JUST CARING - OREGON, HEALTH-CARE RATIONING, AND INFORMED DEMOCRATIC DELIBERATION

This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must l earn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democrati c deliberation. Part I of this essay notes that rationing is a ubiquit ous feature of our health care system at present, but it is mostly hid den rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flaw ed as a model of health rationing, it gives us worthy moral lessons fo r health reform at the national level, which I analyze and defend in P art III. The most significant of these lessons is the importance of ra tional democratic deliberation in articulating fair rationing protocol s for a community. In Part IV I sketch the philosophic justification f or this approach and respond to some important criticisms from Daniels .