If you don’t like ObamaCare, you probably really don’t like Donald Berwick, the current administrative head of Medicare and Medicaid.

You know him. He’s the one who’s “in love” with the Britain’s National Health Service, the guy who insists that we “must — must — redistribute wealth,” and tells us that, since rationing is unavoidable, we’d best do it “with our eyes open.”

But in regards to government-funded health care — including Medicare and Medicaid — Dr. Berwick is right, so it does no good to shoot the messenger.

Medicare, Medicaid, and all collectivized medical care require rationing for the simple reason that all scarce resources must be rationed.

When you and I live within our means, we’re rationing. Although we usually think of it as budgeting, what we do is figure out how much money we have to work with, set our priorities, and then ration our resources accordingly. Some for food and housing. Some for medical care. Some for our kid’s education and future. We each have different sets of priorities and values, so our spending is highly individualized and personal. We get to do this, because we own those resources. Because what we would like to spend far exceeds what we can spend (as limited by our personal financial reserves) we must privately ration.*

The need to ration doesn’t change simply by pooling resources. In fact, pooling resources into common ownership makes planning all the more difficult. When medical resources are collectivized, we turn the industry which cares for us when we are injured, ill, or dying into a Tragedy of the Commons. Instead of Hardin’s example of cattle overgrazing the land, our infinite demand for health care leads to rising prices and a soaring national debt — unless we ration.

Without rationing, we will run up trillions of dollars of debt and drive the country towards bankruptcy. Oh, wait. We’re already doing that … and without rationing, it’s going to get much worse.

In a free society, individuals make their own rationing decisions according to personal priorities and privately owned resources. If a neighbor’s help is needed, it must be asked for and then given voluntarily. When resources are collectivized (or nationalized, or socialized, it’s all the same thing) a central decision making body must do the rationing. Individual personal priorities are subordinated to the priorities of the group — which in practice ends up being a small group of the politically powerful.