This is a very important question seeing how universal healthcare is a recurring issue in presidential political campaigns, and has been discussed by the US Congress in increasing frequency over the past decade or so.
Megan McArdle has written a thought-provoking article over her blog at the Atlantic on this very issue. She frames the morality of the argument nicely as coming down to one thing: who is made better off, and who worse off, by the system?
Too often this issue is framed as a matter of efficiency, and not as a question of morality. Is it moral to empower a third party, such as the government, to become a single-payer of health insurance costs in order to forcefully take money (through taxation) from one group of people so that it can be transferred to another group of people? For example, is it right to take from the young and rich to give to the old and sick?
Megan writes: “The 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.”
She then adds:
How do we decide which class is more “deserving”? Our intuitions offer dozens of ways, but I think these are the major metrics:
1. They are needy. The class we propose to benefit has greater need for the money than the class from whom we propose to take.
2. It’s not fair. The class we propose to benefit has been unluckier than the class from whom we propose to take.
3. They are responsible. The class from whom we propose to take has in some way contributed to the problems we are trying to rectify.
I think these 3 questions summarize well the assumptions behind the rhetoric promoting universal healthcare.
Megan asks some honest questions that often get no airtime in the universal healthcare debate – mainly because arguing the merit of ideas is not as emotion-inducing as pleas for sympathy. No one wants people to think they are heartless and cruel, which is what you get accused of when you try to argue that universal healthcare is not a basic human right, and may just be immoral and unjust, since it involves forcible taxation of unwilling citizens, and, as is demonstrable in so many socialistic nations, actually reduces the quality of the healtcare that citizens recieve.So, on to her honest questions…
First, Megan writes: “As a class, are the old and sick needier than the young and healthy? No they are not. They have more assets and less poverty than any other group.”
Second, “As a class, are the old and sick unluckier than the young and healthy? Considering people as beings with duration in both time and space, no they are not. The overwhelming majority of old and sick people were once young and healthy. They got to be young and healthy, and old and sick.
Getting old is not, as many of my interlocutors seemed to believe, unlucky. It is, rather, inevitable–unless you’re really unlucky, unlucky enough to die. The elderly have no fairness claim on the young.”
Third, “As a class, are the young and healthy more responsible for the bad health of the old and sick? Quite the reverse. Many people in the old and sick category did nothing at all to deserve their fate; they just aged or were victims of fate. But some members of the “old and sick” class contributed to their fate. Contra many of my interlocutors, there are a lot of very expensive diseases that have a substantial lifestyle component: high blood pressure, coronary artery disease, diabetes, lung cancer, emphysema/COPD, congestive heart failure . . . many of our nation’s biggest killers, and consumers of health care dollars. So as a class, the old and sick are somewhat responsible for their poor healthcare outcomes, although I will leave it up to the doctors to argue exactly how much responsibility they bear.”
“By none of these three standards, therefore, can I make a compelling case for taking money from one huge group of young healthy people, and handing it over to another huge group of old and sick people. Even if I leave aside things like property rights, coercion, deadweight loss–things I realise my liberal interlocutors aren’t particularly concerned with, but my libertarian inquisitors will be–I don’t see how the massive transfer implicit in single payer is justice-enhancing.
If we are worried that some people cannot afford healthcare, there is a much simpler solution than constructing a giant government-run system; we could just give them the money to buy it.”
Yes, while this solution might have some shortcomings as well, it would at least serve justice more equally, fairly and responsibly to ALL groups of people. Not to mention that it would discourage wastefulness in healthcare spending and encourage the kind of cost reductions that are inherent in a competitive market. Socialized products and services typically reduce quality and increase prices, and thus the tax burden. None of those things is good.
One last thing. She adds:
“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.”
So, while I think that there is a place for making provision for those who are truly in need on an as-needed basis, it doesn’t require the kind of tax burden that the full-scale provisions of universal healthcare would place on taxpayers. Providing universal healthcare over-reaches in its burden, and it promises more that it can genuinely deliver.
It sounds compassinate, but it isn’t. Not to the patient or the taxpayer. There is a better way that doesn’t trample social justice in the name of defending it. We need to be willing to ask the hard, honest questions of who, in the end, is made better off, and who worse off. And it would help if we could keep emotions and a condescending attitude out of the debate.