JUST CARING - HEALTH REFORM AND HEALTH-CARE RATIONING

Health reform must include health care rationing, both for reasons of fairness and efficiency. Few politicians are willing to accept this cl aim, including the Clinton Administration. Brown and others have argue d that enormous waste and inefficiency must be wrung out of our health care system before morally problematic cost constraining options, suc h as rationing, can be justifiably adopted. However, I argue that most of the policies and practices that would diminish waste and inefficie ncy include implicit (and therefore morally problematic) rationing. Cr itics of rationing see as its most morally and psychologically troubli ng feature that an identified individual is denied potentially benefic ial care. That psychic anguish may not be eliminable, and perhaps ough t not be eliminated. But if rationing protocols are fairly adopted thr ough a process of free and informed rational democratic deliberation t o which all have access, the moral objections are largely overcome. Su ch a process is possible only if implicit rationing is recognized and rejected.