Wanted: A Clearly Articulated Social Ethic for American Health Care

JAMA ◽  
1997 ◽  
Vol 278 (17) ◽  
pp. 1446-1447 ◽  
Author(s):  
U. E. Reinhardt

1992 ◽  
Vol 18 (1-2) ◽  
pp. 73-96 ◽  
Author(s):  
David C. Hadorn

The structure and principal decision-making processes of the American health care system have, in recent years, evolved to closely resemble those of the legal-judicial system. This transformation reflects important common values that underlie both systems, including the values of life and liberty. This Article analyzes quasi-legal features of the health care system and draws conclusions about how those features might be used to address the problem of health care rationing. It concludes that coverage rules, if properly developed, can provide the sort of objective framework necessary to evaluate claims of health care needs. This Article also demonstrates that by defining legitimate health care needs, society can thereby potentially eliminate or forestall the need to ration necessary care. This can be achieved by using carefully developed coverage rules, rather than the informal rules currently in place, in conjunction with already existing due process methods for interpreting and implementing those rules.


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