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Mr. Vale said that unlike the Republicans’ successful takedown of immigration reform using the “amnesty” argument, the “rationing” threat has “less bang for the buck” with the public.

In addition, talking about rationing can ricochet back on Republicans when it emerges that health care is already more or less rationed by insurance companies.

“What on earth is not rationed in this world?” Peter Peterson said in an exasperated tone during a recent TV appearance. The wealthy businessman and philanthropist has waged a public relations war for the past two years on the growing federal deficit and debt.

Republicans such as Rep. Paul D. Ryan of Wisconsin have concerns about government rationing but do not want their argument to be pegged as simply a scare tactic. Despite Democrats’ complaints that the Republican Party does not have a plan for health care reform, Mr. Ryan is sponsoring a comprehensive reform plan, and he acknowledged that the debate isn’t really about whether health care is rationed or not.

“The question is: Who does it? Is it the government or is it the patient, the doctor, along with their insurance?” Mr. Ryan said. “You do not want to put these kinds of decisions in the hands of the federal government.”

Mr. Ryan’s Patients’ Choice Act of 2009 would, in his words, give most power over rationing to the patient, instead of either the insurance company or the government.

Mr. Obama also used the term “self-rationing” to describe what would happen if employer-provided benefits were taxed, as key lawmakers have said they want to do.

While Mr. Ryan’s plan would include a tax on employer-provided benefits, that money would go toward refundable tax credits of $2,300 for every individual and $5,700 per family instead of going into government coffers. Mr. Ryan calls it “delinking the tax exclusion from the job and giving it to the person.”

Although it is generally agreed that health care already is rationed, some insist that the Democrats’ reform plan, including a government-run “public option” for insurance, would eliminate rationing altogether.

“Nobody on the Democratic side is talking about putting anything into effect that would ration care. It’s a totally bogus argument,” said Jacki Schechner, a spokeswoman for advocacy group Health Care for America Now. “The state of our health care system right now is atrocious, and people are denied the care they need every day.”

Democratic lawmakers and activists argue that their plans likely will include comparative effectiveness research, or studies to help the government and industry determine the most effective treatment methods for diseases and illnesses.

“We’re trying to figure out what treatments are best for people,” Ms. Schechner said.

Many conservatives argue that, based on programs in European countries, the only way the government can provide less expensive health coverage than private insurers is by rationing care. They argue that the government will use the research to determine the best and only source of treatment for each health problem.

“The only way you can do that is restricting access or taking it out on providers,” said Dennis Smith, a senior research fellow at the Center for Health Policy Studies at the Heritage Foundation. “Bending the curve means we’re going to put restrictions on new medical advances.”

And health care analysts say that private insurance is already funding research to find effective and less costly medical treatment.

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