Rationing Health Care

Rationing is a practice or policy of intentionally creating scarcity. With respect to medical care, rationing is the intentional denial of interventions known to be medically appropriate, beneficial, and available. Typically, this now occurs for the sake of limiting expenditures, and increasingly for the sake of being profitable [as opposed to allocation of truly scarce resources such as certain organs for transplant].

Rationing health care is a direct repudiation of the moral traditions that have guided Western medicine for nearly two thousand years. According to the Hippocratic Oath, excellent skills in medicine were not enough: skills can be used for good or evil. The Hippocratic Oath prohibited abortions and providing poisons to end life and called upon physicians to be just, avoiding all harm to patients. Christianity adopted this Oath, except for the references to the Greek gods, the promise to give medical education only to one’s own sons and the prohibitions on “using the knife.”

Beyond the Oath, however, Christianity and Judaism significantly changed the moral structure of medical care and of the physician-patient relation. The Hebrew prophets, as biblically portrayed, healed the sick free of charge. Jesus also healed without charging fees. Additionally, there is the biblical model of the Good Samaritan. He is the good neighbor who takes the half dead victim of robbers to an inn, giving him care there. Not only does he pay the innkeeper for additional care in his absence, but he also puts no limit on the amount and cost of the care. No cap is put on expenditures; the need for care determines cost. Christian and Jewish physicians made it the norm to treat everyone, however needy and however poor. The marketplace did not dictate practice or intrude into the physician-patient relation.

Some of the current practices of for-profit managed care organizations no longer base the standard of care solely on what is medically indicated to heal, sustain, and/or comfort patients. And there is no moral imperative to offer free care. When justice is conceived of as the maximization of utility, the moral imperative is to prohibit care that cannot be compensated. We should not allow ourselves to be trapped into the utilitarian reasoning that sanctions the rationing of health care for the sake of saving or making money, or for any other reason. It is still true: No one can serve both God and Mammon.