THE INVISIBILITY'S THE THING. This is a rather bizarre point by Michael Kinsley:
If a superior level of care is available, the care being guaranteed to everybody is inferior. In other words, you are rationing -- denying people useful, if not vital, health care to save money. Worse, you are letting people buy their way out of the rationing if they can afford it -- the way affluent young men were allowed to buy their way out of the Civil War draft.
At the moment we don't guarantee anyone any level of health care, so this moral dilemma can be saved for another day.
This is like watching a kid step in front of a car and breathing a big sigh of relief because you never took an oath to save kids from oncoming automobiles. We're not saving the moral dilemma for another day, we're just ignoring it today. As it is, we have almost no guaranteed floor, and all rationing is done by income, and done without limit. If we did guarantee a certain level of care, at least there would be a minimum below which poverty couldn't push you. Kinsley's protests are a dodge, a complicated, and unconvincing, rationale to deny our complicity.
I often wonder if some of the right's obsessive affection for Health Savings Accounts and individualized medicine doesn't come from exactly that desire: In a communal system, we'll have to make choices about how to apportion care, and they will be hard. Sometimes we will feel guilty. In a "consumer-directed" system, the market, which is to say income, will make those choices for us. It will make them cleanly, lopping the poor right off the balance sheets. It will make them less humanely, and with no consideration as to individual circumstances or where treatment could do the most good, but at least we won't be consciously involved. You often hear about the market's role as an "invisible hand," but in health care, it's an invisible executioner. And maybe that's what we like about it.