Rationing in the fiscal ice age

One of the few predictions about the National Health Service (NHS) in the approaching fiscal ice age that can be made with reasonable certainty is that the long-simmering debate about rationing will boil up more fiercely than ever before. Internationally the NHS’s ability to manage scarce resources has frequently been held up either as a shining exemplar or as a dire warning, not least in the political struggles over healthcare reform in the United States. But, of course, it is neither. The British experience can best be seen as a case study of the dilemmas and difficulties involved in managing the allocation of scarce resources. And it is precisely because the dilemmas and difficulties remain unresolved – and perhaps can never yield a final resolution – that they have prompted public and academic arguments over the decades: arguments that will flare up ever more fiercely as resource constraints bite in coming years. What follows, therefore, is a selective discussion of issues that are likely to feature in the debate.