A citizen's decision to spend $100,000 on health care is his decision. Even with the knowledge that only a couple good days are to be gained by this big expenditure, if the money is yours, then spending it as you like is your decision. This is the fundamental problem with public sector health care, and I would like to refer to it as a problem of 'grace'.
When you work for charity, you receive grace. Be a scoutmaster, a nurse or just pick up trash on the side of the road for a few hours, and it changes the way you feel about yourself and your community. The time is given by you, and what you receive is grace--call it a gift from god, or a calm to your psyche, it is not where it comes from that matters, but what you feel and how you feel about receiving grace.
You may receive grace by giving to charity. The feeling you have when you drop a $20 that you earned into the Salvation Army food drive box, or the coat drive for children is grace.
Some believe that you receive grace through taxes. I do not believe this. Taxes are coerced, and not voluntary--if the were, if you paid your taxes as you felt the government deserved, then you might receive grace from that, but I do not believe that coerced tax qualifies. I do feel better having paid my taxes, but it is not the same feeling.
When a charity director decides to disburse money to an individual, that director weighs the needs of the individual against the needs of the next individual who will come along. He also considers his donors--what their intent was for the money he disburses, and how he can convince them that their money was well spent.
When a social worker disburses a government check, the process is different. There is little reason to consider the needs of the next individual, because in the mind of the social worker, there is unlimited funding from the government. And a social worker need not make a justification to the tax payer. Social workers follow a different script, a script not of need and compassion, but one of blind rules and regulation. Perhaps just rules, but there is no grace.
If an old man decides to fore go expensive medical therapy, knowing that this will probably lead him to die, perhaps six months sooner than he would with therapy, part of his decision may be that he wants to leave his wife and family with enough means that they may go on without him in greater security. This is a decision of grace, and we can understand his decision. It need not be a tragedy--it is a course chosen by an informed individual, who perhaps has chosen the path of less pain, and the dollar amount versus the time in his life is his decision, freely made.
But a social worker cannot make such a decision. For a social worker, medical therapy must always be taken, and to fore go such therapy would be abuse, or must mean that the patient has made the wrong decision, and therefore must be depressed or in some way impaired. Such patients might be compelled to receive expensive medical therapy, if that is the social worker's decision.
Government control of health care distorts the economics of medicine. But more than that, government control distorts the way we perceive the value of health care, and steals from us the grace to do what is right.