Health care is physical, not metaphysical. It consists of goods, such as penicillin and heart stents, and services, such as oncological attention and radiological expertise. Even if we entirely eliminated money from the equation, conscripting doctors into service and nationalizing the pharmaceutical factories, the basic economic question would remain.

We tend to retreat into cheap moralizing when the economic realities become uncomfortable for us. No matter the health-care model you choose — British-style public monopoly, Swiss-style subsidized insurance, pure market capitalism — you end up with rationing: Markets ration through prices, bureaucracies ration through politics. Price rationing is pretty straightforward: Think of Jesse James and his “Pay Up, Sucker!” tattoo on his palm. Political rationing is a little different: Sometimes it happens through waiting lists and the like, and sometimes it is just a question of money and clout. American progressives love the Western European medical model, but when Italian prime minister Silvio Berlusconi needed a pacemaker, he came to the United States to have it implanted.

Rich people always get better stuff. That’s what it means to be rich. And money is only one resource: Political connections matter enormously in some places, as might a good family name or employment in a powerful firm. If you live in one of the poorer corners of the world, you may have “free” health care, meaning that if you should become infected with HIV, you will get a free aspirin. On the other hand, the Coca-Cola Company distributes antiretroviral drugs, free of charge, to employees around the world being treated for HIV.