Rationing health care

Below I posted a video of Dr. Donald Berwick praising England's socialized medicine model. I have listened to an audio tape of Dr. Berwick in which he said, "The question is not whether we will ration care; the question is whether we will ration with our eyes open." Anybody know what that means? I'd sure like him to explain. Because Obama appointed Berwick when the Senate was in recess, no Senator got the chance to ask him to explain what he meant by that statement prior to his being appointed.