Detoxifying the concept of rationing.

Andrew Hantel's proposal for dealing with cancer drug shortages exemplifies the kind of clinician-led discussion of rationing the U.S. political process requires. I argue that the U.S. will not get a grip on healthcare cost escalation until we set true budgets for healthcare. We will not be able to do that until the public accepts that rationing, done right, is an ethical necessity, not an ethical abomination. Because endorsing rationing is a third rail for politicians, "top down" leadership is currently impossible. As a result, health professionals must lead a "bottom up" educational process. Hantel shows how this can be done. Copyright 2014 The Journal of Clinical Ethics. All rights reserved.