The Allocation and Rationing
of Medical Care
Long-term solutions to our emerging health care crisis will require major alterations in basic orientations toward medicine in the United States. Reevaluation of our social priorities is crucial at three levels. First, we must come to some consensus as to how much of society's limited resources we are willing to allocate to health care. Most observers contend that when the cost of health care exceeds 10 percent of the GNP, efforts to stabilize it are essential, but we continue to expend vast sums of money on goods and services that we can largely agree are less worthwhile than health care, and on some that actually are costly to our health. What priority do we place on health care as compared to education, national defense, housing, leisure activities, pets? How much are we willing to take from these competing areas and transfer to medical care? These first-level macro-allocation decisions entail basic politics, since the funding pie is apportioned according to societal priorities.
Second, once a consensus is reached as to how high a priority ought to be put on health care as compared with other expenditures, the resources available for health care must be distributed within the many areas of health care. Assuming that society refuses to make major alterations at the first macro-allocation level, hard decisions will be necessary in order to allocate limited medical resources in the most just and equitable way. What proportion of the health budget should go to primary care and preventive medicine, as compared with high