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.

And yes, we’re talking about taxpayers. Nobody at all is talking about rationing the care you may choose to buy for yourself; if Rupert Murdoch wants to spend $100 million on a treatment that probably won’t work, but might prolong his life by a few weeks, he’s perfectly free to do so. The real policy question is simply whether taxpayers should be obliged to do the same for everyone — and the answer is obviously no.

Now, the Journal isn’t really confused on this point. Surely it understands the difference between rationing care and limiting public spending on care. The point, however, is to confuse readers, and make them think that spending controls on Medicaid are the same thing as having bureaucrats pronounce death sentences on the middle class.

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?

Inquiring minds want to know.