We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
What no one wants to say is that there are variety of groups; some of which are deserving of beneficial treatment; and some are not. For example, old people should not receive tax-funded heart transplants. Why not? Because they are too old to function as productive members of society.
At this point an intellectual would say: Who are YOU to say which groups are worthy of beneficial treatment? That's a classic Marxist argument; the idea that all groups must be treated equally, except when they are being compensated for previous inequality.
But the equality argument fails the litmus test of public opinion. For example, black infants have no market value. White infants are worth upwards of a million dollars. But you'll never see that fact mentioned on 60 Minutes, because the government wants to manufacture reality. In never-never land, all babies are of equal value.
So with that said, I must humbly disagree with Mr. Sowell. Making tough choices does not always involve trade-offs, if the group which is being denied beneficial treatment has no value in the court of public opinion.
You've got your "intellectuals", "Marxists", etc. and their ideologies all mixed up.
Indeed, it is intellectuals a.k.a. progressives - such as Ezekiel Emanual (the father of ObamaCare) - who have argued that the elderly and disabled shouldn't receive certain treatments because their economic value to society is too low. While not a "classic Marxist" argument, Marx disciples certainly believed the same thing as evidenced by their actions.
The "litmus test of public opinion" is the tyranny of the majority - the type of rule whereby a black majority country, such as South Africa, can institute laws legalizing the murder whites and the taking of their property - which Mr Sowell opposes and which is supposed to be prevented by the Bill of Rights which was drafted to protect the rights of the individual, not the demands of the majority.
Mr. Sowell is correct that in this world of finite resources, choices necessarily involve trade-offs. He also warns in other essays about the problem of unintended and unanticipated consequences - like the ones you evidently failed to consider when you posted your weak argument.