Rationing health care: moving the debate forward

Groups in Britain are encouraging the debate that the government won't lead

When governments and politicians do not act, the people may. In Britain neither the government nor the main opposition party will openly acknowledge the inevitability of rationing health care. Instead, they talk of increasing the effectiveness of health care, spending more on the health service, and setting priorities locally.

Their implication to the public is that nobody will be denied potentially beneficial treatments. But almost all of those who spend any time studying this subject recognise that people have always been denied potentially beneficial treatments, and they always will be no matter how much is spent on health services. These commentators believe that governments should come clean with the public and lead a debate on how best to ration health care. Because British political leaders will not accept this challenge, various organisations and ad hoc groups have begun to try to find ways to include the public in the debate on rationing health care. Some of these initiatives are covered in this week's and last week's BMJ.

Most commentators accept that rationing is inevitable, but the debate keeps returning …