Ezra Klein defines “rationing”:
[T]he only thing that’s really rationing is the thing your doctor tells you is rationing. If he can’t start you on a fourth drug regimen because the insurance won’t pay for it or the government says no, that’s rationing. If he doesn’t start you on a fourth drug regimen because he doesn’t think it’ll help and the focus now has to be on making you comfortable and trying to get you into a clinical trial, well, that’s just good care.
I know, I know, strictly speaking there is no such thing as “no rationing.” However, that renders “rationing” essentially meaningless, hence semantically useless (though still politically charged). So, Ezra’s being helpful here in making a distinction that highlights a difference.
The next step is to help the doctor and the patient know when that fourth drug regimen will be of help. That’s what comparative effectiveness research is for. The final step is to get doctors to do what Ezra’s hypothetical doctor did: follow the evidence. These are not simple steps, not least of which because they’ve been hijacked by political and financial incentives.
By the way, Ezra cites a Merill Goozner piece that is worth reading.