The WSJ gave Betsy McCaughey half of their opinion page on Thursday to expose the views of Ezekiel Emanuel (“Obama’s Health Rationer-in-Chief“). The disapproving essay concludes with a question, “Is this what Americans want?” and seems to presume that Emanual’s principles for allocating scarce medical resources are so horrifying that simply describing them is sufficient to reject them.
However this did not reduce my enthusiasm for Emanuel’s philosophy. McCaughey’s citations show Emanual raising essential issues, making excellent ethical arguments, and providing solutions that make perfect sense for government spending on individual welfare.
The problem with this debate is that it is about two separate but sometimes correlated questions:
- How much healthcare should government provide?
- Should government healthcare usurp private markets for the same goods and services?
What is both reasonable and necessary for government healthcare would be unethical for free market medical services: Namely, a system for rationing finite resources that considers cost and benefits in a social, not individual, context. Government can’t pretend that it has unlimited resources. And in this debate I have not yet heard an explicit argument in favor of the default method for allocating scarce resources: queues.
Government needs some socialist basis for (A) taking money from some people (via taxes) and (B) giving it to others (via medical services). Of course a major part of the debate pertains to (A), i.e., the degree and manner in which government is justified in coercing some people to contribute towards the health of others. But given some level of government-sponsored healthcare Emanual offers an ethical framework — indeed, the only coherent one I have encountered — for part (B): disbursement of finite resources
The second question raised above is more difficult, but insofar as a rationing system is employed to problem 1A it need not interfere with private markets. I.e., Govenrment should not encumber private commerce in medical goods and services even if it does itself engage in socialized medicine.