All of economics, every last bit of it, is about scarcity. About what is scarce and what is not, and about who does and who doesn’t get their needs (and sometimes wants) satisfied.
Much of the debate about healthcare is in fact a scarcity problem. There aren’t enough practitioners in practice to handle every patient, so some people don’t get doctors. It’s a combination of self-selection where people who can’t afford to take time off to have an ingrown toenail treated professionally hack at it with a pocketknife instead, and insurance selection where granny’s insurance will pay for hospice but not a new hip, and actual medical discretion now and then.
But this is about what medical care does right. Triage.
In times of very acute scarcity when many people are injured and need medical attention to survive, but few doctors are available to treat them, medicine does triage. The details can be complex, but one of the features of triage is that if doctors are too scarce to save everyone, they prioritize saving *as many people as possible*, even though that often means giving specific people no treatment at all. The scarcity is distributed so that *as few people as possible* suffer from scarcity.
This is not about mass trauma triage.
Imagine for a moment how utterly absurd it would be if there was an earthquake, but there were enough doctors to simultaneously treat everyone injured in it, but they insisted on following triage protocols and the very worst injured were given black tags indicating “do not treat”, even as surgeons who could save them sat idle, because everyone else was being treated. No civilized person would defend that kind of thing.
But this is not about hypothetical earthquakes with plenty of doctors.
The world produces significantly more food than needed to feed everyone. Quite a few people actually are angry that much of it is destroyed even though many people starve for lack of food. Many agree that is unacceptable that, even though there is enough to go around, not enough goes around.
This is not about hunger or food waste, or stores throwing bleach in the dumpsters to keep people from eating stale crackers.
This is about scarcity, and who gets it.
By it’s very nature as a lack of enough, if scarcity exists then someone must get it; there’s no accounting trick to pay Tuesday if there is no hamburger today. Various economic philosophies try to distribute scarcity in various ways. Some try to give the scarcity to the least productive, some try to split it as evenly as possible, still others just admit that the scarcity goes to the lowest status or losers at violence. Various implementations of those philosophical principles handle those philosophies to varying degrees of faithfulness and effectiveness.
But this is not about economics. This is about one of the fundamental decisions of morality: who gets the scarcity?
There is only one answer I can possibly accept:
As few people as possible, and no more.
A nurse in a triage ward who has to mark the patient who will not be treated should not be so sad at what they do as the one who orders that food be destroyed, lest some bargain hunters pilfer from the dumpster instead of buying from the commercial establishment. The hypothetical trolley controller standing as his hypothetical lever and wondering if he is a murderer would be aghast if he understood a zoning board’s decision that causes dozens of non-hypothetical to die of exposure so that a handful of high-status people, the eldest sons of the ones who got credit for industrializing the land that was credited to the winners of violence.
Any political or economic philosophy or policy that ever wantonly destroys a scarce thing, or fails to produce a scarce need that could have been produced, is evil. Those who manufacture scarcity for their own profit, to accumulate their own positional goods, have created a new hell. Not for themselves, but for their victims, and on Earth.
When there is not enough to go around, it doesn’t go all the way around. The answer is the same whether it be food, shelter, textbooks, medical attention, love, mosquito nets, or anything else that people need. Who should miss out?
As few as possible.