“I disagree with Charles Krauthammer’s idea that health care would be rationed under single-payer insurance system. It is already rationed by cost.”
Leaving aside Ms. Hohle’s “disagreement”, government-run single-payer healthcare is by definition rationing. When the government pays, the government sets the terms. It will, and necessarily must, decide who gets what healthcare when. The government obviously will not be blindly cutting checks according to the whim of any person, anywhere, at any time…whether patient or provider.
On this point, David Leonhardt is more honest. In advocating for socialized medicine, he readily admits that government will ration healthcare. But to make that reality more palatable, he simply obliterates the distinction between government force and voluntary private decision-making:
“The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly.”
The “rationing” angle is yet another of the fallacious arguments used to justify a complete government takeover of Medicine. The crucial questions to ask are: What is rationing, and does the allocation of goods and services by the price mechanism in a free market constitute rationing?
Rationing is variously defined as:
Government-imposed restrictions on the allowance of people’s food, clothing and fuel in both World Wars…
The allocation of product among customers during periods of short supply. When price is used to allocate product, it is allocated to those willing to pay the most.
The controlled distribution of resources and scarce goods or services. Rationing controls the size of the ration, one's allotted portion of the resources being distributed on a particular day or at a particular time.
Rationing is defined by Webster’s (1979) as “a fixed portion; share; allowance…to distribute, in times of scarcity”. This implies a central authority with the power “to distribute”–for example, the government under single payer health care. In common usage, the term “rationing” is sometimes used to describe market forces such as the price mechanism and supply and demand. Nevertheless the fact remains, the term rationing stems from the war time government-imposed system of distributing specific goods…i.e., force is the essential ingredient that defines rationing. In the free market, force is necessarily absent, because all legal private associations are voluntary. The legal use of physical force is the exclusive domain of government.
It is force that is conveniently ignored by Ms. Hohle and Mr. Leonhardt. “Rationing” by cost (or price) in a free market is the absence of physical force and compulsion in human relationships. Rationing by government is physical force and compulsion. Don Watkins describes what real rationing amounts to:
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.
Loose definitions aside, there is essentially no such thing as “rationing healthcare by cost” in a free market since there is no central authority to do the rationing. There are only producers of healthcare trading their work for the earnings of others willing and able to pay for it, by voluntary agreement to mutual advantage…i.e., by trade, just as in most other economic sectors.
It can be no other way. It is an inexorable fact that man’s needs and desires are not a free gift of nature, but must be produced by actual human beings through productive work…i.e., a process of reason applied to physical labor. As any honest man knows, one cannot consume what one has not produced. As any honest man knows, one can morally consume what another has produced only after acquiring it by voluntary means…by trade or private charity. As any honest man ultimately knows, one cannot consume in excess of what one earns.
What Ms. Hohle and Mr. Leonhardt object to is justice. Morally, being unable to pay for your healthcare…while unfortunate…gives you no right to seize it forcibly by theft or through political surrogates you elect. The fact that some cannot afford the healthcare they need does not constitute the rationing of healthcare, any more than a person’s inability to afford a Jaguar amounts to Jaguar rationing. You have only the same rights as others…to consume according to what you earn. Justice, not rationing, is the ruling principle in a free market.
To repeat, what Ms. Hohle, Mr. Leonhardt, and their ilk ignore is the issue of force. This equivocation of government-imposed rationing with market “rationing” is meant to obliterate the difference between political and economic power…between the dollar and the gun. They are tacitly admitting that government-run healthcare amounts to a dictatorship with the power to obliterate individual rights. But the truth won’t sell in America, so the crucial nature of the choice we face is camouflaged behind such rhetoric as the false choice between “rationing well and rationing badly”, with government control rather than free and voluntary choice being the lesser of the two evils. The socialists need to hide the fact of what Americans will be giving up, what government control actually means, as well as the only valid alternative to socialized medicine…capitalism. So they simply imply that freedom is a “bad” version of what government must do.
The real target of their attack on the “price” or “cost” rationing is the self-supporting human being who manages to find a way to pay for his healthcare by his own efforts. It is this productive person who will be denied his rightful treatment under “good” rationing, for the sake of the non-self-supporting...i.e., the moocher. It is for the sake of the moocher that government will be handed dictatorial power over all of medicine.
Disingenuousness is their only weapon. As Don Watkins says:
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.
Sanders-Cruz Healthcare Debate Rehashes Old Talking Points, Illustrates Problem of Government in Healthcare, 2017
"Sanders' debate performance, meanwhile, was a reminder of some of the dangers of populist rhetoric on policy making. Sanders insisted healthcare ought to be a right for all Americans. When Cruz pointed to rationing, waiting times, and lower quality service in countries with such arrangement, Sanders claimed that healthcare pricing was a form of rationing of its own. Insofar as government intervention distorts pricing incentives, he's right. Decades of government regulation, intervention and favoritism in the insurance and healthcare industries have largely divorced prices from any market forces, which can 'control' prices better than any bureaucrat."