Why do we ration health care?

Queueing has two effects:
1.  it minimises the likelihood that resources are under-utilised;
2.  it is a form of rationing; some people will leave the queue before they reach the end.  In the health system this generally means they get better on their own, they die or opt for private treatment.

The first of these effects may be beneficial as it reduces the overall cost of the service since resources do not stand idle.  This is offset however by costs associated with the queue itself.  For example people who are off work sick are unproductive, a cost to the economy but not to the NHS.  Furthermore people and systems under pressure will be more inefficient and therefore more expensive. All around me doctors and nurses seem to me constantly firefighting.  The result is that they cannot plan ahead and resources are wasted.  In my case I effectively blocked a high-cost bed (in CCU for a week), which is a real cost to the NHS, and ultimately to the tax payer.   Worse, they make mistakes, resulting not only in additional cost but in health-care bad or even lethal outcomes for patients.  Then come the bureaucratic apologies ("we were not as attentive as we should have been").

The argument for rationing is also made more complex because the public generally do not take a cost-benefit approach to health matters.  The red-top press would suggest that all human life, at least their reader's lives, are infinitely valuable; not a week goes by without an article about children denied cutting-edge medical treatment because of cost-constraints, the effect of the "post-code lottery" on distribution of services or a cancer drug denied because it is not on NICE's approved list.

But the politicians, of all parties, are not prepared to stand up and face this issue.  Talk of the NHS being "ring fenced" from austerity plans is code for saying we acknowledge the public view that all life is sacred, while not actually acting accordingly. Austerity bites as much inside the ring-fence as on the outside because the cost of health rises inexorably through more sophisticated treatments, an ageing but growing population.  Better medicine even has its cost because as we keep people alive longer inevitably they make more demands on the system.   

Politicians need to step up to the mark and acknowledge openly that it is unrealistic for the NHS to deliver y what the public demand, to expect that all treatments can be made available at all times to everyone.  Then we can debate what we are prepared to pay for health, and where we want to spend it.