Rationing: the case for “muddling through elegantly”

doi:10.1136/bmj.311.7008.811

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David J Hunter

Director Nuffield Institute for Health, University of Leeds, Leeds LS2 9PL

EDITOR,--Chris Ham's editorial on health care rationing1 misrepresents my position on the issue. He suggests that I subscribe to an approach to rationing by muddling through. My actual position is rather more subtle, hence the description “muddling through elegantly.” I emphasise “elegantly” because I do not seek to defend the previous closed system, in which resource allocation decisions were often dressed up as clinical ones and hidden from public scrutiny.

I, too, support greater transparency in decision …