Wednesday, August 22, 2007

Clear Thinking On Socialized Medicine

From Megan McArdle at The Atlantic:

But wholesale transfers to large classes, from large classes, are not good moral philosophy unless those classes are very well specified to the moral effect you are trying to achieve.

For example, we could take money from taxi drivers and give it to surfers. Some of the taxi drivers would be bad people who don't deserve their money; some of the surfers would be sterling chaps whom society has failed to justly reward. But still, we all2 recognize that this would be moronic, because virtue and vice are fairly randomly distributed within and between the two populations. There is no reason to think that on net, we would have enhanced social justice...

A gigantic single-payer system is a pretty blunt instrument; it transfers money from one group, the young and healthy, to another group, the old and sick. It does not distinguish much more finely than that between the deserving and undeserving within that class. This is why discussions of particularly deserving or undeserving people within the larger class, such as your fine old Uncle Bob who served his country in two wars before becoming a minister, are irrelevant; as with the surfers and taxi drivers, almost any class we can specify will contain some very worthy members who deserve more from society than they have gotten. What we need to know is whether the class of old and sick people as a whole are much more deserving than the class of young and healthy people; whether our transfers do more good than harm.

Single payer advocates seem to invariably assume that the answer is yes. This is a natural reaction; the old and sick inspire our sympathy. But I am not sure that, as a group, they should also summon our sense of social injustice...

There is indeed a very compelling moral argument to be made in favor of some sort of government sponsored health care finance, which is simply this: no one should die, or suffer unduly, because they don't have the money to pay for treatment. Some of my libertarian readers will say that this still doesn't give the government the right to take the fruits of our labor by force, but in fact, I find this argument fairly convincing.

However, that doesn't mean that I should therefore be in favor of a single payer system. The fact that some people cannot afford some good, even a really important and valuable good like food or healthcare, is not a good reason to nationalise the production of that good.

I agree with her.


Queen of Dysfunction said...

Not to mention that a single payer health system administered by the government would likely serve NOBODY particularly well.

allen said...

The really sad thing about articles like this is that they're based on the assumption that the decision to embrace or reject socialized medicine is amenable to argument and discussion. But that's just not true, at least in the short run.

The attraction of socialized medicine is the exciting possibility of getting something you want very much by sticking someone else with the bill.

Once the initial excitement dies down though, more reasonable people start to remember how often they've gotten something for nothing and how often the something turned out to be rather less then was promised.

Emotions happen in a flash, reasoning takes more time. That's why I'm hopeful we'll slow down our rush toward socialized medicine as the countries that've already been there start to back away from socialized medicine.

It's already starting to happen in Canada, England, Germany and Sweden at least. But the steps are small and easy to ignore. We just have to hang on until those "civilized" countries that decided on socialized medicine decide that they've made a mistake.

Ellen K said...

One thing that seems missing from every single payer model is that cost doesn't stay the same. It almost always grows unless you put price controls. Then you end up with suppliers leaving the market, which pushes up the cost of supplies even higher due to scarcity. The only way around that is escalating revenue (taxes). So the program sold to voters for 10% of their paycheck would end up costing much more.

Darren said...

That's the utilitarian reason I'm against it. There's also the "social security" parallel that doesn't look too good.

Then there's that whole freedom, marketplace, individual responsibility thing.

I so enjoyed reading Conscience of a Conservative :-)