The term rationing has been bandied about so frequently in polarized political settings in the United States that most of us on this side of the Atlantic cringe when we hear the word. We cringe because the term is used as an opposition device to any reform proposal no matter how big or small its intent or potential impact. When a seemingly innocuous proposal encouraging physicians to talk to elderly patients about living wills, advanced directives, and their end-of-life care options elicits rhetorically charged references to “death panels,” it seems we have reached a new low for American discourse on rationing. It is no wonder then that proponents of comparative-effectiveness research (CER) are so careful to avoid the R word and even the cost word (note: it is comparative-effectiveness research, not cost-effectiveness research, that found its way into the PPACA).

In sharp...

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