The Clarks’ situation is hardly unique. In their home state of Texas, one in 10 children have no health coverage of any kind, in large part because successive Republican governors have refused to allow their citizens to take part in the expansion of Medicaid that has proven one of the only universally successful parts of the Affordable Care Act. Even with excellent insurance coverage, out-of-pocket expenses for emergency care can run into the four-figure range before the deductible kicks in. Meanwhile, the least fortunate Americans are those who find themselves just wealthy enough to be disqualified from Medicaid but poor enough to find their employer-sponsored health insurance plans beyond their means. Nor are families with children the only people who find themselves making life-or-death decisions on the basis of cost. As I write this, more than 10 percent of Americans are refusing to take medication prescribed by doctors because they cannot afford to pay for them.

All of which is to say that, whatever the GOP argues to the contrary, we have rationing in America already. The question is whether we should be rationing on the basis of the need of patients rather than on that of wealth — or willingness to incur life-crippling debt. To whom should our limited health-care resources be devoted to if not the young, the elderly, and the disabled? This year millions of Americans will have elective surgeries while millions of others go to bed thanking God that another day has passed without one of their children becoming injured or seriously ill — or dead.