Recent proposals to reform the health care financing system have sparked discussions concerning the need to ration health care. Relative to other western industrialized democracies, the US rations primary and preventive care more, tertiary care less, and makes greater use of price rationing and bureaucratic controls. Because insurance coverage is not universal and the extent of coverage varies across services, the poor and those patients needing long-term care are most heavily affected by price rationing. The current system also works to the advantage of procedure-oriented specialists and to the disadvantage of primary care physicians. Major reform of health care financing could change what is rationed, how it is rationed, and who is most affected. However, some rationing will remain necessary under any conceivable financing system.