Cartoon: Rationing Health Care

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A common objection to single-payer health care in the US is that it would lead to health care being rationed. And I wonder, in what parallel universe do they live where the US isn’t already rationing health care?

Americans who can’t afford health care get pushed to the back of the line – or entirely out of the line. That’s rationing.

From an article on the Commonwealth Fund‘s website:

While other countries may ration because of national budget constraints and supply-side factors, the United States’ lack of access to comprehensive insurance and affordable care represent a de facto form of rationing that leads people to delay getting care or going without it entirely. […]

In a recent Commonwealth Fund survey, fewer than one of 10 patients in the U.K., Germany, the Netherlands, or Sweden reported skipping needed care or treatments because of cost. This contrasts sharply with the U.S., where one of three Americans reported the same. […] While nearly one of five U.S. adults skip doses or do not fill a prescription because of costs, just 2 percent to 9 percent of patients do so in the other countries discussed here.

We shouldn’t be arguing over if we’re going to have rationing, because we are. Rationing is basically unavoidable. The real argument should be over what form our rationing will take. And our current form – rationing health care by class – is particularly cruel and inefficient.

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For me, drawing for a living is an odd combination of going “wow, this looks really great” and also despairing “why can’t I draaaaw?” And often that’s over the exact same artwork! I’m continually frustrated by my lack of drawing ability and also a total egotist who loves looking at my own work.

This may be a necessary contradiction. If I didn’t see the (glaring enormous horrible) flaws in my drawings, I wouldn’t have any drive to improve. But if I didn’t get pleasure from my own drawings, doing this for a living would be horrible. So it’s about achieving some sort of balance.

In this cartoon, I think my favorite bit of drawing is that we can see the street stripes through the hole in the chest of the character in panel two. I think it looks neat and also makes it more visually obvious that he’s got a hole there.

I’m also pleased that no two characters in the strip are wearing the same shoes – although in a way that’s a waste of my drawing time, since it really doesn’t make a difference to how readers experience the comic.

I’m least pleased by everything in panel one. Her hair looks stiff and wrong and not-hair-like, and the background is lacking in detail or personality – it could be a stage set. And although I worked hard at the dog – I spent more time trying to get that dog right than I did on any other figure in this cartoon – I’m still not happy with it.

Should I go back and redraw it? Or say good enough, move on, there are other panels to work on? For panel one, I said “good enough.” It’s pleasant looking enough and it carries the storytelling.

In panel three, on the other hand… I originally drew the seated character with a leg that was bent in too many places.

But I began worrying that readers would miss that detail. I mean, some readers will always miss some details – that’s unavoidable – but the fewer readers miss important storytelling details, the better. In the end, although I’d finished everything but the colors, I erased the leg and redid it. I think the new version is more obvious.

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The week I was working on this cartoon, I was waiting at a bus stop and noticed a single boot lying on the ground. This happens now and then, and I always wonder how someone came to lose a single boot. As you can see, that was on my mind when I drew the boot in panel four.

Those are the sort of details that I don’t expect most readers to notice. They’re there as a sort of reward for readers who like looking closely for details. The cartoonist term for these little, funny, but irrelevant details is “chicken fat.” The term was coined by Harvey Kurtzman and Will Elder, two of the best cartoonists who have ever laid ink to paper.

In an interview, Elder said:

I don’t really recall where we first started referring to, what Harvey called, my “chatchkies”, extra gags, as “chicken fat.” But I think the term just came out of what we both knew were the parts of the strip that gave it more flavor but did very little to advance the storyline. That’s what chicken fat does…it advances the flavor of the soup and, as we all know now, too much chicken fat will kill you!

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Thanks to those of you who support my patreon and making it possible for me to do things like draw cartoons and feed my cat (although if you asked my cat, she would tell you that she’s never been fed, never EVER not even once, but my cat is a liar.)

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This cartoon has four panels. Each panel shows a different scene.


A woman with spikey hair is standing in her living room. She’s holding a hand to her cheek, and lots of cartoon “pain stars” are floating near her cheek.  She’s wide-eyed and unhappy looking as she speaks into her cell phone. A dog sits on the floor nearby, looking at the woman adoringly.

WOMAN: What’s the point of an insurance plan that doesn’t cover dental?

VOICE FROM PHONE: We only cover essential treatments. Teeth aren’t that important.


Two people, a man and a woman, are on a city sidewalk. They are both looking with bewilderment at an enormous, unnaturally perfect hole in the man’s chest (it also goes through his tee shirt).

There’s litter on the sidewalk, including a newspaper called “The Cartoon Times” with a big headline saying “Man Reads Background Gag.” (I’d normally use an androgynous word like “person,” but the space was so tiny I had to opt for the three-letter word. :-p )

WOMAN: You should see a doctor about that.

MAN: Too expensive. Maybe it’ll get better by itself?


A woman wearing a black tank top and jeans sits on a sidewalk. She’s got very short, spikey hair and tattoos (including tattoos of Snoopy and Lucy). One of her legs has fallen off mid-calf; she’s got a bone sticking out, and her foot and the lower half of her calf (still in jeans) are lying on the street in front of her.

She grinning, trying to be cheerful, but she’s wide-eyed and sweating. She’s holding out one palm in a “no need” gesture.

Two emergency medical technicians in uniform are staring at her, surprised. In the background we can see their ambulance. Near the top of the ambulance, the company’s motto is printed: “We move broken peeps.”

WOMAN: I can’t afford an ambulance. I’ll just walk.


Two women walk through a hilly park. There are trees in the background, a bush in the foreground, and a tree stump (Woodstock from Peanuts is standing on the stump). A single abandoned boot lies on the ground.

The first woman, blond with neck-length hair and waring shorts and a button-up short sleeved shirt, is in a panic. The second woman, wearing a hoodie and flip-flops, is rolling her eyes.

FIRST WOMAN: Universal government-paid health care? That’d be HORRIBLE! We’d have to start RATIONING HEALTH CARE!

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Rationing Health Care | Barry Deutsch on Patreon

This entry posted in Cartooning & comics, Health Care and Related Issues. Bookmark the permalink. 

36 Responses to Cartoon: Rationing Health Care

  1. 1
    Elusis says:

    On Tuesday, I had a hearing test and then an appointment with the audiologist to discuss replacing my decade-old hearing aid.

    I called to schedule this appointment in January, and mid-April was the soonest appointment I could get. I had to drive to another city because the audiologist in my own city was booked until June.

    They placed my order for the new hearing aid, which should come in a few weeks, but I can’t get it until July because that’s the next time the audiologist had an open appointment for new hearing aid fittings.

    Also, I will have to pay about $2600 out of pocket because my insurance, like most, does not cover hearing aids for adults, despite the mountain of evidence that addressing hearing loss protects against depression, loss of cognitive function, etc.

    Boy, I’m sure glad we don’t ration care in the US.

  2. 2
    Jacqueline Squid Onassis says:

    I called to schedule this appointment in January, and mid-April was the soonest appointment I could get. I had to drive to another city because the audiologist in my own city was booked until June.

    Yep. I was told to make an appointment with the sleep psychologist. I called the sleep psych in November and it’s only another month until my appointment!

  3. 3
    Dreidel says:

    Health care isn’t “rationed” in America! “Rationing” refers to a product or commodity that’s produced in less quantity than the demand (like coffee or nylons during WWII), so each customer is only allowed to purchase a fixed, limited amount.

    There’s no shortage of health care in the U.S., as long as you have the $$ to afford the medical fees and perhaps the transportation costs to a doctor’s location.

    Ask your cat. She understands rationing, when she decides when to respond to your petting with either purrs or a cold indifference.

  4. 4
    saucy turtles says:

    I called to schedule this appointment in January, and mid-April was the soonest appointment I could get. I had to drive to another city because the audiologist in my own city was booked until June.

    Aren’t you glad you don’t live in Canada, where you have to wait for health care? /s

  5. 5
    Dianne says:

    It’s only going to get worse as health care providers quit practice for reasons ranging from overwork to getting threats from patients to not being legally permitted to practice standard of care medicine. Red states are already having difficulty attracting ob/gyns and ER doctors per WaPo. I’m reasonably certain they’re having trouble with oncologists as well, based on the increases in pay offered for locum tem positions. The going rate in some red states appears to be $25K/week. I’m not even mildly tempted.

  6. 6
    Dianne says:

    Though to be fair, if you have a nationalized health care system and then elect a government whose overt goal is to underfund that system, it’s going to get pretty bad too. Look at the UK.

  7. 7
    Dianne says:

    Sorry, one more comment: Is the first woman in the last panel holding her legs together because she’s trying to avoid incontinence related to a urinary tract infection that she hasn’t gotten treated because she can’t afford to and/or can’t get an appointment?

  8. 8
    Ampersand says:

    LOL! No, a UTI wasn’t my intention, but I like that interpretation.

  9. 9
    Eytan Zweig says:

    Dreidel @3 – It’s true that the healthcare isn’t being rationed by the providers in the US. Rather, people are rationing the amount of resources they individually can spend on healthcare. That’s also a valid use of the word.

  10. 10
    Jacqueline Squid Onassis says:

    1) I like the idea that the dog in panel 1 is just HUGE
    2) I saw this reposted by the Trans Army account on fb last night which is why…
    3) … I was able to read the gag on the newspaper in panel 2
    4) Can I really be the first to mention Woodstock in panel 4?

  11. 11
    Ampersand says:

    1) I did intend it to be a big dog. :-)

    2) Oh, cool that they shared it!

    4) You’re the second person to mention it to me.

  12. 12
    JaneDoh says:

    Great cartoon! When I lived in DC, I had to make an appointment for my annual checkup with my endocrinologist on the way out the door or the wait would be 18 months. Now I actually live someplace with single payer health care, and it is amazing! So much less to worry about! I never have to call about insurance coverage, missed payments, and preapprovals, or worry about someone in the room who might not be in my plan… And the wait times are considerably shorter than when I lived in DC. And people with possibly time sensitive medical needs get to cut the line (as they should).

    My favorite panel is the third one. I love the seated characters tattoos. And the leg injury. And the motto on the ambulance.

  13. 13
    Jacqueline Squid Onassis says:

    Just made an appointment with the surgeon recommended for revisions after multiple rhinoplasties. It’s on August 22nd. In this case, I’m okay waiting 4 months as I’d prefer to hit my out of pocket max in January, if possible.

    Oh, my. Did I just self ration? I think I did.

  14. 14
    Ampersand says:

    I love the seated characters tattoos.

    I couldn’t remember what the tattoos were and had to go look. But yeah, I like those tattoos a lot! Thanks.

  15. 15
    Elusis says:

    Health care isn’t “rationed” in America! “Rationing” refers to a product or commodity that’s produced in less quantity than the demand (like coffee or nylons during WWII), so each customer is only allowed to purchase a fixed, limited amount.

    Congratulations, you’ve successfully described one aspect of how the “managed care” system works! In my case, my regional HMO has hired fewer audiologists than are needed (apparently) by its customer base, so there is a limited “amount of audiology” available for purchase. Meaning that some people who want to “purchase audiology” aren’t going to be able to, and others (like me) are going to have to wait excessively long times to get our “allotment.”

    But fortunately that isn’t the only definition of rationing! When insurers refuse to pay for needed health care (for example, a medical device, a particular drug, or a procedure), they are restricting the availability of that care to their customers, some of whom will have to go without meeting those needs because they cannot afford to pay for the thing wholly out of pocket. Like my hearing aid, for example, even though it has documented medical benefits (and financial as well – I can’t do my job if I can’t hear, and my efforts to listen with my “good ear” turn out to cause me major neck and shoulder issues, which then… cost more health care!) And like the knee replacement I’m going to need, because I have zero cartilage left between the bones, which my insurer is going to refuse to provide to me because my BMI is above their arbitrary limit.

    Both of these (providing less than is needed and thus limiting how much each person can have/how quickly they can access it, and refusing to provide access to things that are needed thus limiting who can get their needs met), conveniently, are exactly what naysayers mean when they tell voters that if we had a national health care system, health care would be “rationed.” They evoke the image of a system in which 1) you can’t get care when you need or want it, and 2) if and when you do get it, you turn out to actually not be able to afford it unless you pay a tremendous amount of money out of pocket.

    Weirdly the people making these arguments never acknowledge how job-linked, network-limited, and sometimes for-profit health care in the US produces exactly those results.

  16. 16
    Chris Borthwick says:

    My partner of fifty-odd years is dying in the [Melbourne, Australia] Royal Women’s Hospital of incurable cancer, which sucks. However, she’s been in there for three weeks now, getting as good medical care (chemo, gyno, surgical. palliative) care as there is anywhere in the world, and I’ve been charged nothing and will be charged nothing. No, I tell a lie: I’ve had a bill for $A100 for take-home medication. She’s not going home, so I suppose that’s a waste, but I won’t fight it. Australian public hospital. They didn’t even ask for a credit card number.

  17. 17
    Charles says:

    I like the hair on the first character. It looks like a Roz Chast character, and has an electrified appearance that conveys dental pain very effectively.

  18. 18
    Ampersand says:

    Chris, thanks for your comment. I’m so sorry for what you and your partner are going through; I hope the remaining time will be as comfortable and meaningful as they can be.

  19. 19
    Ampersand says:

    Charles, thanks. To me the hair looks like Sideshow Bob. :-p But maybe it’s reading better for readers than it is for me.

  20. 20
    Schroeder4213 says:

    We recently had a real life experience that illustrates the point of this comic!

    Last Thursday, our three-year-old son fell backward off his brother’s bed and hit his head on the wood floor. Afterward, he seemed lethargic, so we rushed him to Urgent Care and then to the Emergency Room on Urgent Care’s recommendation.

    The ER basically told us his score on some scale they use to determine whether a CT scan is necessary was “borderline” and let us decide whether to do a CT scan or not. “It’s totally up to you.” A CT scan is between $300 and $3,000, in addition to a totally unknown quantity of ER and Urgent Care bills.

    We are okay financially, so we ultimately decided to do it. Turns out he had a skull fracture and needed to stay home from preschool for a week. If this had happened a few years ago when we were less financially secure, cost probably would have been a big factor.

  21. 21
    Ampersand says:

    That “what if” is so frightening!

    My niece Sydney (who lives with me) had a skull fracture at about the same age (she fell out a window) and had to stay in the hospital for about a week. It was scary, but she recovered completely and it’s now an anecdote she seems to enjoy telling. I hope it’ll be like that for your son!

  22. 22
    Marian says:

    Do you draw on paper, or use a tablet?

  23. 23
    GiveMeHealthcare says:

    Democrat voters are fine with this system. They vote to preserve the for-profit healthcare system every time. After all, alot of them like their insurance! The 40,000-50,000 Americans that die every year is just the price the rest of us have to pay for wealthy Dem’s comfort and convenience. And yet they think they deserve credit for being better, more moral people than Republicans. Wild!

    It’s been over a decade since the Supreme Court ripped the spine out of the ACA, a blatant government subsidy program for private healthcare, and they haven’t come up with a damn thing since. Liberals like to talk about how hybrid healthcare systems exist and are a valid alternative to universal healthcare and yet they never, ever propose such a plan. Why? Because preserving the healthcare status quo is the Democrat’s only goal. When’s the comic about that?

  24. 24
    RonF says:

    I have always wondered why dental care is treated as a separate category from health care for every other body part you have. Does anyone know?

  25. 25
    Ampersand says:

    Ron – I think not including dental is a cost-cutting measure. (Cutting costs for whoever’s paying for the insurance, at least.)

  26. 26
    Jacqueline Squid Onassis says:

    Democrat voters are fine with this system.

    If you don’t want people to think you’re with the fascists, “Democratic voters” is the correct terminology. The word you used has been a calculated show of disrespect ever since Bush the Yunger.

  27. 27
    Ampersand says:

    Hi, Marian – sorry it took me so long to reply, I just now noticed your question.

    I draw entirely on tablet. Usually (including with this cartoon), I draw with a program called Clip Studio Paint.

  28. 28
    RonF says:

    JSO @26:

    If you don’t want people to think you’re with the fascists, “Democratic voters” is the correct terminology.

    Using the word “Democratic” risks confusing the political structure with the political party. “Democrat” is clearer.

    The word you used has been a calculated show of disrespect ever since Bush the Yunger.

    That sounds nonsensical to me. Where did you get that from? And if you are so worried about disrespect, why did you use the spelling “Yunger”?

  29. 29
    RonF says:

    Amp @25:

    Interesting speculation. How did they pick on teeth in particular, I wonder? There are specialties for feet and other parts of the body, after all.

  30. 30
    Adrian says:

    Ron @29, the big division between teeth and other kinds of medical specialties is that dentists don’t go to medical school. They aren’t in the American Medical Association. So back in the old days when insurance companies were negotiating coverage, they cut deals with doctors and hospitals.

  31. 31
    Dianne says:

    Ron @29: In addition to teeth, glasses are often not covered (though other ophthalmologic issues may or may not be), psychiatric care is almost inevitably under-reimbursed (26 visits/year is, at best, half of an adequate treatment plan), and podiatry is hit or miss. So, yeah, it’s not just teeth, although dental issues are the most obvious gap, probably for the reasons that Adrian and Amp pointed out.

  32. 32
    JaneDoh says:

    The interesting thing is that teeth are also treated differently in other countries. It isn’t just an American thing. Might be the med school vs dental school thing. Also the perception that a lot of dental care is optional until it really hurts.

  33. 33
    Jacqueline Squid Onassis says:

    Using the word “Democratic” risks confusing the political structure with the political party. “Democrat” is clearer.

    Yes, Ron. Nobody understood the difference for the 140 years before Republicans decided that using “Democratic” instead of “Democrat” was just too confusing. Thanks for that insightful, irrefutable explanation. Now I can remember how in the 80s nobody could tell the difference between the Democratic Party and the democratic system under which we lived. You’ve explained the obvious and I, for one, shall be eternally grateful that you’ve made sense of what every reasonable person thought was an obvious show of disrespect.


  34. 34
    Schroeder4213 says:


    In Ron’s defense, it’s no longer presumptively true that voters in the Republican Party are “democratic” in the “democratic system” sense, so maybe it is necessary to clarify nowadays.

  35. 35
    Jacqueline Squid Onassis says:

    In Ron’s defense, it’s no longer presumptively true that voters in the Republican Party are “democratic” in the “democratic system” sense, so maybe it is necessary to clarify nowadays.

    Heh. I was just thinking about stopping by to comment that, of course, since the GOP has gone explicitly anti-democratic, that there’s no longer any chance of confusion for Ron and his fellow travelers so they may as well go back to the correct and preferred “Democratic governor/senator/congressbeast/mayor/alderman/etc.”

    But I was too late!

  36. 36
    RonF says:

    Actually it’s the GOP that presses more for returning control of things like regulation of abortion, school choice, school curricula, etc. to State and local voters. That seems far more democratic than concentrating control of these things to an unelected Supreme Court or Federal bureaucrats.

    Adrian @ 30:
    That sounds pretty plausible, especially considering Dianne’s point about opthamologists that I have personal experience with.