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Symbols, Rationality, and Justice: Rationing Health Care

Published online by Cambridge University Press:  24 February 2021

Daniel Callahan
Daniel Callahan*
Affiliation:
The Hastings Center, Briarcliff Manor, New York; 1965, Harvard University
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Abstract

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.

Type
Articles
Information
American Journal of Law & Medicine , Volume 18 , Issue 1-2: Rationing Health Care: Social, Political and Legal Perspectives , 1992 , pp. 1 - 13
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 1992

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References

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9 Daniel Callahan, Director.

10 This Article does not address the details of that kind of system.

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25 Under a managed care system, the patient chooses, or is assigned to, a primary care provider who then controls the patient's access to hospitals and specialists. Under most plans, the provider's income decreases if the provider approves expensive specialists or hospital care. Id. at 784.

26 Under a health maintenance organization system, the patient pays a fixed sum and the organization promises to provide a defined package of inpatient and outpatient services. Doctors may be paid as salaried employees or on a fee-for-service basis. Id. at 774-75.

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37 Id.

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39 For example, coronary artery bypass surgery for an elderly person, or resuscitation efforts with a very low birthweight baby.

40 OR. REV. STAT. § 414.720 (1991).

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42 Id. at 50.

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45 See id. at 65 (testimony of Rep. Les AuCoin) (“Oregon's health plan is a program of expansion, not of limits.“).

46 Lawrence D. Brown, supra note 41, at 50.

47 See Hearings on Oregon Rationing, supra note 44, at 157, 160 (statement of Sisters of Providence in Oregon).

48 See id. at 151 (statement of Peter O. Kohler, M.D., President, Oregon Health Sciences University); id. at 157 (statement of Sisters of Providence of Oregon).