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M. Gregg Bloche, MD, JD; Peter D. Jacobson, JD, MPH

JAMA. 2000;284:2776-2779.

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

In American politics, health care rationing remains unmentionable, except as an epithet for attacking opponents' medical cost control schemes. In 1994, Republicans and the insurance industry condemned President Clinton's health care reform plan as mandatory rationing.^1-2 A few years later, Democrats returned the favor, rolling out the "R-word" to characterize congressional Republicans' efforts to coax Medicare beneficiaries into managed care.³

Managed health plans likewise treat rationing as taboo, promising in their contracts all "medically necessary" care and saying nothing about the need to withhold beneficial care to contain costs. Plan managers and politicians seem to presume that the public will punish them in the marketplace and voting booth for even hinting that serious cost control requires the sacrifice of clinical benefits.

Much of today's legal conflict between health plans, clinicians, and patients reflects the nation's inability to openly reconcile social . . . [Full Text of this Article]

Background: Federal Law and Physician Incentives

Author Affiliations: Georgetown/Johns Hopkins University Program in Law and Public Health, Washington, DC (Dr Bloche); University of Michigan School of Public Health, Ann Arbor (Mr Jacobson).

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