Family and Preventive Medicine and Medicine, University of California-San Diego School of Medicine, La Jolla, CA 92093, USA.
Am J Bioeth. 2011 Jul;11(7):7-14. doi: 10.1080/15265161.2011.577511.
U.S. politicians and policymakers have been preoccupied with how to pay for health care. Hardly any thought has been given to what should be paid for--as though health care is a commodity that needs no examination--or what health outcomes should receive priority in a just society, i.e., rationing. I present a rationing proposal, consistent with U.S. culture and traditions, that deals not with "health care," the terminology used in the current debate, but with the more modest and limited topic of medical care. Integral to this rationing proposal--which allows scope to individual choice and at the same time recognizes the interdependence of the individual and society--is a definition of a "decent minimum," the basic package of medical treatments everyone should have access to in a just society. I apply it to a specific example, diabetes mellitus, and track it through a person's life span.
美国的政治家和政策制定者一直专注于如何为医疗保健买单。几乎没有人考虑应该为医疗保健买单——就好像医疗保健是一种不需要检查的商品——或者在一个公正的社会中,什么样的健康结果应该优先考虑,即配给。我提出了一个配给建议,该建议符合美国的文化和传统,不是针对当前辩论中使用的“医疗保健”术语,而是针对更适度和有限的医疗保健话题。这个配给建议的核心是一个“体面的最低标准”的定义,这是每个人在公正的社会中都应该获得的基本医疗服务包。我将其应用于一个具体的例子,即糖尿病,并跟踪它贯穿一个人的一生。