Let’s say it’s 2027 and I’ve just turned 65. I fill out a Medicare application on-line and opt for a plan with superior heart coverage (my father died of a heart attack), not too much knee coverage and physical therapy (my job doesn’t require heavy lifting), no cancer heroics (my mother turned them down and I wish to follow her example), and lots of long-term disability.Yes, it's a terrible approach. Cowen conflates decision and choice. It is definitely possible (and probably true) that people can rationally decide between preferred forms of treatment. The problem is that, unlike Cowen, most people are not a tenured university professor with a guaranteed income in retirement. They can't choose anything. In a similar sense, I might be able to rationally decide to colonize Europa rather than Titan, but I cannot choose between the two: I lack the ability to do either. The whole point of Medicare is to provide medical treatment for people without the means to make the choice, whether or not they can rationally make the underlying decision.
Is that so terrible an approach? Is it obviously worse than having the Medicare Advisory Board make all of those choices for me?
If Cowen wants to say that people without the means to make the choice shouldn't get medical care in their old age, let him say so directly, and we can debate the issue on the merits.