To explain myself further, all economic transactions in a market based system results in "rationing" of a good or service on the basis of the desire of potential purchasers to obtain the good or service, and, their ability to pay.
Assuming that the health care in question is necessary to sustain life, and all individuals have an equal desire to survive, then the best care is available to those of the greatest economic status, i.e., those able to pay cash or those able to afford sufficient health insurance. Those with lesser economic means either do without, or have a lesser level of care.
I realize that to apply this to a decision to buy a Coca Cola, or to buy a Mercedes vs. a Hyundai, it would be hard to characterize it as "rationing". However, when it is applied to health care that may be a matter of life or death, apportioning of a scarce and life sustaining resource among individuals based on the individual's ability to pay is economic rationing of that resource.
The working poor and indigent will get some level of care, but cannot expect to get the best quality care, and perhaps not even adequate care to meet their needs.
As another example of rationing within our system, I know of someone who had a severe accident and his leg was crushed. He was told that he could regain use of the leg with multiple operations and recuperative therapy. His HMO refused to pay for anything more than an amputation and post amputation therapy and some rehab. If he had the cash to pay for the better, more expensive care, he would have gotten it.
Perhaps my definition of rationing is different than yours. My definition follows theoretical economic concepts that when there is a scarce resource and there is insufficient supply to meet the needs of all candidates that need it and equally desire it, there must be a system of rationing that resource among the potential recipients. Under some systems, the rationing system is based on an individual's need. In other systems, it is based on the ability to pay. One is an institutionalized rationing system, and the other one is market based. Nevertheless, in both systems, the scarce resource is allocated among potential recipients with some getting a lot, some getting a little, and some getting none. So, in both cases, as I see it, it is rationing.
I am sure that others will disagree with me, and will say that not getting what you cannot afford out of your own pocket is not "rationing". But when the good or service is vital to continuation of one's life, I doubt that you can say that a lower income person decided not to obtain necessary health care because it just wasn't that important to him, and he would rather spend his money on tickets to baseball games instead.
On the other hand, we have public education, which is not fee based. I guess we can quibble about the quality of public education, but unlike health care, every child is entitled to go to a free public school. So, unlike health care, a basic education is not rationed.
While you may not agree with my statement that health care is rationed, I hope you better understand why I consider it to be rationed.
