I think it’s because the author conflates two very different concepts of “rationing” and treats them as the same thing.

There is a fundamental difference between the innocuous example of three people “rationing” the pizza they are sharing, and a government body choosing who gets what treatment and when.

In the first instance, the three pizza-eaters presumably come upon a solution of their own free will. They bought the pizza and they come up with a way to share it. In the real sense of the word, this is not rationing. Sure, it’s dividing up a fixed resource, but it’s a voluntary decision among consenting individuals. And I’d bet they could buy another pizza if they were still hungry.

In the case of NICE, a group of bureaucrats or politicians sets the terms, and then backs it up with law, regulation, and government force, making it impossible for individuals to freely make decisions and exercise their individual rights. This is true rationing, and what people mean when they react negatively to the idea — “A fixed portion, especially an amount of food allotted to persons in military service or to civilians in times of scarcity.” People aren’t afraid of voluntarily agreeing to share some fixed amount of pizza… they don’t want government telling them that the only kind of pizza they can have is anchovy (even though they are allergic to fish), but that there’s a wait, and they’ll get their single slice in 3 to 6 months.

A third example the author provides is the “covert rationing” that supposedly goes on, but it is a misleading idea that presumes that because someone might live close to medical care or can afford more care, it is inherently a moral outrage. It assumes that health care is a right, and that because a day laborer can’t afford the same care as a millionaire, this is rationing. But it is not. It is simply a fact of reality that people with greater resources can do more — they can have more pizza or an MRI when they need one.

Health care is not a right; it is a commodity provided by freely practicing physicians and businesses, to those people who can pay for it. Dr. Torchiana seems to think that this–the free market model–is covert rationing and that it functions irrationally (and by implication, immorally). He is wrong. It is the only system that respects individual rights, the only moral system, and it is the only system that will work.

For more on this issue, read Moral Health Care vs. “Universal Health Care” by Lin Zinser and Dr. Paul Hsieh.