Dr. Kohler has covered a lot of ground in his essay1-the state of our nation's health care system, the success and problems of the Oregon Health Care initiative, and the ethical issues associated with rationing. Each deserves serious consideration, but I will confine myself to his ethical questions for two reasons; first, the moral question is, I believe, central to any attempt to fashion a just health care system; and, second, Dr. Kohler misconstrues my position on the ethics of rationing.

When all is said and done, I agree with Dr. Kohler that explicit rationing can be morally justified. It is…