More broadly, haven't liberals historically prospered when they promised and delivered more for the average American (more Social Security, health security, prosperity, clean air) in exchange for increased spending? Why not try the same with health care? Give pandering a chance.
1. We're broke. We don't have more to give, or even credibly promise.
2. As Robert Samuelson's column puts it: we're at the point where more health spending -- harms our ability to spend more on health.
It's not that industry and such are better; but they remain the foundation for all funding of good things.
Choke off such productive growth, and you choke off the source of money for other good things, including health spending.
3. All health spending is rationed. We can't put an ambulance and paramedics on every block. The question is: who decides?
4. There is waste. But who decides how to appropriate?
5. The problem with generous government approvals is that political pressure will distort what should be spent.
I'm a Baby Boomer. We'll demand knee replacements so we can still dance (somewhat) as we used to.
And we have the votes to make it happen.
6. But the real question is: when do these pay back society? If a middle-aged delivery driver gets a knee replacement so he can stay on the job and not go on disability, great.
But how does society benefit if a 75-year-old retiree gets a knee replaced so his shuffleboard form remains unmarred?
7. Political pressure means LESS health care that's needed. And MORE health care for those with political clout. Those are different.
8. Of course, there are equality questions, but not the ones that usually come up. If we as a society pay for your knee replacement, do you have to keep working to pay back society?
9. So is it fair that the healthy keep on the treadmill, and the unfit get to kick back?
Equality isn't possible -- especially if politicians run it. The problem isn't how to get the maximum, for that would be 100 percent, and our economy would collapse before then.
The problem is how to get the optimum allocation of health care.
And that raises brutal questions for a democracy that aspires to equality -- but can't bear to deny anyone anything.