Hard choices: who lives, how, and who decides? The physician's dilemma

America's health care dilemma is the result of increasing medical capabilities in the face of necessarily limited health care expenditures. The question thus arises, who should receive the benefits and who should be denied? If we wish to create an even distribution of health care we can not allow people as broad a change of choices as they have enjoyed in the past. We may not be able to allow people to buy all of the health care they could afford if allowing such a market would reduce the chances of the poor to obtain urgently needed medical care. Any equitable allocation scheme will require persons to make distributions and access decisions about individual ill people. This is a social role to which no group is presently well suited.