Is Rationing Inevitable?

A compelling picture of the growing confrontation between physicians in private practice and third-party payers is provided by the correspondence in this issue1 on Dr. Gerald Grumet's recent essay, "Health Care Rationing through Inconvenience."2 The problem underlying the discontent is cost. The payers — government, business, and the health insurance companies — are at the end of their economic rope. Unable to support the continued escalation of medical costs, they are determined to use whatever means they can to control expenditures. Two consequences, vividly described by Grumet, are a growing morass of regulations and bureaucracy and an increasing surveillance of . . .