At the heart of our national failure to contain health care costs is our reluctance to empower anyone to say no to medical spending that might yield clinical benefits. That rising medical costs cannot be restrained without withholding beneficial care is widely acknowledged by scholars of health policy. Yet neither President Clinton nor his Congressional opponents risked stating this truth during last year's debate over health care reform.
Quite possibly, the president and his critics figured it right. Candid political discourse about the withholding of beneficial treatment may not be what most Americans are prepared to hear. If not, and if the covert rationing of care is unacceptable (or unsustainable), then the scheme of privately administered limit setting developed in rich detail by Clark C. Havighurst in Health Care Choices may represent the most appealing alternative.
Havighurst, a professor of law at Duke University and a former health policy adviser