It doesn’t come from the welfare state, but from central planning:
Obamacare provides the illustration of this, as I think many people have intuited. The “economic problem,” of course, is inescapable in health care. The supply of health care is scarce (only so many resources can be dedicated to it relative to other ends in society) and the demand is pretty close to unlimited. Somehow or other we have to decide how to allocate these scarce means among all the different ends–preventive medicine, end-of-life care, primary research, specialists v. generalists, etc.
Now one possibility that–thank goodness–we have historically rejected in the United States is the idea that certain people should just feel a moral obligation to die for the good of society. You do hear this sometimes–that some people should voluntarily forgo life-extending treatment for the “good of society”–and it sends chills down my spine. This is essentially the Maoist approach.
The alternative is to come up with some way of allocating scarce resources among competing wants. The myth of Obamacare is the same problem repeated: it rests on the idea that we can simply change the means of health care delivery (central planning of health insurance) but it will not require determining the ends at some point–i.e., in the end who gets treated and what treatments are covered and which are not. So, for example, the core of Obamacare is the system of cross-subsidies for some treatments (maternal care) and the expense of others (unmarried or infertile people). So infertile people have less money for things that they want to do (such as join a health club) because they now have to pay more money for things that the central planners have decided is more important than whatever they would do with their money.
And of course, E. J. Dionne remains clueless, as always.