect of the law, it’s a mandate which offers no real choice: either you obtain a government-defined product or you break the law and pay a penalty.
