Making Choices: Rationing in the U.S. Health System

April 1993
EBRI Issue Brief #136 | Special Report SR-17
Paperback, 36 pp.
PDF, 262 kb
Employee Benefit Research Institute, 1993

Download Issue Brief PDF pdf

Executive Summary

  • "Care is rationed in our current system in several ways. The public policy issue is not whether we ration care, but can we find a more rational method of allocating resources?"—Bill Custer, Employee Benefit Research Institute
  • "Most countries have found it difficult to decide what not to cover, so they have pushed the decisions down to local levels. True rationing at the federal level requires a truly defined and managed health care delivery system nationally."—Roger S. Taylor, PacifiCare Health Systems
  • "The public has a lack of trust in the leadership, and most people are unwilling to make sacrifices because they are not convinced it is needed and that it will help others. The public perceives the health care system as a complicated system full of black holes, and so they are not convinced that making cuts in some areas will help others." —John Immerwahr, The Public Agenda Foundation
  • "Because medicine is as much art as science, rationing medical care by guidelines and gatekeepers may be the most direct route to quality. It may be time to worship rationing as both the route to quality and as an economic necessity."—Dallas Salisbury, Employee Benefit Research Institute
  • "A global budgeting system is the only cost containment alternative that would involve the type of systemwide restructuring necessary to achieve the results that the American people expect but with the checks and balances and opportunities for involvement that will ensure their support."—Karen Ignagni, AFL-CIO
  • "Coordinated action by all payers would impose a discipline on total spending that no one payer could command. Providers would be forced to reduce costs rather than shift them. "—Larry Atkins, Winthrop, Stimson, Putnam & Roberts
  • "If we are going to explicitly decide what to cover and what not to cover and how much, who is going to get to make these decisions? If we just turn it over to the medical profession, then the values that will dominate those choices are those of white, middle-aged, upper-middle class men."—Joshua Wiener, The Brookings Institution
  • "The Oregon Plan eliminates the implicit tools of health care rationing imposed by states, businesses, and the federal government today, and replaces them with an open, clearly defined, resource allocation process that combines considerations of clinical effectiveness, social value, and fiscal responsibility. ">—Mark Gibson, formerly with the Oregon State Senate President's Office