Who Makes the Hard Calls?

Via Atrios

This story is particularly tragic. Thirteen year-old Lauren Rainey has a multitude of medical problems, including an airway defect that leaves her very vulnerable to suffocation. She is also dependant on Medicare benefits that have been cut off.

Obviously this isn't just. That despite the rules that were created to be even handed, it leaves the decision in the hands of someone who is, by those very rules, separated from the impact. This is what happens when decisions are made by those distant, whether by location or emotion, from the case. So who makes the hard calls? Certainly neither the HMO's nor Medicare (an HMO people don't have the ability to opt out of) will deliver just results so long as people are just account numbers.

Any ideas?