ABSTRACT
The title of this article is meant to encapsulate the three general problems of rationing health care in the U.S.—but I believe it is relevant for other countries as well. Must we ration health care at all and how might it best be done? Can it be done in a fair way? What are the obstacles-political, medical, and public opinion-that stand in the way of rationing? The combination of those questions, each touching on difficult and controversial issues, have made rationing hard to talk about publicly, evaded by politicians, abhorred by the public, and resisted by physicians. I believe that, however difficult, every health care system, however organized, must ration and that its necessity makes it an ethical requirement. There are no theoretical limits to what human beings can want in the name of their health, but there are many practical limits, cost most notably. The issue with rationing is not whether but how.
