Rationing One Way Or Another, Ctd

Apr 12 2011 @ 1:25pm

Kevin Drum defends an explicitly political, rather than market, approach to healthcare rationing:

The fact that these debates are angry and heated is unsurprising, but it's also healthy. These tradeoffs should be explicit and difficult. The big difference here isn't in whether healthcare is rationed, but in how the rationing is done. Patients are rationing themselves in both systems, but a system that rations via taxes is relatively friendly to the poor while a system that rations on price is friendlier to the wealthy. Knowing that, you can take your pick.

I didn't mean to imply that "death panels" – to embrace the term positively – were not democratically accountable. Ultimately, they are. You can listen to raucous debates in the House of Commons about someone's need for an MRI, or the number of nurses in a local hospital, or the choice between a generic and a new drug with uncertain advantages. I guess I'm saying that what Kevin regards as healthy, I regard as an impossible, dismaying and gridlocking politicization of Sophie's choices. It's psychologically and socially easier to let the market take care of much of it above a certain level – because the market feels more neutral and, in America, almost a source of moral authority. So we do not have to decide another's life or death, we can let economics do it.

I know this sounds like a cop-out (and in some ways it is) but a core difference between conservatives and liberals is the way in which conservatives like their world as apolitical as possible (I use the term conservative here to describe classical conservatism, not the strange blend of Randianism and religious fundamentalism that is now gripping the GOP). What has happened with the issue of healthcare is that conservatives have had to accept – painfully – that we cannot quite duck this question entirely through the market any more, because the success of the market, in spawning more and more possibilities in healthcare, has forced us to be more callous than we really want to be and than we really are.