The moral argument against single-payer

Must-read op-ed that lays out the arguments:

In discussing the morality of a single-payer system, those efficiency considerations are irrelevant. In discussing the morality, one thing matters1: who is made better off, and who worse off, by the system?

Most advocates of single payer, I think, care most about this justice claim. They may also think that they can make the system more efficient, but if one could somehow prove scientifically that a private system would be cheaper and better, they would still favor a public system as long as a substantial population remained uninsured.

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.

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  • Evan

    “They may also think that they can make the system more efficient, but if one could somehow prove scientifically that a private system would be cheaper and better, they would still favor a public system as long as a substantial population remained uninsured.”

    Wow, the assertions made without evidence never stop here on Kevin, MD.

    How is it possible for a system that leaves a substantial population uninsured to be in any way better FOR THOSE WHO ARE UNINSURED? Is this possible? If not, then the private system by definition can’t be “cheaper and better.”

  • Anonymous

    Great article! Clearly a system that leaves more people without access to medical care is the “more moral” one–because, after all, the important issue in morality is making sure that people’s wealth is considered sacred. Interesting basis for “morality…”

    I gotta say, this blog is a shining example of Confirmation Bias.

  • scalpel

    Clearly it would be better if the uninsured just bought their own insurance. But if they don’t want to, they can always pay cash. We take credit cards too.

  • Anonymous

    The epitome of morality today is I have mine and I am ok,so who cares about you. Its so much better with a private system that sucks milliosnand in some cases billions to reimburse insurance exectives,and denies care even to the supposedly insured.
    But don,t worry Kevin,nothing will change. no industry contributes moe money to congress than the insurance industry.

  • Anonymous

    “The epitome of morality today is I have mine and I am ok,so who cares about you.”

    Some would find a problem with imposing a “moral” obligation on taxpayers. The issue is simply that you are seeing a “right” to money that is not lawfully yours, and are prepared to make a seizure of that property for your own uses, all the while applauding yourselves for your “morality”.

    It’s good to know that you’re out there, helping your fellow man, when he shows up looking for medical care. You mean to say you don’t do that kind of work? Well, color me surprised… Your interest must not extend that far.

  • Mike

    Its about the line between charity and socialism.

    But it truly sucks for those with a pre-existing medical condition who cannot get insured. Maybe the governemnt can have a provision for insurance for those who cannot get insured by private payers. Then at least it would force everyone to purchase one before they get to suck at governement teat.

  • Anonymous

    Insurance can not possible ever work for people with chronic pre-existing condition. Once your house is on fire, it is uninsurable as the risk of it catching fire is now 100% and can not be spread out. For that group we can tell them earn to pay you bills until you can’t, then die, count of voluntary charity, or use involuntarily siezed wealth (taxes) to provide them with at least certain minimum services.

    In that case, I prefer the later once they have spent their own earning on their care. If they don’t consider it worth the product of their labor, then it isn’t worth mine either.

    For the rest of us, currently healthy, I prefer a voluntary choice, not coerced or bribed, to buy or not to buy insurance. It is a personal risk and a personal choice. All health care choices should be treated equally by tax policies, not with massive incentives skewing the system toward making us dependent on employers, who don’t have our interests at heart. I would like to see not only the President’s proposal to treat privately purchased insurance with the same tax treatment as employer covered care–it is afterall only fair–but also the same treatment of those who chose to save and self-insure instead.

    If a 21 year old put pre-tax dollars into an untaxed investment account to save for his care, and he retained average health through middle-age, he would have a nest egg that would, in a pinch provide him with healthcare comparable to the upper limits of the best policies that can be bought. That is a choice that he should be free to make without bias in the tax system favoring him putting his care under the control of healthcare bureacracies–which is what happens with “health plans.”

    Freedom has it’s risks but taking responsibilty for ones own decisions and risks is what makes an adult and fosters the attainment of the greatest human potential.

  • Anonymous

    It’s funny, but many of the same people who are against big government and socialized medicine are begging the Fed to reduce interest rates. Apparently, the only moral welfare is corporate well fare.

    If Jesus was about one thing, it was about helping the poor. Greedily proclaiming that “wealth” should be considered sacred and not people is, well, not very Christian.

  • Anonymous

    “If Jesus was about one thing, it was about helping the poor.”

    Regarding the sick, I would respectfully submit that Jesus would have healed them. I don’t see a line forming to do that for free. What, you’re not ready to volunteer? Ah, but you’re prepared to take what isn’t yours, and give it to some-one else. How very, um, Christian, of you. Proclaiming morality while declaring for yourself the right to deprive others is a risky proposal. Be the first to live what you propose, give your money to help the sick. You know, that line, “Let him without sin cast the first stone.”

  • Anonymous

    The single-payer/free market/third party payer argument jumps the gun on the fundamental question.

    Is there a basic level of care we are willing to fund for all citizens, and if so, what are its parameters? It has both moral and financial implications.

    Until that is resolved, you cannot realistically hope to enact single payer with any hope of containing costs or significantly transition the government out of what we currently have.

    CJD

  • Anonymous

    “we” aren’t willing to fund anything for all citizens, but we the majority of non-smokers are willing to force nicotine addicts to fund some things for children.

    I don’t think that was Christs idea of charity and compassion, but whatever.

  • Anonymous

    “”we” aren’t willing to fund anything for all citizens, but we the majority of non-smokers are willing to force nicotine addicts to fund some things for children.

    I don’t think that was Christs idea of charity and compassion, but whatever.”

    Well, I don’t claim to know the mind of Christ, but the New Testament is very anti wealth and pro-caring for the poor. Modern Christians often find it convenient to ignore these facts, especially rich televangelists.

  • Anonymous

    But he is not recorded to have said anything about stealing other peoples wealth or careing for the the poor with confiscated property. He spoke of freely giving—which is an entirely different matter than the big government compassion of liberals–which is well illustrated by the current bid to expand SCHIP on the back of smokers.

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