The problem of resource allocation in health has stimulated much thought and research, in attempts to provide objective, rational methods by which necessary choices can be made. One such method was proposed in a paper in this journal. The authors argued for a utilitarian approach, which they claimed to demonstrate was acceptable to society at large. This paper argues that the evidence supporting such a claim was flawed; such a utilitarian approach is not socially acceptable, and is therefore not relevant. (...) Rather more relevant directions for research are discussed, based on the assertion that a degree of realism is essential when considering the problems of resource allocation. (shrink)

Massachusetts's new health insurance law has been shaped by much more than presidential politics. Ten years of evolving policy on health insurance and hospital finance have exerted powerful influences. Ironically, enacting universal access required paying hospitals much more money for their currently insured patients. This costly compromise may destabilize the law's implementation.