gatekeeping by a primary care physician, prior authorization and utilization review, assumption of financial risk through capitation payments to the provider with financial disincentives for hospitalization or referral to specialists, and so forth. Many see the issue in terms of the rationing of health care, a term used in two different senses. First, market economies deny goods to those who cannot afford them, and this includes the good of health care. This is a form of rationing by price that has a long history in the United States, to the detriment of the poor, and it is a problem that presently affects about 15 percent of all Americans. Second, the term can refer to the denial of commodities to those who have the money to buy them:
The question now being raised is whether health care should be rationed in this sense, whether its availability should be limited, even to those who can pay for it. This kind of rationing would affect the 85 percent of all Americans who currently have health insurance and any others who may later be added to their ranks.
Once the Clinton Plan was announced, various Republican groups offered plans of their own. It was clear that there was a split in the Republican ranks on the issue and that the different proposals took different approaches to the problem. There were three basic proposals s
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