Rationing Is Not a Four-Letter Word

From Basic Bioethics

Rationing Is Not a Four-Letter Word

Setting Limits on Healthcare

By Philip M. Rosoff

A provocative argument that the best way to deliver high-quality healthcare to Americans is to institute a comprehensive and fair system of rationing.





A provocative argument that the best way to deliver high-quality healthcare to Americans is to institute a comprehensive and fair system of rationing.

Most people would agree that the healthcare system in the United States is a mess. Healthcare accounts for a larger percentage of gross domestic product in the United States than in any other industrialized nation, but health outcomes do not reflect this enormous investment. In this book, Philip Rosoff offers a provocative proposal for providing quality healthcare to all Americans and controlling the out-of-control costs that threaten the economy. He argues that rationing—often associated in the public's mind with such negatives as unplugging ventilators, death panels, and socialized medicine—is not a dirty word. A comprehensive, centralized, and fair system of rationing is the best way to distribute the benefits of modern medicine equitably while achieving significant cost savings.

Rosoff points out that certain forms of rationing already exist when resources are scarce and demand high: the organ transplant system, for example, and the distribution of drugs during a shortage. He argues that if we incorporate certain key features from these systems, healthcare rationing would be fair—and acceptable politically. Rosoff considers such topics as fairness, decisions about which benefits should be subject to rationing, and whether to compensate those who are denied scarce resources. Finally, he offers a detailed discussion of what an effective and equitable healthcare rationing system would look like.


$36.00 X ISBN: 9780262027496 336 pp. | 6 in x 9 in 2 graphs


  • Dr. Philip M. Rosoff has taken on one of the most confused and difficult issues in healthcare, that of rationing. He knows that it is coming and will be necessary, and he sets out a thoughtful and imaginative way of doing so. His way will not be easy, but then no way will be. But his book offers great help and insight in helping us get there.

    Daniel Callahan

    President Emeritus, The Hastings Center

  • In this highly engaging, scholarly, compassionate, and, indeed, passionate book, Dr. Philip M. Rosoff proposes what may well be the best solution to health disparities stemming from limited resources. Most and more importantly, in this book that is rich with poignant and representative examples, Rosoff grounds his approach (as all such realistic proposals should) on what people, emotionally, will accept—in this case, their accepting that they will not receive life-saving care in the last months of their lives although they are among those who could have received it.

    Edmund G. Howe, M.D., J.D.

    Editor in Chief of The Journal of Clinical Ethics

  • Rosoff deserves credit for taking a distinctive approach to the problem of health care rationing. He calls our attention to the fact that there are many non-monetary forms of rationing that are integral and widely accepted parts of our health care system. If we make more explicit the reasons why these forms of rationing fail to elicit the heated and hate-filled rhetoric other proposed forms of rationing now elicit, then we might be able to have a more civil conversation about health care rationing as well as a fairer approach to implementing it. This is a project worthy of serious consideration by all reasonable persons, even politicians.

    Leonard Fleck

    Professor of Philosophy and Medical Ethics, Michigan State University