Learning to Say "No."
Thurow, Lester Carl
New England Journal of Medicine. 1984 Dec 13; 311(24): 1569-1572.
Thurow argues that American society must sort out its inconsistent ethical beliefs concerning health care in the face of increasing medical expenditures coupled with declining economic growth. A capitalistic ethic which allows the wealthy unlimited access to expensive treatments regardless of effectiveness coexists with egalitarian values which ensure equal access to these treatments through public or private health insurance. The result is an insurance system with no cost constraints. Greater reliance on market mechanisms to control costs, however, will discriminate against the poor and alter social values. Thurow concludes that physicians must develop professional norms that include the weighing of costs and benefits in treatment decisions. (KIE abstract)