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The allocation and rationing of health care resources is, no doubt, one of the most pressing issues confronting contemporary society. These issues considered from a micro and a macro level of economic analysis are linked inextricably to utilitarianism which, in turn, relies upon a cost-benefit analysis which balances reasonable individual needs against the availability of medical resources within the larger community. From an ethical viewpoint, the cost-benefit approach to the distribution of health care resources is impractical because it seeks to reduce (or convert) all health benefits to dollar amounts, thereby seeking very awkwardly to convert quality of life benefits into unyielding economic terms. One proposed solution to this inequality gaining wide acceptance, is to evaluate the quality-adjusted life years (QALYs) produced for each available health care dollar. The United States has tried a mélange of different strategies for cost containment, both regulatory and market oriented in nature. But all have been incremental (e.g., managed care for particular plans administered prospectively for Medicare hospital payments) rather than system-wide (e.g., budgetary limits and restricted rules on insurance choice and pricing). This Article endeavors to evaluate the competing cost containment strategies for the distribution of health services and concludes that the informed debate should no longer focus on the issues of whether health care should be rationed; but rather, on how to ration it equitably and consistent with principles of Distributive Justice. The ultimate conclusion drawn from this analysis is that the most efficacious and humane treatment, and in a patient's best interests, is always a medical judgment made by physicians as the primary gatekeepers to health care resources.



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