The Ultimate Tax Authority

I believe that creating a government mechanism that has the legal power to deem people not fit to receive medical care, is a very dangerous business. And that is what rationing would be – a legal means to withhold medical care from some, so others can have it. The ultimate tax authority, one might say.

Isn’t it ironic that people agonize over the death penalty for even the most heinous criminal, yet many advocates for a single-payer medical system seem enthusiastic about institutionalizing another sort of death penalty for ordinary citizens simply because they need medical care?

Discussions of rationing medical care can sound repellent, even if presented as a purely academic exercise. Example: some of Dr Ezekiel Emanuel's work.

Describing his "complete lives" theory of allocating medical resources, Dr. Emanuel wrote that it:

"empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible."

He correctly identifies the nasty part of rationing - who can be allowed into the lifeboat, who will be pushed back into the ocean?

If I and I alone were empowered to make these decisions, I would agree that Emanuel's system is fair. See, I trust myself - but I don't trust all you others. I expect everyone else feels the same way about me, making decisions about whether to save you or your relative. So that presents a practical problem - who will run this thing? Emanuel only says "us." Questions I have for the good doctor are - who do you mean by "us" exactly? And who will appoint "us" to this job? And who defines or limits the power that "us" will have? What assurance can there be that the powers of "us" won't be expanded ad infinitum? And who decides if "us" made a fair decision? And what happens if someone disagrees with "us"? There are many more such Q's, but you get the idea. O brave new world that hath such people in it as "us".

Emanuel also wrote that his system

"prioritizes younger people who have not yet lived a complete life - and also incorporates prognosis, save the most lives, lottery, and institutional value principles".

Well, that's nice. No one could possibly object to a system that is fair and saves the most lives. Oh, well, maybe you would, if you're not invited.

And what's that part about a lottery? Emanuel explains that

"lotteries could be used when making choices between roughly equal recipients."

Heads or tails, ma?