Straight Talk about Rationing

Among the many reasons given for the utter collapse of the Clinton administration's health reform initiative is the failure of that initiative to openly address the issue of rationing [1, 2]. The leadership of the Domestic Health Policy Task Force, including Ira Magaziner, firmly believed that explicit talk of rationing was political suicide. Critics of Hillary Clinton's task force insisted that attempting to sell the American public on a plan for reform that would rein in costs and expand coverage for the uninsured without acknowledging the necessity of some form of rationing was, at best, dishonest [1-3].

Although there will be no systematic national effort to reform the delivery of health care for many years, the need for an autopsy of the recently deceased health reform effort is real. Although the private sector and state governments must now carry the health reform ball in the United States, the question still remains: Is rationing inevitable [1-5]? If so, can Americans talk publicly and reasonably about how to ration? A report from the Health Care and Medical Priorities Commission of the Swedish Ministry of Health and Social Affairs, No Easy Choices: The Difficult Priorities of Health Care [6], accepts rationing as inevitable and provides an important example of how the subject can be publicly addressed.

The Commission's task was to arrive at ethical values and principles that could be used by the national government to stimulate debate and discussion about rationing in the Swedish health care system. American readers still reeling from the Clinton debacle will be interested to learn that the term “rationing” is never used. The Commission, which was created in 1992, is …