In the 1960s the idea that a physician would play a dual role, ie patient advocate AND stewart of "society's scarce medical resources" was not a topic for discussion.
Of all the changes in the past 35 plus years this is the one that I find most disturbing and antithecal to what a physician is about.
Is it coincidental that the movement for social justice in the United States parallels the ascendancy of managed care. The American College of Physicians speaks of the need for a fair distribution of medical resources as if the activities and skills of thousands of health care professionals were a fungible entity that simply needed to allocated by central planners in spite of the obvious fact that this fictious entity is not owned by any one person let alone by the abstraction "society" Do these "spokesmen" of one element of organized medicine speak this way because they do not realize the fallacious argument and rhetoric involved ? Or do they speak that way in spite of the fact that they do understand what they are saying and realize the unreasonable effectiveness of that type rhetoric ?
Most people would not object to something done in the name of the "good of society" . Most people do not realize the bogus nature of the concept.
There are voices speaking out against the social justice fallacy and its partner utilitarian ethics including the physicians at the Association of Physicians and Surgeons, analysts at Cato Institute and the occasional blogger.