The Wisconsin Medical Association wants to ration Wisconsin Medicaid. From its statement “The Wisconsin Medical Society’s Statement of Principles for Allocating MA Program Resource:”

The goal of the Wisconsin Medical Society should be to communicate to and provide policy makers and legislators its members’ informed opinions on how best to allocate resources for health care. Therefore, the Wisconsin Medical Society shall support and work to implement policies regarding the state Medical Assistance (MA) program that allocate those limited resources to benefit the greatest amount of people with the best health care possible with the resources that are available. • Acknowledge that the goal is health rather than health services or health insurance • Commit to a public process with structured public input • Commit to meet budget constraints by modifying benefits rather than cutting people from coverage or reducing payments to levels below the cost of care • Commit to use available resources to fund clinically effective treatments of conditions important to Wisconsinites • Develop explicit health service priorities to guide resource allocation decisions.

This sounds a lot like what is done in Oregon. The statement then sets a list of priorities, which you can read in the document itself, and states:

To sort and rank items within the categories, the Wisconsin Medical Society encourages the State Legislature and the Department of Health Services to consider priorities within the categories when making choices in determining the prioritization of health care resources

So, a medical association is stating that doctors should not provide optimal care to all patients, and indeed, that public health can matter more than the individual patient in their treatment rooms. A medical association promoting such a dual mandate, it seems to me, can tear medical ethics apart.

Like I have been saying, single payer health care–with its dependence on fixed budgets–and rationing go together like Sees and candy. I plan to write in more detail about this soon.