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Rationing Is Not a Four-Letter Word: Setting Limits on Healthcare

Online ISBN:
9780262320764
Print ISBN:
9780262027496
Publisher:
The MIT Press
Book

Rationing Is Not a Four-Letter Word: Setting Limits on Healthcare

Philip M. Rosoff
Philip M. Rosoff
Duke University Medical Center
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Published:
29 August 2014
Online ISBN:
9780262320764
Print ISBN:
9780262027496
Publisher:
The MIT Press

Abstract

The healthcare system in the United States is the most expensive in the industrialized world, yet delivers very mediocre outcomes in such measures as equity, infant mortality, and longevity. In addition, a major portion of the American public either lacks health insurance or is underinsured. It is highly unlikely that the Affordable Care Act will do much to reverse the situation, despite decreasing the numbers of uninsured. Costs continue to rise and occupy an increasingly large percentage of GDP. Limiting the amount and kinds of healthcare interventions – rationing - available is both necessary and inevitable to avoid fiscal disaster. This book argues that we already accept draconian and open rationing throughout the health system, such as in organ transplantation. The features that make this and other rationing schemes acceptable are fairness, openness and equality of treatment. Rosoff suggests that combining fair and sensible rationing of interventions that arguably do not offer significant or meaningful benefit, such as intensive care for the dying or expensive chemotherapy for the terminally ill, with institution of a nationalized insurance program offering comprehensive care to all, would not only control costs but fulfil an ethical imperative to the nation’s residents. The book considers the political and structural obstacles to instituting such massive alterations, but ultimately argues that both economic and moral reasons would necessitate these radical changes.

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