Kevin Drum’s up in arms about a Steven Landsburg article in Slate.

I read the article, and I have to say, it’s one of the most tactless and incompassionate pieces I’ve read in a long time. But is it wrong? Landsburg argues that most poor people wouldn’t want “ventilator insurance” — they want the basics of day-to-day life. Would Tirhas Habtegiris, the woman who was removed from life support because of inability to pay, have preferred to get $75 cash from the government before her illness, or would she rather have the insurance?

Landsburg claims that Habtegiris clearly would have taken the money. I’m not so sure he’s right — I think nearly anyone who has a philosophical objection to removal from life support would gladly pay $75 for a lifetime assurance that it would never happen, regardless of their financial circumstances (as an aside: based on my philosophical principles, I’ve paid considerably more than $75 to draft a living will that ensures I will be removed from life support if I have no chance of recovery). Of course, no one actually gets to make Landsburg’s hypothetical choice, so the question is hardly worth asking or answering.

What Landsburg’s argument scratches the surface of, but never directly addresses, are the phenomenal problems that will have to be overcome in order to implement a national health care program. I’m all in favor of nationalized health care, but when we get down to the nitty gritty, if this thing ever gets passed, it’s going to be a pain in the ass. Every medical decision, from getting a wart removed to bypass surgery to keeping vegetables alive on ventilators, will become a political one. Think of how often the deductible on your HMO package is changed. Now multiply that by 300 million angry calls to Congress whenever a national health care decision is made — not to mention all those “I told you so’s” from O’Reilly and Limbaugh.

If I was making the national health care decisions and I had to choose between keeping Habtegiris “alive” and, say, back surgery that might enable someone to go back to work, I’d have no hesitation in pulling the plug on her. Does that make me callous and incompassionate? Maybe, but that’s the sort of decision that will have to be made, millions of times each year, by a government-sponsored health provider.

To me, what’s much less compassionate is the status quo, where millions go without health care, where “minor” conditions become life-threatening illnesses because the uninsured can’t go to the doctor. I realize that national health care might mean that sometimes heroic measures can’t be taken because they cost too much, but I’m willing to admit that’s the right thing do. Are you?