Several people have said that single payer must be moral, because it works just like other insurance: some people get more out of the pool because they have to tap it, while others get less.
Uh . . . do you really not understand the difference between voluntary and forced transactions? You are perfectly entitled to pool your risk with that of others at any price you care to pay . . . or not, just as you please. This action has no moral content, although I concede that The Church of the Suburban Methodist may have made purchasing adequate insurance one of its tenets.
Millions of people subscribe to US Magazine . . . and for that matter, the Methodist church. Would it be morally okay to force everyone to adopt some belief about the existance of God, or Salma Hayek, because millions of Americans have found it very satisfying to do so?
Update What about mandatory auto insurance? This is completely different. We don't force people to buy auto insurance in order to forcibly pool the risks of bad drivers and goods, thereby transferring money from the good drivers to the bad ones. We force people to buy auto insurance to protect others; drivers have a high potential to cause damage they can't pay for. It's a social arrangement to minimize externalities.
Moreover, we don't force everyone to buy insurance whether they have cars or not. We don't even force car owners to buy insurance. We just force people to buy insurance if they drive on public roads, in order to protect their fellow citizens from the possible negative consequences.
What about the mandatory auto insurance I mentioned on your last thread? A fellow commenter seemed to find that comparison unconvincing on the grounds that some people can choose to not have a car, as well as the fact that you can shop around for lower rates. But not everyone has the luxury of choosing to forgo driving, and the fact that you have a choice of insurance agency doesn't really change the fact that you still are required to have a minimal level of coverage.
Excuse me for being blunt, but yeah we do undertstand the difference and that is why we aren't libertarians. We understand that a whole lot of things happen that the person has no repsonsibility for and we our better off if we share the burden of them. Somethign like insurance only works because it is mandatory. If you Libertarians want to live in some free for all Deadwood style utopia, good riddance, go set one up somewhere, the vast majority of society has rejected that philosophy.
More economics.
Perhaps the biggest difference between auto insurance and health insurance is that with mandatory auto insurance, the mandatory part is liability only. This has nothing to do with covering your own property or person.
Collision, comprehensive, uninsured/underinsured, towing, etc. are all completely optional.
I don't think there is any health counterpart to auto liability insurance, other than the medical malpractice insurance which we all pay for indirectly.
Ah, okay. Yes, if we take Nozickian theories of morals as a given, universal health care is bad. You are right, we are wrong. Unless, of course, we *don't* take Nozickian theories of morals as a given.
What cdeegan said.
Auto insurance to insure your own losses are completely voluntary (unless you havn't paid off your car yet, but that's a private contractual matter between you and the lender).
Evidently we'll have to start making fire and police protection a "pay as you go" system in order to make it morally defensible.
This assumption that police and fire departments must automatically help citizens is simply wrong. Not as wrong as universal health coverage would be, because insurance companies are lobbying against that, but still wrong.
So from now on if you're being blackmailed or stalked or robbed, be prepared to pay the cops before they'll help you. If you can't afford it, tough.
This is the only morality that matters. F**k you, jack, I've got mine. Anything else is just LIBERAL, LIBERAL, LIBERAL! And they've been discredited. Just ask Rush Limbaugh or Dick Cheney, who have PhD's in Morality.
Uh . . . do you really not understand the difference between voluntary and forced transactions?
yes, we do. many of us aren't stupid; we just disagree. And we'd appreciate you substantially reducing the amount of condescension in your posts.
Most people believe that government-sponsored safety nets have both a moral and an efficiency component. And most every government-sponsored safety net is going to include inter-generational transfers, when measured at any point in time.
Now, you can believe that government programs are amoral, because governments by definition are not moral agents. But I don't think a lot of people agree. While us liberals may prefer the application of government programs to be based more on science and less on faith, even PZ Myers would likely admit that the original decision whether or not to extend a particular safety net is based both on the morals of the particular legislator as well as concerns about efficiency.
So, people like Ezra are making a moral claim that the current system of providing health care coverage in this country is immoral, and the way to make the system more moral is to spend tax dollars and impose regulations.
Yes, these are forced transactions. That's the whole point. Only by force of government can the delivery of health care get closer to the desired moral standard.
Claiming that achieving this moral goal will require an immoral generational transfer of wealth is really truly missing the point.
Ummm, yes, because there are absolutely no deleterious societal outcomes when someone with a preventable disease but no health insurance becomes very sick, and ends up in the E.R., running up hundreds of thousands of dollars in bills which have no chance of ever getting paid.
Other than, you know, increased costs for everyone, as money is spent in a spectacularly inefficient manner.
Megan, be careful when you write:
...drivers have a high potential to cause damage they can't pay for.
Because, you know, someone devious might point out that sick people who lack health insurance have a high potential to rack up health costs they can't pay for.
Finally, agreeing with Francis: it would be nice for you to tone down the condescension in your posts, especially when you're, you know, wrong.
Yes, forcing someone to follow a certain religion would be immoral. But there’s nothing inherently immoral about taxation or wealth redistribution.
It seems like you’re switching arguments here. First you were arguing that single payer is unjust because it transfers wealth from the more deserving to the less deserving. Now you seem to be arguing that single payer is immoral simply because it’s mediated by the government, and therefore ‘forced’.
On the first argument: the distributional effects exist in both public and private insurance, and are simply a consequence of how the system is financed and how risk is pooled. If you financed health insurance through taxes on smokers, drinkers, and millionaires, that would have a certain distributional effect. If you financed it through a regressive payroll tax, that would have another. You could design a single payer system to redistribute wealth in almost any direction you liked, as long as it raised enough money. Therefore, at least in principle, a well designed single payer system is likely to be superior to privatized healthcare in terms of distributional fairness.
The second argument seems to rest on a pretty common libertarian fallacy, which is the automatic presumption that private sector transactions are inherently more moral that government actions, because private transactions are ‘voluntary’.
In a certain narrow sense it is true that private sector transactions are ‘voluntary’ and government transactions are ‘forced’, but this doesn’t really correspond at all with our normal intuitions of what ‘voluntary’ and ‘forced’ mean. You could say that I chose my current employer provided health care ‘voluntarily’, but only within a very limited range of choices. I could go without insurance (which would be pretty risky), buy individual insurance (which would likely be more expensive and less secure, since my employer has more bargaining power), take the employer coverage, or look for another job. Moreover, everyone in my risk pool exerts an externality on me, as I do on them. When you combine all of this with the fact that my health care isn’t guranteed, it’s not at all clear to me that I currently have more freedom then I would under single payer.
We don't pool car insurance risk.
If you are a high-risk customer (young, male, with a bad credit history) you will pay more.
The equivalent would be if people carried no insurance and the state were automatically insuring every driver for liability out of general taxes.
Two excellent points! Just as non-drivers are not forced to purchase auto insurance, it would be highly unfair to compel the purchase of health insurance for people who choose not to get sick. And it's true that auto insurance is hardly compulsory: any driver who does not want to purchase auto insurance can choose to forgo public roads and drive their cars along the vast network of privately owned and operated roads.
RC-
I'm not sure I understand your last point. On the one hand, you write, you can (1) chose your current employer provided health care which contains a range of choices, (2) go without insurance, (3) buy individual insurance or (4) look for another job. On the other hand, the government can eliminate all of those choices
and impose a single one on you (and everyone else, for that matter).
How come its not at all clear to you that you currently have more freedom (4 choices) then I would under single payer (no choices)?
(I'm not trying to be a jerk, and appreciated the thoughtfulness of your comment, but the last sentence seemed to strike an off-note. If you had said, "Gov't has a good reason to curb freedoms here" or some such argument I could follow the logic, but to suggest single payer might be an expansion of freedom....)
Attacking bad arguments is about as meaningful as beating up cripples. woo hoo. congratulations. your mom must be so proud.
Megan, now try attacking some of the good arguments.
for example, here's a bad argument: Megan, you're grouping people by classes. What are you, some kind of Marxist? Hey everyone, Megan's a commie! Commies suck! Therefore Megan sucks! Therefore all her arguments suck! Therefore we should have single payer health care in the US!
here's a better one: Megan, health care is not delivered on a class basis but on an individual basis. While measuring what classes of citizens use the most health care may be relevant for setting tax levels, it is utterly irrelevant to the moral point as to whether or not the government should be paying for any particular individual's care.
See the difference? Now you try.
ps: I bet you find the condescension in this comment really annoying. Now re-read your prior posts.
Two excellent points! Just as non-drivers are not forced to purchase auto insurance, it would be highly unfair to compel the purchase of health insurance for people who choose not to get sick. And it's true that auto insurance is hardly compulsory: any driver who does not want to purchase auto insurance can choose to forgo public roads and drive their cars along the vast network of privately owned and operated roads.
Perfect! I was trying to craft a properly snarky response to that earlier but I'm glad I decided against it since you summed it up better than I would have.
In one of the earlier threads, someone commented that there aren't really a large group of wealthy elderly. Having lived near retirement communities, I beg to differ. I worked for slightly over minimum wage in college doing care for the truly sick elderly. I would drive past their golf courses, and it used to gall me that I couldn't afford to move out of my parents house, because my payroll taxes were taking such huge chunk out of my income. And what was some of it buying? Honestly? More golf-course time for these people. A third of all tax dollars (federal, state, and local) go to the elderly. As far as I am concerned, THAT is immoral. To the extent they can, all people should be paying their own way. Only the truly needy should be getting assistance.
I do beg to differ with the point about auto insurance. It is true that auto insurance protects others from the driver. It is also true that health insurance can function this way. People who do not have access to care, and acquire an infectuous disease (HIV, TB, syphillus, etc), are much more likely to spread it to others because it goes undiagnosed and untreated for a longer period of time. As antibiotics continue to lose their effectiveness, we are likely to see a stronger public health argument for universal care.
Beziers:
My employer gives a choice of two pretty similar health plans, both from the same company. And the other options I have are pretty clearly inferior. So it's not really much of a meaningful choice. And if I lose my coverage, than I'm left with no choices at all.
What if the single player plan provided every citizen with a voucher with which every citizen could buy privately administered insurance? In this case I would surely have more choices than I have now.
My point is there's nothing inherently less free about single payer, unless one considers the right to go without health insurance some sort of holy freedom which it would be immoral to restrict.
Actually, there's a reason that auto insurance shouldn't be used as a parallel to health insurance. It comes from the Giuliani/Romney comparisons, where they point out that auto insurance doesn't pay for oil changes, gas, etc.
Auto insurance insures a commodity which not only has a finite and defined market value but which can, if it's not functional enough, be replaced in whole. Health insurance doesn't. Auto insurance works in the libertarian-loved marketplace because you can make decisions about your car as a replaceable commodity. Your life is irrepleaceable, and cannot be exchanged out for a different one should your heart stop beating or brain stop working.
They insure two entirely different things - they simply don't exist in the same realm.
"Uh . . . do you really not understand the difference between voluntary and forced transactions?"
Wow. You really need to reexamine your attitude - writing almost unbearably pretentious posts is one thing, directing that completely unfounded self-regard toward your commenters is another.
h . . . do you really not understand the difference between voluntary and forced transactions? You are perfectly entitled to pool your risk with that of others at any price you care to pay . . . or not, just as you please.
Actually I do. My partner is a bankruptcy trustee. We see hundreds of cases a year where people bankrupt on their medical debt. People don't die in the streets, they get care, and then they don't pay, and the rest of us pay. We pay with taxes, we pay with increased rates charged by hospitals and doctors to compensate for care for the poor, we pay with decreased quality of care because of losses from charity care, we pay because we have to donate to charity to cover their care. And so on. Except for charity, none of this is voluntary.
Single payer rationalizes this involuntary situation.
Although touched on, I still haven't seen an answer to why universal health care is NOT part of our infrastructure. Getting into this debate about insurance or “forced transactions” obscure the true issue.
The better our infrastructure is, the better our society is. Good highways quicken the delivery of goods, reduce the cost of transporting and vehicle maintenance, and saves lives. Safe and abundant water supplies help prevent the spread of disease, allows us to live in deserts, and helps extinguish fires. Policing helps keeps us safe from predators, catches those who would harm us, and organize search and rescue for the lost and hurt. Regulations ensure only useful, safe drugs are used to treat us. Food inspections keep tainted products off of store shelves (sometimes).
Everyone except for Libertarians recognize the importance of a good infrastructure for the health of our society. That society is no less dependent upon the health of its citizens. All citizens, not just the ones who can say “I got mine Jack, screw you” deserve the benefits of being a member of society. And that should include not just using the highways, access to safe water, police protection, useful drugs and safe food, but our physical health too.
Lets look at th the other side of socialized "single payer" medicine; in 2006 Britain's Department of Health reported that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year.
In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year.
Canada is not immune to the issues either - in a March 2006 interview with Dr Brian Day, President of the Canadian Medical Association, he states "the Supreme Court stated that Canadians are suffering and dying on wait lists and that governments across the country have shown inertia in dealing with the plight of patients...... ....and they struck down the segments of the Quebec health law that outlawed private insurance for medically necessary services" so even Canada is looking toward private insurance as a solution to their issues.
There is a real problem with the uninsured in America, and as a Health Insurance Broker, I talk to my clients about how they as employers, myself as a broker and the health insurance carriers have a responsibility to get these people insured through innovative group and individual products.
We have a large pool of healthy Americans who are not insured, we need them to step up and become part of the solution.
In addition, we Americans need to take responsibility for our own health. A significant portion of medical claims are directly related to the American lifestyle (we as Americans have the resources to become fat and lazy). I feel that through employer sponsored wellness, consumerism and disease management programs we can continue down the road of a "healthy America". Result: a reduction of the large claims that have our healthcare spending spiraling out of control.
On the one hand, you write, you can (1) chose your current employer provided health care which contains a range of choices, (2) go without insurance, (3) buy individual insurance or (4) look for another job. On the other hand, the government can eliminate all of those choices
and impose a single one on you (and everyone else, for that matter). How come its not at all clear to you that you currently have more freedom (4 choices) then I would under single payer (no choices)?
Beziers: one way of looking at this is to point out that "more choice" does not equal "more freedom". One freedom Americans do not have is the freedom not to have to worry about their health insurance -- not to have to worry that procedures will not be covered, not to worry that they'll be bankrupted by unforeseen health-care emergencies that turn out to exceed the maximum benefits they never realized their plans had, etc. This is not a facetious argument. The sensation of living in societies with universal health care -- and I'm not necessarily talking single-payer here, but universal, as in France or the Netherlands -- is much more worry-free than in the US. That is a very important kind of freedom.
There are a number of analogies in contemporary American culture. For instance, in Europe and Asia, you know that anywhere you travel, you will be able to easily find an inexpensive network with prepay that will work with your current mobile phone. In the US, you end up with weird complicated nightmares of "choice" -- a million calling plans, areas where there may be no network that works with the mobile phone you own, etc. This is the legacy of a highly privatized and deregulated approach to mobile telephony, compared to Europe; and it is not unrelated that mobile phone penetration in Europe is over 90%, while in the US it seems stuck at about 50% of the population. (Analogies to health insurance coverage seem hard to avoid.)
Or you might just take the sensation of walking into a Starbuck's (or alternative US premium coffee joint) versus that of sitting down at a cafe. The premium coffee place generally forces one to engage with a confusing menu of complicated choices whose differences are not immediately apparent. At the regular old cafe, you pretty much order an espresso, a cappucino, a regular coffee or cafe au lait and you're done. There is a kind of unfreedom involved in being forced to engage with that complicated menu. It may have more "choices", but the consumer doesn't have the sense of being more "free". Again, this is very close to the difference in sensation I get in the US versus the Dutch health care system.
Megan sez:'What about mandatory auto insurance? This is completely different. We don't force people to buy auto insurance in order to forcibly pool the risks of bad drivers and goods, thereby transferring money from the good drivers to the bad ones. We force people to buy auto insurance to protect others; drivers have a high potential to cause damage they can't pay for. It's a social arrangement to minimize externalities.'
And having a large number of people without access to health care has no externalities? If it did, could these be corrected by Universal Access?
Example: consuming red meat and diary products over a long period of time is strongly associated with heart problems. Would a levy on these products that is used for direct treatment of heart diseases be Socialized Medicine or the correction of a market externality? If you think it is dreaded Socialized Medicine, how is the example different from that of car insurance?
I agree with Ralph the School Bus Driver. Health care is part of infrastructure.
Beziers: one way of looking at this is to point out that "more choice" does not equal "more freedom".
Ding ding ding.
Libertarians fetishize choice to a ridiculous degree. It's why the idea of catastrophic health insurance is so ideologically appealing - it allows "choice" in the healthcare market that doesn't currently exist under a system of comprehensive health insurance.
The problem is, the "choice" is moronic. All you're doing is adding in a whole rubric of needlessly complex hurdles to obtaining the same care...but it's okay, because they're "choices". If you go to buy a car, there are basic assumptions regarding what comes with it - an engine, wheels, axles, transmission, etc. In the reductio ad absurdum that is the childlike libertarian fascination with "choice", you'd be forced to go through a several-hundred item checklist to "choose" things that had, to this point, been standard items in a car purchase.
It's okay though, because now you have agency. Pointless, frustrating, face-clawing agency.
Shorter Starscream: I'm too stupid to make choices, so nobody else should be allowed to be. It doesn't matter if someone wants an option that only Starbucks has; it's too confusing for me, so we ought to eliminate all those choices and only provide the options that I want.
Hint: Libertarians support catastrophic health insurance not because of "choices" per se, but because it actually makes sense for the way insurance works. Insurance -- like the extended warranties that stores offer -- is a financially stupid thing to spend money on unless one can't afford the expense that the insurance covers. Hence: catastrophic health insurance, yes, routine health insurance no. Just like homeowners' insurance covers the house burning down, but not a leaky toilet or a burnt out light bulb.
David says: Hint: Libertarians support catastrophic health insurance not because of "choices" per se, but because it actually makes sense for the way insurance works.
OK, who does and when and where did they do it? I have never seen this presented by a Libertarian of any stature. But could have missed it.
So, rather than deal with a problem when it is small and manageable, Libertarians only want the national system to pay when things are out of control and horrendously expensive. Rather than spend the $200 for a doctors appointment it is rational to wait until the appendix bursts and septicemia sets in. Let's spend $250,000 to save $200. Brilliant Libertarian logic.
This is our current system. Rather than have access at the start of problems let everyone use the most expensive method possible, the emergency room. Universal access will tend to save money, not increase health care costs.