Wk. Mariner, RATIONING HEALTH-CARE AND THE NEED FOR CREDIBLE SCARCITY - WHY AMERICANS CANT SAY NO, American journal of public health, 85(10), 1995, pp. 1439-1445
With adequate cost containment unlikely in the foreseeable future, hea
lth care use will have to be curtailed, ideally with open and explicit
criteria for equitably allocating resources or rationing. Yet, consen
sus on any such criteria appears remote because Americans cannot say n
o to health care. Americans may refuse to accept rationing for two rea
sons. The absence of any global limitation on health care resources ma
y-encourage patients to believe that health care resources are not sca
rce and do not need to be rationed. A belief in vitalism-that everyone
is morally entitled to unlimited longevity and good health-may discou
rage setting limits on one's own care. Together, these characteristics
may foster the belief that denials of health care services, especiall
y by health insurers, are arbitrary or unfair refusals to pay for exis
ting resources and not a necessary method of rationing scarce resource
s. If this hypothesis is true, Americans are unlikely to achieve conse
nsus on any equitable allocation of health care unless they face an ac
tual shortage (credible scarcity) of health care resources that makes
it necessary to ration care.