The irrational argument for rationing health-care
Opponents of Obama’s attempt to radically expand government control over medicine have warned that his program will lead to the same sort of rationing we see in other countries that have socialized health-care. But Obama’s supporters are trying to dismiss these legitimate fears by distorting the very meaning of “rationing.”
Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for.
Singer calls this rationing “by ability to pay.” Columnist David Leonhardt concurs:
The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally.
Let’s define our terms.
To impose rationing, Ayn Rand explained in a letter to a friend, means “to distribute [goods and services] in a certain particular manner–by the decision of an absolute authority, with the recipients having no choice about what they receive.” Rationing means that the government decides how much of some good or service you are allotted.
This bears no relation to what happens under the price system of a free market. On a free market, goods and services are not rationed. They are produced by individuals and then voluntarily exchanged for the goods and services others have produced. A craftsman builds a chair, which he sells for money, which he uses to purchase a doctor’s services. A doctor trades his services for money, which he then exchanges for a lawnmower.
The difference between prices and rationing is the difference between you choosing what groceries to buy and the government telling you what food you’re allowed to eat.
Commentators like Singer treat those two as equivalent because, on their view, goods and services do not belong to the individuals who produce them, but to society. They hold, in effect, that brain surgeons and MRI machines are the property of society, which has the right to distribute “its” resources as “it” sees fit. But a doctor’s services or a hospital’s equipment are not social resources. They are created by individuals, and those individuals have a moral right to dispose of their time, effort, and property as they see fit. Rationing deprives them of this right. As Ayn Rand wrote:
Rationing IS coercion, that is, orders, and nothing else whatever. The essential distinction of a free market, as against any other kind of system, lies in the absence of coercion and in the method of exchange by voluntary choice.
The real reason for our health-care woes is that we do not have a free market in medicine today. But those pushing the “everything is rationed” line are trying to wipe out the last vestiges of freedom by means of erasing the crucial distinction between voluntary trade and force. To the extent they are successful, they are able to deflate any moral opposition to socialized medicine. Instead of a fight between those who believe in freedom for doctors and patients and those who don’t, supporters of government health-care want to bicker over different means of achieving the same collectivist end. That’s the only kind of fight they can win.