National Health Policy Without Rationing?

Abstract

To the Editor. — The editorial by Bone and Elpern 1 points up the conflict between patients' expectations of care and their willingness to pay for this. It is unquestioned that the explosion in health care costs has been, at least in part, consumer driven. Equally, the liability situation makes physicians ever more eager to accede to the patient's every demand. Bone and Elpern make the statement that explicitly rationing medical services may become the norm unless a national health care policy is developed. However, what is a health care policy if not a de facto way of rationing health care? Is it not in truth rationing health care to deny a terminally ill patient the benefit of intensive or high-technology care by fiat? In addition, the authors seem discomfited by the fact that high technology health care could become an option only for those who are able to pay