4
The Role of Government
Institutions

Although the key to impeding the emerging health care crisis and stemming our dependence on high-technology medicine is the alteration of public expectations, any allocation/rationing policy will be produced by the political institutions. Despite the important role that the private sector plays in defining the boundaries of health care, a role that is accentuated by for-profit medicine and the influence of corporate benefits managers, the most crucial factor is the extent to which the courts, legislatures, and administrative agents are willing and capable of facing the difficult issues and making decisions that will avert the crisis. The government alone cannot alter the health care system, nor should it, but it ought to take responsibility for framing the dialogue and moderating the demands of the public and the interests of the health care community. Unfortunately, U.S. political institutions seem unable or unwilling to take seriously this responsibility. This chapter analyzes the characteristics of our political institutions which restrain optimism that such action will be forthcoming before it becomes too late.


The Courts and Medical Decision Making

Health law emanates from three sources: common law, statutory law, and administrative law and regulation. Common law is the tradition of civil law that originates from individual case decisions in federal, state, or local courts. Common law precedents may vary from state

-135-

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Rationing Medicine
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Preface ix
  • Acknowledgments xi
  • The Context of Health Care in the United States 1
  • Critical Health Care Issues 39
  • The Allocation and Rationing of Medical Care 77
  • The Role of Government Institutions 135
  • Prospects for the Future: Making the Hard Choices 189
  • References 253
  • Index 275
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