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[–] [deleted] 0 points 2 points (+2|-0) ago 

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[–] Vader_MtEGA 0 points 4 points (+4|-0) ago  (edited ago)

It would be nice to ration it in a way that is based on need

This here is the issue. There's no such thing as rationing any economic good based "on need." Every desire to consume is a "want" not a "need."

This may sound like quibbling to you, but when you begin to discriminate goods into two classes, wants and needs, you obviously have to define the point, for every type of good, where a simple "want" (a desire to consume) becomes a "need" (necessary consumption point to continue existing). And there is no way to do this in a manner that satisfies anybody. Haley the strung-out heroin addict probably sees her daily hits as needs, because she will fall into dangerous and plausibly lethal withdrawal if she doesn't get them; but you, if I might presume you don't use heroin, can only see heroin as a recreational drug you're unlikely to use, a want that you're very unlikely to prioritize. And how many times have you heard somebody say "I gotta get my coffee, I need it to concentrate on my work," when it's obviously not a necessary consumption at all?

If I may presume further, typically when someone discriminates between "wants" and "needs," the implied value judgment conveyed on each good is that a want is not a necessary consumption, which means that its absence in a particular person's life is not considered a utility loss worth preventing; while a need is a necessary consumption, whose absence is considered a loss worth preventing. This implies that the rationing of goods that are "wants" can be left to a normally-functioning market, since people are under no duress to consume those goods and thus need no protections against suppliers raising the price point beyond where it should be, while the rationing of "needs" demands some kind of consumer protection against price points "too high" for some segment of the population to afford the good they "need," which of course implies a market that isn't free.

This is where the concept of rent controls in major urban areas come from: Johnny Newyork can afford his Manhattan highrise apartment because the city government mandates that his landlord not charge more than $X per month in rent, and so the landlord can't be permitted to raise the price, lest Johnny become unable to pay for his housing and be evicted. The end result of this is inevitably to cause a shortage in the supply of the good that is needed, relative to the demand for that good, because suppliers aren't incentivized to produce enough of the needed good to meet demand, since they can't charge the price that they should be able to charge for the level of demand present. Johnny may keep his apartment, but it will decline in quality as his landlord is disincentivized to maintain it (after all, a shortage of available housing = surplus of people who would be willing to live in increasingly squalid apartment conditions just to have an apartment at all), and other people who weren't already able to find housing will be out of luck, as the landlords will not be incentivized to build additional housing for them too.

The example of rent controls shows that sometimes, a confluence of various factors leads to a situation where there is simply too much demand for a "need" to be met. For a related example, Denver has a huge homeless problem because a bunch of people moved there in the last 4-5 years due to their recent decision to relax their marijuana restrictions. This move occurred because a change in the laws of the land made the area more attractive for people to live in -- a factor outside of the immediate forces of supply and demand. In economics this is called a demand shift and it causes a short-term shortage in the supply of the good in question, because too much new demand has entered the market relative to its current ability to supply that demand. In the long run, demand shifts resolve themselves: the short-term price increase incentivizes suppliers to divert their resources to the market, and a greater quantity of the good is supplied to the market; some people desiring the good drop out of the market, reducing demand; and this brings the price point to a new equilibrium where demand and supply are met.

Where we run into problems, as moralistic humans capable of empathizing with the suffering of other humans, is that the comparatively sterile description of "dropping out of the market and reducing demand," in the Denver housing example, refers to people arriving in Denver, realizing they can't afford to live there, and either being forced to leave as a result, becoming homeless and staying in Denver homeless as a result, or possibly even becoming homeless and dying as a result of it. You can of course extend this concept to healthcare, where "dropping out of the market" for healthcare is more likely to refer to people either dying from preventable ailments due to a lack of resources to give those people that healthcare at a price they could afford, or forgoing treatment for some nonlethal but harmful medical condition for the same reason. Our emotional reaction to seeing theoretically-preventable suffering inhibits our ability to make the best logical decision for the entirety of our city, our state, or our species. It might be in everyone's best financial interests if Grandma stops trying to fight her battle with cancer and chooses to take less expensive palliative quality-of-life care rather than throwing resources at more expensive attempts to cure her cancer with declining probabilities of success, but we tend not to see that part, and instead see that we have ways of curing cancer, but that Grandma didn't receive them and succumbed to cancer instead.

Then throw in politicians and lobbyists who make an entire career out of preying upon the emotional weakness of mankind for their personal benefit, and boom, we're talking about how Grandma NEEDS this treatment and she CAN'T be denied treatment, even though it's obvious to everyone in the room, Grandma included, that she shouldn't be burning the family's six-digit savings on a 20% chance to beat this disease.

It's exactly as @BlancoCanyon said: there's always a line somewhere in every good, healthcare included. That's why we call them wants: there's a point where no matter how bad someone might believe they need something, they have to decide the price isn't worth it. In that sense all goods are wants.

But all of this is tough to absorb if you aren't used to very utilitarian modes of thinking, while the emotional response to others' suffering is the core of our heart of hearts, very literally what separates humans and other higher-order animals like apes and wolves from the lesser beasts on Earth. The latter frequently and obviously wins out, to the detriment of everyone.