The article discusses the importance of involving physicians in decisions about allocating and rationing high-cost medical services. The author argues that physicians should be part of these decisions because they are the ones who ultimately make the tough choices about limiting care. The author disagrees with the idea that rationing decisions are painless and believes that effective rationing can help reduce costs by avoiding unnecessary use of resources. The author mentions a case where rationing was effective in cutting costs by limiting the amount of care provided.