I think there's a substantial difference between denying care as some sort of a punitive measure and rationing care due to a shortage of resources. Active smokers aren't put on lung transplant lists; it's not a punishment for smoking, there just aren't enough donated lungs to go around. I see no reason why a smoker should get a lung instead of someone who took care of theirs, and I see no reason why an anti-vaxxer should get a respirator instead of someone who did everything in their power to avoid the disease.
If lungs and respirators start growing on trees, well then great, everyone gets what they need. But while there's a shortage, smokers and anti-vaxxers can and should be at the back of the line.
The reason active smokers arent put on lung transplant lists is because institutions that do transplants (of any kind) are super cunty about survival rates. If someone is actively smoking, the odds of them living 5 years after a lung transplant aint good. And if they die it reflects poorly on that program and their ability to get accredited.
Hospitals are definitely starting to ration care again. I believe the article i posted this morning talked about the state enacting guidelines to allow it.
While I 100% think that every antivaxxer is a massive fuckin queynte who should be kicked in the taint, its not a good way to ration care. The reality is a LOT, hell id go so far as to say the overwhelming majority of care is futile and extremely wasteful. I imagine most people arent familiar with ECMO, but ECMO across the country is at the highest utilization rates EVER by a massive margin(ECMO is basically the most intense form of life support out there) . The survival rates for these patients on ECMO has to be in the single digits, they are phenomenally resource + staff intensive. The costs to the hospital (not what the patient/insurance but the actual hospital cost) is around 200,000-350,000 per patient. This is extremely extremely wasteful (not from just a money standpoint) but from the standpoint that you could have all these resources treating dozen potentially hundreds of other patients with far greater survival rates.
Yet here we are with probably every single ECMO circuit around the country running almost non stop. Because here in America we don't know when to let people die.