 If we are considering a social policy or population strategy for allocation, we are seemingly bound by basic principles of procedural fairness that pre-empt special-pleading and other exceptions. These principles are also principles of rationality, and in the case of allocation policy they obviously apply. But there are also special presumptions about an allocation policy that also tap into our intuitions about the rationality of a general policy, but concern the specific nature of an allocation policy. There appear to be three presumptions about such a policy that cannot be sensibly challenged: A) the rationing or prioritizing policy is necessary because health resources are scare; B) resource use effectiveness, if not the end of the story, is at least part of it; and C) some ordinal measure of health outcomes must be used to compare outcomes.