Paul Krugman puzzles over a dazzling bit of dishonesty in a Wall Street Journal op-ed on Oregon’s Medicaid program.  Here’s the basic issue:

Aaron Carroll reads the Wall Street Journal, which is outraged, outraged, at the prospect that Oregon’s Medicaid system might seek to limit spending on treatments with low effectiveness and/or patients who aren’t going to live much longer in any case. Death panels!

Carroll points us to the actual staff recommendation, which is far milder than the WSJ blast would have you believe. But as Carroll points out, the larger point is the absurdity of the Journal’s position. On one side, it’s fanatically opposed to Medicaid expansion — that is, it’s eager to make sure that millions have no health coverage at all. On the other side, it claims to be outraged at the notion of setting priorities in spending on those who do manage to qualify for Medicaid. It’s OK for people to die for lack of coverage; it’s an utter horror if taxpayers decline to pay for marginal care.

Krugman (and the Aaron Carroll, whom he is citing here) doesn’t quite put the matter this way, but it seems to me that you have a basic issue of scarcity here: in part on account of objections from conservatives, money for Medicaid is short.  So best to distribute what little there is to those who need it, not everything can be covered.  So the discussion ought perhaps to be about that.  That’s not, sadly, what the Wall Street Journal was interested in.  Their interest, rather, was in using such perennial problems as evidence that Big Government will put you to death.  That is a rather different issue.

So Krugman wonders:

So I understand what’s going on here. What I don’t understand is the mindset of the editorial writers. At some level they have to know that they’re engaged in an act of grotesque cynicism. Do they admit that to themselves? Do they rationalize it by saying that truth is a secondary consideration when you’re engaged in a crusade against the evils of big government? Have they mastered true Orwellian doublethink, managing to believe things they know aren’t true?

My vote is they are probably capable of knowing the difference, but have long ago confused success at selling an idea with the idea’s being true.  Or perhaps something else: they believe their are better arguments out there, and though the one they offer may be a stinker, you argue with the arguments you have, not the ones you’d like to have.  Someone, after all, will come along an iron man them out of this one.