Taking Care of Our Unlimited Wants

In a recent post, I criticized conservative pundits who've portrayed the administration’s health care reform proposal as a move toward "socialized medicine." Opponents of the so-called "public option" seem to be among the most eager to frame these reforms as a wholesale government takeover of the health care industry.

As I've said, I believe this is a false argument. But underneath this bit of conservative sophistry is a fundamental truth about the nature of our health care dilemma.

The debate over national heath care is really a debate over social priorities. For many opponents of the Obama plan – most of whom legitimately fear that the public option is a backdoor to single-payer – the central question in this debate is whether those who have health insurance should be compelled through the tax system to financially support those who lack insurance. Progressives tend to see this as a no-brainer – health care is, after all, a "basic right" – but the issue becomes increasingly complicated when we begin to consider expensive medical innovations that are available to only the wealthiest citizens.

If every American is entitled to health care, what level of care should be provided to each American? Should every citizen be afforded access to the most cutting edge medical technology? I think most progressives would agree that we cannot provide every citizen with the best possible care – the cost would be far too high. So how do we decide which illnesses should take precedence, and which procedures should be funded?

The Obama administration’s push to address these difficult questions through comparative effectiveness research not only oversimplifies an extremely complex problem – it also ignores the moral dimensions of the problem. Those who criticize the inequity and inefficiency of the market must describe what they believe are the best – and most ethical – ways to prioritize treatment through the government.

These are not simply scientific questions; they are questions that involve serious moral judgment. We live in a country with limited resources and unlimited wants – this is the fundamental economic problem that all societies face. If the market is no longer rationing health care resources, the government must. But so far, those who advocate broader government control of the health care industry have been hesitant to acknowledge this point – or to explain their moral priorities.

It’s true that the government will not be taking over the health care system, but if we do move toward single-payer – as many progressives would like – the government may be purchasing most people's care. Even with their enormous bargaining power, the feds simply cannot afford to fund our unlimited wants.

There will have to be tradeoffs, and those who support a single-payer system should be honest about those tradeoffs.