In 1949, when President Harry Truman first proposed mandatory health insurance, he coupled his initiative with an expansion of federal aid to medical schools.  But Obama makes no provision for an expansion of the pool of doctors, even as he grows the population of patients by up to 50 million.

Indeed, by cutting medical fees by dropping the reimbursement rates under Medicare, he likely will hasten the retirement of many medical professionals worsening the underlying shortage.  The Times quotes medical experts as predicting that the three years specified in the House bill as the time by which universal health insurance coverage will take effect "is not nearly enough time to build the supply of doctors needed to care for the additional tens of million of people who would become newly insured."

Because there will not be enough doctors, nurses, and medical equipment for the massive influx of patients under the Obama plan, there will be rationing, more draconian year after year.  As in Canada, it is this fundamental discrepancy between the number of patients and the population of doctors that will lead to rationing.  From there, the inevitable consequence will be cutbacks in care for the elderly.  Optional procedures, vital to quality life but not to survival, are likely to be limited.  Hip replacements, new knees, hearing aids, and such are less and less likely to be approved.  And, medical administrators will be less likely to OK surgery or expensive medical treatments for the elderly who they perceive to be at the end of their "quality" years.

It is the shortage of doctors, not any specific language in the text of the legislation, that makes rationing and the so-called "death panels" cited by Sarah Palin inevitable.

We all agree that everybody should have health insurance, but let us precede this step by expanding the number of doctors and nurses so that we can cover everyone without sacrificing the care for anyone.  Otherwise, we are not giving 50 million new people medical care.  We are consigning 300 million, and particularly the elderly among them, to long waiting lists.