ICU resource allocation: life in the fast lane

However, many motorists in the USA were not eager to participate in this utopian plan designed to rescue the whole. American motorists traditionally drive at a speed that is comfortable for them, considering the surrounding circumstances regardless of a posted limit. The Federal Government assigning a speed that did not feel comfortable to the average motorist virtually guaranteed eventual noncompliance [2]. This otherwise fair rationing plan set the stage for a roadway game of evasion, detection, and escalating technology supporting both sides [3]. The law was eventually repealed because it could not be enforced [4].As a practical matter, motorists who would comply with the law would not exceed 55 miles per hour regardless of the NSL. Motorists who, for whatever reason choose to exceed the speed limits, will always try to stack the deck in their favor when dealing with speed limit enforcement. As technology for detecting speeders improved, so did the technology for detecting detectors [5]. And so a fair and equitable rationing plan designed to benefit the whole at the cost of minimal individual conformation failed because the administrative cost of enforcing individual compliance effaced the advantage [6].Two and a half decades later we find ourselves in a similar situation for medical economics, searching for a speed limit that will restrict excessive and capricious allocation of scarce healthcare resources. Distributive or social justice with regard to healthcare is particularly difficult given the Western mentality that healthcare, from immunizations to experimental fertility treatment, is a basic human right; a right sacrosanct from the clutches of rationing, the very antithesis of democracy as we know it. If, however, we continue to ignore the increasing speeds in the allocation highway consumers have come to enjoy, we have the potential to compromise all levels of healthcare. The paradigm of a democratic nation might be obliterated with a bankrupt healthcare