Healthcare reform through rationing.

Currently, the U.S. government cannot afford to pay for or ensure access to healthcare without limitations for all its citizens, as healthcare has become so expensive. Therefore, implementation of a rationing program is likely in the future for the U.S. healthcare system. Key stakeholders in such an initiative include citizens, healthcare providers, and the government. Americans expect to have unlimited access to care, but they do not like its high cost. Healthcare providers focus on giving the highest quality of care, with costs as a secondary concern. As a payer, the government wants to provide broader access to healthcare and, at the same time, reduce healthcare expenditures. The current debate over healthcare rationing surrounds three key questions: (1) can medically necessary procedures be ethically denied, (2) do Americans have a right to unlimited access to healthcare regardless of the costs, and (3) what is the limit on the availability of healthcare resources for those with the ability to pay. Proposals for rationing include developing a program similar to the Oregon Health Plan, using the quality-adjusted life years method, promoting self-rationing to consumers, or encouraging healthcare providers to actively and openly participate in bedside rationing. These proposals are evaluated based on their economic efficiency, fairness, and utility. The Oregon Health Plan is recommended among these proposals as it benefits the stakeholders through the explicit and equitable allocation of scarce healthcare resources.