Making Sense of the Rationing Switcheroo

Paul Krugman observes the madness of conservative rationing rhetoric:

But nobody is proposing that the government deny you the right to have whatever medical care you want at your own expense. We’re only talking about what medical care will be paid for by the government. And right-wingers, of all people, shouldn’t believe that everyone has the right to have whatever they want, at taxpayers’ expense. The Declaration of Independence did not declare that we have the right to life, liberty, and the all expenses paid pursuit of happiness.

And of course Huckabee knows this; he’s being completely cynical here — and his whole party is going along.

I think it’s actually worth exploring the logic of this position. I see two ways in which it can be rendered coherent, albeit repugnant. One is basically the “welfare state for me, but not for thee” of old people. Any effort to reduce government spending on health care for the elderly is intolerable socialism, and any effort to increase government spending on health care for the non-elderly is also intolerable socialism. That’s cynical, but it also reflects the objective difference in the age structure between the parties.


Another way of looking at it is this. Currently Medicare is an unlimited commitment to pay for old people’s health care. Ultimately, that needs to be transformed into a commitment that is limited in some way. The Obama administration’s idea is to limit it technocratically, through comparative effectiveness research. The idea is that for some arbitrary level $X of taxpayer spending on health care, the funds will be allocated to the treatments with the highest cost-benefit outlook. Other treatments can be paid for out of pocket. The conservative alternative is to limit the commitment through high deductibles. The government will pay for whatever, but only if you’ve already spent $Y out of pocket. Since $Y will represent a higher share of your income the richer you are, this is a proposal that’s much friendlier to wealthy old people than to less wealthy ones. And that, in turn, is very consonant with the conservative movement’s general commitment to advance the economic interests of wealthy people.