Dr. Ubel has raised an issue with no easy answers. Rationing and the perception that we must ration will be with us for the foreseeable future. Physicians must participate at all levels in the process to achieve consistent and appropriate care. The standard of care provided should be referenced to a societal norm, which physicians must help to establish. Physicians must then use that standard in individual patient care.This is rationing, and the medical system cannot exist without it.