Now that we are all waiting for the Supreme Court decision on
“Obamacare” there is a lot of (mostly predictably partisan) argument about
where things go from here in the health care field. What no one on either side seems to be aware
of, or willing to grapple with, is the simple fact that it is impossible to
offer the best health care to every single American. There simply aren’t enough
doctors or nurses or hospitals, let alone enough money in the federal budget,
to give everyone the kind of health care that a wealthy CEO can buy.
Nor is it clear that society “owes” everyone the very best,
most expensive health care available. We
certainly don’t feel that society “owes” everyone the most expensive meals, the
most opulent houses, admission to the most expensive colleges, or the most
expensive luxury cars. Why is health
care any different?
But more to the point, since it will be impossible to give
every American top of the line health care, how do we decide who gets
what? Right now the market decides – if people
can afford it (or the insurance that covers it), they get it. If they can’t afford it, they don’t get it. It isn’t
an ideal system, but it does allow people to make personal choices about how to
spend their money.
Would a government bureaucrat’s decision be any more
fair? On what basis would a government bureaucrat
decide who gets a new kidney and who doesn’t, who gets a replacement knee and who
doesn’t? On what basis would a government bureaucrat decide if and when to
withdraw all but palliative medication to a terminally ill patient? Would we
all be more content if those decisions were being made for us by someone we don’t
know and didn’t elect?
This is the crucial health care issue that no one seems
willing to grapple with. If there isn’t enough health care to go around (and
there isn’t, by a long shot), what is the best way to allocate what is
available? Despite the problems with
free market forces -- and there certainly are some-- I don’t see any better way.
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