[Recognizing the situation (1): a plea for an open debate about rationing].

The rise in health costs is due to the tremendous advances in medical science and other causes, such as a system offering a unique financial stimulus for health professionals to provide more services, non-functioning competition, patients' demand for every possible form of treatment as rapidly as possible, a compliant political community and also new players such as consultants, the ethics industry, lawyers and nursing academics. On the other hand, the public is not willing to pay more in taxes and health insurance premiums. The resultant dilemma sooner or later forces restrictions on health care which can be called either optimisation, rationalisation or rationing.