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January 5, 1990

Old Age and New Policy-Reply

Author Affiliations

The Hastings Center Briarcliff Manor, NY

The Hastings Center Briarcliff Manor, NY

JAMA. 1990;263(1):33. doi:10.1001/jama.1990.03440010031010

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In Reply.—  The last paragraph of the letter in criticism of my article raises directly the problem I am concerned with. The very nature of rationing and allocation decisions is that they must be made for the collective good of society as a whole, not simply for the individuals involved. Our projected costs for health care for the elderly in the years ahead are simply astronomical, well beyond any reasonable capacity to pay for them. The idea that we can deal with those problems by having individual physicians, patients, and families make decisions about allocation makes no sense in the long run. What is good for individuals and families is not necessarily good for society as a whole. That is the painful truth of the matter when we must make rationing decisions. The fundamental question, then, is how we can assure the elderly of decent care up to a reasonably