RATIONING HEALTH-CARE AND THE NEED FOR CREDIBLE SCARCITY - WHY AMERICANS CANT SAY NO

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.