Over the past four decades, the share of income devoted to health care nearly tripled. If policy is unchanged, this trend is likely to continue. Should Americans decide to rein in the growth of health care spending, they will be forced to consider whether to ration care for the well-insured, a prospect that is odious and unthinkable to many. This book argues that sensible health care rationing can not only save money but improve general welfare and public health. It reviews the experience with health care rationing in Great Britain. The choices the British have made point up the nature of the options Americans will face if they wish to keep public health care budgets from driving taxes ever higher and private health care spending from crowding out increases in other forms of worker compensation and consumption. This book explains why serious consideration of health care rationing is inescapable. It also provides the information policymakers and concerned citizens need to think clearly about these difficult issues and engage in an informed debate.
Henry J. Aaron is a senior fellow in Economic Studies at the Brookings Institution, where he holds the Bruce and Virginia MacLaury Chair. Among his many books are Can We Say No? The Challenge of Rationing Health Care, with William B. Schwartz and Melissa Cox (Brookings, 2006), and Reforming Medicare: Options,Tradeoffs, and Opportunities, written with Jeanne Lambrew (Brookings, 2008). William B. Schwartz is an expert on national health policy and is a professor of medicine at the University of Southern California. He was formerly chairman of the Department of Medicine and Vannevar Bush Professor at Tufts University and was also president of the American Society of Nephrology. Melisssa Cox is a student at Yale Law School.
"informative and insightful...'Can We Say No?' is a useful book to stimulate needed discussion and debate. It would be a valuable textbook for a public health or public policy class in comparative health care systems." Ross Mullner, University of Illinois at Chicago, Inquiry - Excellus Health Plan |"CAN WE SAY NO? provides important evidence about how capital limitations might affect the American health care system. Aaron's account of how limits on spending have worked in the NHS is particularly credible" Joseph White, Case Western University, Public Administration Review, 1/31/2007 |"The authors are impartial, astute, and wise. For anyone interested in drawing lessons about health care reform from the experience of other advanced nations, there is no better place to start than this brief and timely volume." Alan Garber, M.D., Stanford University |"This book is a well-written and insightfulanalysis of the challenges facing decisionmakersin both countries. The authors' focuson the inevitability of rationing, on fundingwhat is a proven benefit to patients, and on thebetter incentivization of efficiency is welcome." Alan Maynard, University of York, England, Health Affairs, 11/1/2005 |"Everything Henry Aaron writes about health care is worth reading, including this busman's holiday of a book on what we should learn from the British health system....Aaron and colleagues believe that skyrocketing spending in the United States will force rationing of health car. He is absolutely correct that projected increases in Medicare, Medicaid, and private insurance spending are unsustainable." Jim Cooper, U.S. House of Representatives, a member of the House Armed Services and Budget Committees, Health Affairs, 11/1/2005 |"It's a valuable survey of the real medical issues involved in British rationing, and gives a taste of the dilemmas the U.S. system will eventually face." Paul Krugman, Robin Wells, The New York Review of Books, 3/23/2006 |"the book offers a highly engaging, accessible, and provocative look at the most significant issue facing American health care." Michelle Mello, Harvard University, Journal of Economic Literature, 12/1/2006 |"This book will be of interest to anyone involved in the implementation of government targets or trying to achieve financial balance." Sheila Bullas, Health Strategies, British Journal of Healthcare Computing & Information Management
