But there is also a real difference between having something rationed by a process and having it rationed by a person. That is, in fact, why progressives are so fond of rules. They don't want to tell grandma to take morphine instead of getting a pacemaker. It's much nicer if you create a mathematical formula that makes some doctor tell grandma to take morphine instead of getting a pacemaker. Then the doctor can disclaim responsibility too, because after all, no one really has any agency here--we're all just in the grips of an impersonal force.The unstated problem that McCardle doesn't really talk about is that the rules have to come from somewhere, meaning they have to come from some government bureaucrat. That bureaucrat is empowered by someone as well and that person or people are Congress ultimately.
But this won't do. If you design a formula to deny granny a pacemaker, knowing that this is the intent of the formula, then you've killed granny just as surely as if you'd ordered the doctor to do it directly. That's the intuition behind the conservative resistance to switching from price rationing to fiat rationing. Using the government's coercive power to decide the price of something, or who ought to get it, is qualitatively different from the same outcome arising out of voluntary actions in the marketplace. Even if you don't share the value judgement, it's not irrational, except in the sense that all human decisions have an element of intuition and emotion baked into them.
How long can people ignore the chain of accountability back to the very people we elect. The solution has to be, as Bill Whittle has noted, a complete and utter House cleaning. Which Congress not incorrectly believes won't happen.