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James E. Sabin, MD; Norman Daniels, PhD

JAMA. 1998;279:703-704.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The central policy challenge for reform of the US health care system in the next decade will be helping society come to grips with the unsolved problem of meeting patient needs fairly under reasonable resource constraints. Providing an excellent level of care to all within acceptable levels of expenditure will require a new way of thinking about quality¹ and a much more open forum for public reflection and debate.² Unfortunately, with the notable exception of the state of Oregon, US political dialogue to date has been characterized more by avoidance and wish fulfillment than by realistic analysis and openly acknowledged hard choices. As a nation we are in the very early stages of a learning curve regarding setting limits and talking candidly about rationing.

Decisions about the adoption and application of expensive new treatments are a central component of both quality planning and . . . [Full Text of this Article]

From the Center for Ethics in Managed Care, Harvard Pilgrim Health Care and Harvard Medical School, and Department of Psychiatry, Harvard Medical School (Dr Sabin), and the Department of Philosophy, Tufts University (Dr Daniels), Boston, Mass.

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