Finally, the NHS controls its budget by controlling the range of medications, tests, and procedures it will pay for. This kind of “rationing” takes place in every health care system; in the United States, such decisions are generally made in private, by insurance companies. But in Britain, with a public health care system that is a constant focus of public attention, the decisions about what treatment will be available—decisions that are literally life-and-death choices for many patients—are public. Should a ninety-four-year-old patient get a hip replacement? Should every man over fifty get a
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