Rationing of health care: inevitable and desirable.

Americans find certain issues in public policy much easier to ignore than to confront. The necessity of rationing health care is one such issue. Because Americans believe that access to health care is a basic right,1 we, as a society, have avoided facing the hard fact that it is not feasible to provide, on demand, all needed medical procedures to every individual who could potentially benefit from them. Unlimited needs, or at least unlimited perceived needs, eventually outstrip limited resources. For this reason, we have avoided open discussions about rationing; it inevitably would become clear to all engaged in such a discussion that rationing entails denying individuals some measure of health care that otherwise would benefit them. Rationing is felt to be unfair, unethical, and potentially discriminatory. Every health care provider knows that we already ration health care. Much has been written about the thirty-five to thirty-seven million Americans who have no health insurance and the approximately thirty million others who have inadequate insurance. Upon consideration, we cannot deny that we already ration by price, geography, and a number of other means. We tell each other, however, that this is "indirect rationing" and apparently we find it morally easier to accept indirect rationing than "direct rationing." A sin of omission is easier to live with than a sin of commission.