If you’re poor, sick, and can’t afford good – or even adequate – health care, it’s your own fault for being poor, and your own problem. That’s the clear message of an editorial that appeared on the National Review’s website yesterday:
Defined at a high level of abstraction, rationing is inevitable in medicine. Not everything that might be in a patient’s best interest can be done in a world of finite resources, and some constraint has to limit his treatment. Thus the left-wing jibe that the market features “rationing by price.”
But there are many good reasons to prefer rationing by price to other forms of rationing, which is why we use it for most products and services. Those reasons are not limited to efficiency, though they include it. The rationing involved in a free market is decentralized, creating more room than a bureaucratic system for people to make different trade-offs. Hence most people do not think of it as rationing at all.
It follows that it is a deep mistake to imagine the wonders of greater government involvement absent rationing. Greater government involvement necessarily means that the government will play a larger role in the allocation — the rationing — of care. In a pure government monopoly, for example, where getting care outside the system was either illegal or only a notional possibility, the monopoly would have to turn down some requests, and so some medical interventions would go undone. Even in a mixed system with a large governmental role, the government’s decision not to pay for a treatment — again, a decision that must inevitably be made many times — will have the practical effect of denying care.
If nothing else, the editorial manages to capture the extent of the ideological gap that health care reform proponents from at least some of the opponents of reform. The editors at National Review clearly view health as a commodity to be bought and sold – as something that you should just do without if you can’t afford to buy it. Proponents of health care reform, on the other hand, tend to believe that it’s self-evident that life and the pursuit of happiness are both much, much harder to secure if you can’t maintain good health.