In response to Maher's comments, we are not opposed to, nor do we fear, the rationing of intensive care. We recognize that rationing has always been, and will continue to be, a necessary part of our health care system. As Maher points out, criteria that have been used for health care rationing include age (Medicare program), geography (Medicaid programs), and the ability to pay (commercial insurance). Nevertheless, health care expenditures continue to escalate, while resources for the delivery of health care become more constrained. Despite its life-and-death significance, the allocation of critical care cannot be exempted from scrutiny. We are not discomfited by the fact of rationing, but, rather, we are concerned that society's failure to accept the responsibility of creating a deliberate and standardized system for rationing may lead to the adoption of less favorable methods of cost containment. As difficult as it may be to determine
Bone RC, Elpern E. National Health Policy Without Rationing?-Reply. Arch Intern Med. 1992;152(2):426. doi:10.1001/archinte.1992.00400140156042
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