Rationing health care.

Two articles in today's New York Times raise provocative questions of health-care rationing and justice. One story is about Zell Kravinsky, a multimillionaire (well, he was a multimillionaire before he gave away $45 million to various foundations) who more recently donated one of his kidneys to a complete stranger. His wife has threatened to divorce him if Zell doesn't tone down his altruistic tendencies, and even his mother disapproves: "You can give money, you can give service. Body parts are quite another thing." Zell's explanation is strictly a utilitarian one: "No one should have a vacation home until everyone has a place to live . . . . No one should have a second car until everyone has one. And no one should have two kidneys until everyone has one."

In the second article, "New Therapies Pose Quandary for Medicare," Gina Kolata discusses medical therapies that could benefit tens of thousands of Medicare beneficiaries but at a cost of (as the late Carl Sagan would have said, in a different context) "billions and billions," indeed at a price that would dwarf the projected price tag for the prescription drug benefit currently being debated in conference by Congress. As Kolata puts it: "The federal Medicare program is expected to decide this week whether to pay for an aggressive and expensive lung operation that could offer a lifeline to tens of thousands of elderly patients. But health economists and medical experts say the treatment, however alluring, is part of an unsettling trend: new and ever pricier treatments for common medical conditions that are part and parcel of aging — procedures that could potentially benefit tens of thousands of patients, at a total cost that would far exceed the kind of prescription drug benefit now being considered by Congress. The questions, these experts say, are how much Medicare can or should pay, and whether cost-effectiveness should enter into the decisions." The chief medical officer for the Centers for Medicare and Medicaid Services, which administers the Medicare program, is quoted as saying "he understood that the costs of new technologies can be staggering. But he adds that cost has traditionally not been a consideration in deciding what to cover. 'If the technology was effective, we would find a way to pay for it,' he said. 'There is no dollar value per life per year at which Medicare would decline to pay.' But," adds Kolata, "costs are mounting."