The Risk of Redefining Rationing-Reply

Abstract

In Reply. —We believe that necessary-care guidelines could provide a basis for deciding what services should be paid for out of tax dollars or by private insurance plans that choose to provide the benefits we describe in our article. Use of necessary-care guidelines would in no way preclude patients from obtaining services for clinical reasons not covered under those guidelines. Indeed, insurance policies would likely arise to cover such services. However, such policies should not be provided out of pretax dollars (ie, as a nontaxable employee benefit)1; individuals wishing to purchase additional services (or insurance to cover those services) should do so without benefit of public subsidy. Finally, we wish to reiterate our belief that a physician- and patient-friendly appeals mechanism should be available to accommodate unusual or atypical clinical presentations that are not covered by the guideline. While we understand Dr Graham's wish that patients and physicians should