A reader writes:

Americans already tolerate rationing - health care in the USA is stringently rationed by price and employment status. If you are not wealthy, or your job does not provide health cover, you miss out on health care.  This form of rationing is dire compared to having to wait some months for non-critical surgery under a universal insurance model as you might in Canada or Australia. Under the current system in the US, many people (40 million) receive insufficient care and face early morbidity and mortality or are bankrupted, both of which have serious, long term economic impact. Under a universal insurance system, the people at the bottom of the pile have to wait a bit for non-critical care.  There really is no comparison.

Even more, permitting a free market in health services is nonsensical. Nothing in the world, as yet, can beat death; but most people faced with death would give everything they have for an extra day, or week, or year, or decade, of life. Material things are worthless in the face of death. That's the problem with a free market in health services.  The wealthy will pour everything they have into high intensity, high tech, high cost, but in the end marginal extensions to their lifespan. That's why the US pours more money into healthcare than any other nation, to achieve an overall lower lifespan and health outcomes than its peers.

Health expenditure is most efficient and has the greatest impact when directed to prevention and timely, high quality primary care. Such a strategy is almost impossible in the US health system as it is currently configured.

And why should we have a problem with free people choosing to "pour everything they have into high intensity, high tech, high cost, but in the end marginal extensions to their lifespan"? And isn't the market a more neutral and less politically manipulable form of rationing than government? I think you really do have to live in a socialist system to see how rational it looks from the outside and how mediocre, passive and bureaucratic it feels from within.

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