Just spending in the face of concentrated need

Recent medical innovations have successfully treated many acute ailments, but one side effect has been the resulting concentration of chronic illness, and thus health care expenditures, among patients who are now living longer. Health care analysts, searching for savings, often propose rationing for such expensive patients, whose needs threaten to overwhelm the system. Yet, targeting the elderly is simply not just. This paper offers both a moral approach to allocating scarce health care resources, which respects the rights of the weakest members of society without bankrupting society, as well as a critical examination of the data regarding concentration of expenses. Spending based on efficacy, in contrast with age- or expenditure-based proposals, is both just and consistent with financial and medical realities.