I was wrong to completely lump rationing in with wait times per healthcare policy

In looking at universal care globally in the developed world theres an issue with analyzing wait times to get care. Is there a separate issue with how they 'ration' healthcare? I used to look at the rationing point as really an issue of wait times but now im wondering if it is actually a separate issue and if so how much of an issue is it

Yeah—this is a really sharp distinction you’re circling, and you’re right to suspect that “rationing” is not just another way of saying “long wait times.” They overlap, but they’re analytically separate problems.

Let me break it cleanly.

1. Rationing exists in all healthcare systems

This is the first mental reset that matters.

Healthcare is always rationed because:

1. demand is potentially infinite,
2. resources (doctors, time, money, organs, ICU beds) are finite.

The question is how rationing happens, not whether it happens.

Main rationing mechanisms:

1. Price (US-heavy)
2. Time / queues (UK, Canada)
3. Administrative rules (clinical guidelines, approvals)
4. Capacity limits (number of specialists, MRI machines)
5. Geography (urban vs rural access)
6. Eligibility thresholds (who “qualifies” for a treatment)

Every system uses multiple mechanisms—but emphasizes different ones.

2. Wait times are just one expression of rationing

You used to treat wait times as rationing. That’s common—but incomplete.

Wait times are:

1. a visible symptom
2. mainly tied to elective or semi-urgent care
3. politically salient and emotionally frustrating

But they are not the whole rationing story, and sometimes not even the most important part.

Examples:

1. Hip replacement in Canada → long wait
2. Emergency trauma → no wait
3. Cancer care → prioritized, often faster than in the US

So wait times = priority sorting, not blanket denial.

3. The separate rationing issue: care denial or restriction

Here’s where your intuition is clicking.

Beyond wait times, universal systems ration by:

A. Coverage decisions

Some treatments are:

1. not covered at all
2. covered only after failure of cheaper options
3. covered only for certain ages or conditions

Example:

1. NICE (UK) may say: This drug extends life by 3 months at $150k → not cost-effective
2. That’s rationing without a wait time

In the US:

1. the same drug may be “available”
2. but only if you can pay or fight insurance

Different rationing mechanism, same underlying tradeoff.

B. Clinical thresholds

Universal systems often require:

1. objective severity scores
2. functional impairment thresholds
3. documented progression

Example:

1. Knee replacement only once pain or disability reaches X level
2. MRI only after conservative treatment fails

This is rationing via rules, not queues.

C. Capacity rationing

Even if money is “universal,” supply still matters.

Limits include:

1. fewer specialists per capita
2. fewer high-tech machines
3. controlled expansion to manage costs

This can create:

1. regional shortages
2. de facto denial (travel or long delays)
3. slower adoption of marginal innovations

Again: not always wait lists—sometimes absence.

4. How big of an issue is this, really?

Here’s the honest, non-ideological answer:

For most people, most of the time:

1. Rationing via denial is rare for essential care
2. Outcomes are comparable or better than the US
3. Financial catastrophe is far less common

Where it does bite:

1. Edge cases
2. rare diseases
3. expensive biologics
4. end-of-life marginal therapies
5. Elective quality-of-life care
6. orthopedics
7. some imaging
8. Innovation lag
9. slower access to newest treatments

But—and this matters—

the US rations these exact things too, just:

1. silently,
2. regressively,
3. and through financial barriers.

5. The real philosophical divide (this is your wheelhouse)

The deeper difference isn’t efficiency—it’s moral framing.

1. Universal systems ration explicitly
2. public rules
3. cost-effectiveness
4. collective prioritization
5. The US rations implicitly
6. price
7. insurance complexity
8. employment status
9. literacy and persistence

One system says:

“We won’t pay for this because it’s not worth it.”

The other says:

“You can have it—if you can survive the maze.”

Neither escapes tragedy. They just distribute it differently.

6. Your revised intuition is correct

To answer your core question directly:

Yes—rationing is a separate issue from wait times.

And yes—it is a real issue.

But:

1. it is not usually catastrophic,
2. it is more transparent,
3. and it replaces financial rationing with clinical rationing.

The uncomfortable truth is:

The US doesn’t ration less—it rations harder on the vulnerable and softer on the affluent.