Peter Singer, a prominent utilitarian philospher, has set out a very strong case that ‘rationing’ health care is both inevitable and ethically sound, if done intelligently. The inevitability of rationing arises inescapably from the fact that our resources to do all things are limited, that we don’t want to devote all of our resources to health care, and that no amount of resources can prevent death indefinitely or in all cases. As such, we need to make sure that the rationing is driven by intelligent considerations, rather than morally dubious ones such as the wealth of the person receiving treatment.
If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades.
Pragmatically, it isn’t possible to prevent the wealthy from spending whatever they can on their own health care. Even if you outlaw it domestically, there are plenty of other states that will welcome their cash. What is possible is improving outcomes in situations where risk and resources are being pooled, whether by private ensurers or by government-run insurance schemes. It is in those cases that we need to do a good job of evaluating what expenditures produce benefits sufficiently large to justify them, and which we must decline to undertake.