<HTML> Enrique, Thanks for responding so thoroughly about the public health care system in Spain and UK. I have a couple more comments to make to your post. In the UK it is fairly common that those with money can buy whatever access they need to get the health care they need. <BLOCKQUOTE TYPE=CITE>Marta > I think that it is dangerous to start making health care judgements based on quality of life -  </BLOCKQUOTE> <BLOCKQUOTE TYPE=CITE>Enrique:Perhaps it is dangerous, but I see no alternative. How else do we make those judgements?  </BLOCKQUOTE> <BLOCKQUOTE TYPE=CITE>Marta> that is what you are really talking about when you talk about rationing. Who decides?  Who loses > in such a Social Darwinist set up? The poor, the disabled, that's who. > Not necessarily.</BLOCKQUOTE> I'd like more of an explanation of what you mean by "not necessarily." Meantime I would like to say that in every third world nation, people who cannot walk go without wheelchairs and are reduced to begging in the streets to survive. James Charlton wrote about this in Nothing About Us Without Us: Dsiability and Oppression. Whether the nation is rich or poor, disabled people are on the bottom of the socio/economic ladder realtive to that country's situation.  This is univerally true in the US, the UK, Spain, etc.. Quality of life rationing does already happen...most everywhere.  In Holland 25,000 people have been murdered by their doctors *when they did not ask for it*.   In the United States quality of llfe judgements are being make all over the country about who should live, and those most likely to be starved to death  are brain injured people whose relatives and doctors have decided their lives are not worth living.  To make a comparison which may be illuminating and bust some myths about brain injuriy, when James Brady, President Reagan's press secretary was shot and brain injured his rehabilitation was of such quality that he regained speech and continues to live at home and participate in most everything, short of sports. He had excellent civil service health care. Another example of quality of life decisions being made.  When Marjorie Nighbert (who had signed a living will instructing her brother to pull the plug if she became disabled) had a stroke and became disabled, she decided that life with a disability wasn't so bad after all and decided that she wanted to live. She wanted her living will terminated and asked for the treatment of food. But her brother  decided that she was not competent to change her mind and the hospital starved her to death anyway.  It is long and agonizing - death by starvation. A book has been written about stealth euthansia cases all over the country - Forced Exit by Wesley Smith. It is no secret that disabled lives are perceived by most people as not worth living. When health care rationing decisions get made by nondisabled professionals(doctors), disabled people's lives are/will be marginalized.  When decisions are made is to who is worthy of treatment and who is not, it is usually the "healthier" whose lives are perceived to be more qualitative and deserving of prolonging.  When cost effectivemenss gets factored in on top of this, as is happening all over this country, it is easier to pull a plug on a life and to justify it in terms of saving HMO and hospital profits or saving taxpayer dollars. Marta  </HTML>