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Prioritizing or Rationing Health Care
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Dr. Caplan [1] presents for our serious consideration a recent Swedish approach to setting priorities for health care resources. Dr. Caplan suggests that adopting the simple ethical principles of this Swedish approach would provide an “enormous boon to health policy,” that is, an orderly approach to reform of the U.S. health care system.
Dr. Caplan's recommendation has two disabling flaws. The first concerns the centrality of the value of solidarity. Put aside for the moment that the use of this language in Europe—and Canada—may be a device to paper over cultural and moral pluralism in a misguided nostalgia for cultures in which everyone is essentially alike. Solidarity is not a fundamental U.S. value. The United States consists of a far more pluralistic, contentious, regional, even neighborhood people and culture than Sweden—or any other country, for that matter. As a consequence, there can be found in the United States serious, thoughtful advocates of divergent views of the obligations of society to its vulnerable members and about the priority that should be given to controlling health care costs. We cannot simply import consensus about health care; if U.S. history is a reliable guide, we may never be able to achieve it, short of a national emergency. Proposals that we look to other countries' responses, as if we could simply import them here, are therefore unrealistic. We must build consensus, which is hard work [2].
Second, we do not have a health care system to reform, because we do not have a health care system. We are nonsystematic, perhaps even antisystematic, in the manner in which we provide health care and nearly every other basic social service [3]. The failure to appreciate this fact explains far better the failure of the Clinton health care legislation than anything having to do with rationing. Dr. Caplan's continuing attachment to the misconception that we have a system in the first place shows how deeply ingrained this failure is.
Laurence B. McCullough, PhD
Baylor College of Medicine; Houston, TX 77030
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
