Rationing Health Care

An article in the Washington Post this morning complains that Obama's health care package will result in the rationing of health care services.

(See: Washington Post ObamaCare Is All About Rationing by Martin Feldstein.)

I am not at all certain whether the health care proposal is a good idea, and I would like an honest and open discussion as to its merits. Unfortunately, there are far too many people such as Feldstein who has decided to suppress intelligent discussion by filling the room with noise.

The facetious nature of Feldstein criticism is simply illustrated by pointing out the fact that free markets themselves are defined as a system for rationing scarce goods and services. In the case of free markets, rationing is done according to willingness (and ability) to pay. The criteria for determining who gets a scarce resource and who goes without is determined by discovering who is willing and able to pay the most money and who either does not have the interest or does not have the money.

Consider Feldstein says in his own proposal.

[U]nlike reductions in care achieved by government rationing, individuals with different preferences about health and about risk could buy the care that best suits their preferences.

This is true . . . if they had the money

This is a rationing system, that pulls health care away from those who do not have enough money to pay for health care that suits their preferences and assigns it instead to those who do have money.

The only resources that do not have to be rationed are those that are so common that everybody can have all they want without effort, or public goods from which individuals cannot be excluded.

The implication in Feldstein's editorial that we have a choice between rationing under this health care proposal and no rationing is absurd. Unfortunately, we are plagued by people who embrace and promote absurdities when they are politically useful, mindless to the effect that this noise has on intelligent debate over the real-world merits or demerits of the proposal.

This use of the term 'ration' allows Feldstein to effectively mislead people by use of the fallacy of equivocation. Equivocation occurs when an agent uses the same term, but relies on an undetected shift in its meaning to generate the illusion that evidence has been given in support of a desired conclusion.

The second definition of rationing is the type that one might be familiar with from World War II, where the government passed laws prohibiting people from purchasing more than a certain minimum amount of goods and services deemed essential to the war – such as gasoline and sugar. However, proof that the government is going to engage in this second type of rationing requires evidence that the government is going to prohibit people from buying particular goods and services. If those types of prohibitions are not in the bill, then the claim that the bill requires rationing in this sense is false.

It is the case that the government health bill says that the government will not pay for certain types of procedures. This would be done to keep down costs. However, in this sense every insurance company in existence publishes a list of procedures that it will not cover – which in many cases includes 'experimental procedures' where the chance of success is low or unknown. Insurance companies impose these limits in order to reduce the amount of money they will have to pay out. In other words, they 'ration' in exactly the same way the government would be required to ration.

There is nothing in the government bill that bars people from buying supplemental insurance to cover options that the government does not cover – if they have the money to do so. In other words, there is nothing in the bill that outlaws price rationing, where those with an interest in these high-cost, low-benefit procedures can pay for them out of their own pocket, provided they have deep enough pockets.

In other words – the type of medical care rationing that many conservatives seem to favor, that allow rich people to bid medical care away from the poor by bidding the price above what the poor are capable of paying, would still exist.

However, my objection here is not just that Feldstein made some false and misleading claims about health care that I have not corrected. My real objection is that people such as Feldstein have an obligation not to make these types of mistakes.

We make a mistake in this country because far too often we stop at correcting a person's mistake while ignoring the moral failings that resulted in that mistake. Feldstein should have known better than this. And if Feldstein is incapable of understanding these points the editors of the Washington Post should have caught the problem and handed it back with questions. Where the author and the Washington Post fail to live up to these obligations the rest of us have the right to ask, "What type of person are you that you see fit to pollute public discussion on such an important issue with this kind of garbage? Is it too much to ask that you show a smidgen of moral responsibility here?"

It is precisely because we do not condemn those who commit the moral crime of intellectual recklessness that we have so much of it – and why we suffer so many ill effects because of it.