In preparation for the inevitable, plans must be made and the techniques developed for the effective allocation and rationing of health care resources ( Evans 1983).
Economic incentives such as those embedded in current cost-containment measures are not a substitute for social decisions about health care priorities and the just design of health care institutions.... These hard choices must be faced publicly and explicitly ( Daniels 1986:1383).
Unless we decide to ban heart or liver transplantation, or make them available to everyone, some rationing scheme must be raised to choose among potential transplant candidates ( Annas 1985:187).
It is in high technology areas where we face the stark reality of patient need against scarce resources in life and death situations that we see rationing with all its sharp edges exposed ( Mechanic 1986:217).
It is becoming increasingly clear that major alterations in the health care system of the United States will be necessary in the coming decades if we are to avert a crisis of immense proportions. Many seemingly unrelated demographic, social, and technological trends in actuality constitute a concatenation that promises to accentuate traditional dilemmas in medical policymaking. The aging population. the proliferation of high-cost biomedical technologies designed primarily to extend life, conventional schemes of retroactive reimbursement by