What's the thought process for the "fairness" of income based rationing? This doesn't seem that rational from either utilitarian or deontological angles. From my perspective it's a very unfair strategy compared to providing equal care to all people.
How else do we ration healthcare? Best looking people first? Oldest first? Youngest first? They all have terrible edge cases that are as bad as richest first.
We can't give everybody what they need because that is physically impossible. I don't want to die, so if we are going by needs I need permanent life support :(. That isn't even slightly practical, so we can't do that either - someone has to do without.
We could directly build more hospitals, train more doctors, etc. It is hard to see what would really change - there would still be horrible stories about edge cases where the system failed and there would still be a great need for more people. We have to draw a line somewhere - why not here? If we can justify going beyond the economic equilibrium, at what point do we stop pouring money into the healthcare system? A serious question which in my view has no satisfactory answer.
In parts of the US, fire departments are run like a business http://www.nbcnews.com/id/39516346/ns/us_news-life/t/no-pay-...
But the reason fire departments aren't run like a business is because fires spiral out of control and affect neighbours. That is not really the problem when we are talking about patient outcomes. Obviously we should all get exactly what we want without having to worry about physical constraints. But when we go from what should happen to what will happen the whole physics-and-reality problem sets in.
We can't provide everyone with all the healthcare that they should get. There are never going to be enough doctors, equipment or hospitals. Sickness is literally an endless source of suffering and we all die of something - there cannot be enough medical assistance to deal with everything even if we devote everything we have to the healthcare industry. Rationing access to healthcare by people's economic contribution to society is just as fair as any other sort of rationing you care to come up with.