First of all, it is an exaggeration to say that such health care is rationed because some cannot pay for it. Rationing is a system whereby one's access to a good or service is controlled despite one's ability to pay, not because of it.
There is nothing immoral about letting one's ability to pay determine whether one gets health care. I would argue that it is morally hazardous to make others pay for all, while some escape payment altogether. Today, 40% of Americans pay no federal income tax at all. Are we now to give them a free ride on all their health care costs as well, while placing a higher burden on others (some of whom are struggling as well)?
We already pay for the health care of the indigent. I balk at paying for the health care of those who merely wish to pay less than health care actually costs. Many people forgo health care insurance despite the fact that they can afford it because they prefer to pay for cell phones, manicures, private school, etc. Health care is essential, these others are not. They choose not to pay for health care insurance because it is very expensive. This is irresponsible. I don't like that it is expensive, but I know that paying out of pocket is even more expensive. One must prepare for the worst and hope for the best -- or take responsiblity for one's gamble.
If Eugene Robinson wants to help those who fall into the gap between medicaid and affordable health care, I urge him to spend his time and money supporting a charity that will help such people. Some exist. If they are not to his liking, he should start one of his own.
However, to demand that I contribute to his charity is theft. To make gov't tax collectors force me to contribute to his charity only makes it legal theft -- it does not change what it is.
When I was poor, I depended on charity and was grateful for it. I pay the gift forward. That is the proper response. To suggest that the gov't do my work for me would be laziness.
I see two problems with gov't run health care insurance:
- It eliminates the incentive to spend health care dollars wisely. Even though my company pays for less than half of my premium, as a payer, I remain motivated to keep health care costs down so as to keep next year's premium reasonably priced. Participants in a guaranteed health care system who themselves pay little tax to begin with, have no such incentive. It would soon make health care much, much more expensive than today. Unless taxpayer funded health care maintains an incentive to use health care wisely (and counting on the good behavior of others is folly) then the system will not work. We cannot hope to insulate people from the costs of living. We must encourage people to take part in hoisting the burden, not attempt to shift it from them.
- Because we have a progressive tax system, most people would end up getting a discount on their health care insurance. Those who pay no federal tax would get free health care and have no idea who was paying their bills for them. They would be unlikely to recognize the gift, but would come to expect it as an entitlement. It is one thing to provide health care insurance to people in the gap, it is folly to provide it at a discount and make others pay far more than their fair share. It encourages irresponsiblity. Charity is fine, but reckless charity damages the recipient by discouraging self-care, lowering self-esteem and cementing dependence.