Brian Beutler doesn't understand why I find flipping back and forth between arguments so annoying:
See, I don't find this tendency annoying at all. In fact, one of the things I like best about being in an argument is when I can win that argument on a handful of different grounds. For instance, I can make both efficiency and morality claims about torture, the death penalty, profiling, health care, and the Brian-deserves-more-free-money initiative now making its way through Congress, and my argument is all the firmer for it. And I should add that keeping in mind both efficiency and morality is an obviously excellent way of picking a health care system, or for that matter any other system that depends on both efficiency and morality to be effective.What actually is annoying is the tendency of one's opponents in a multi-flanked argument to complain that the war is being fought on too many fronts instead of either hitting back strongly, or, more preferably, ceding the point altogether.
The problem is not that the arguments are multi-flanked; it is that the multi-flanked argument becomes a way of avoiding conceding any particular point. Just as you have pinned down the crux of some particular efficiency argument, your opponent says "Well that doesn't really matter, because what I'm worried about is the morality of it." Then, when you look like you might be winning a point about morality, your opponent suddenly says, "Well, that doesn't really matter, because my system is more efficient!" Aggregate claims have to consist of propositions that are individually true, but this sort of argumentative style prevents us from ever determining whether they are, or not.
Obviously, if you're trying to defend a predetermined position, this is a feature, not a bug. And it's certainly a bipartisan vice. But it makes the debate pointless, especially since I can play, too! The result is that we go around in circles, reassuring our echo chambers of like minded supporters without ever having any sort of productive discussion.
Multi-flanked arguments are fine. In the case of health care, they're even necessary; health care, after all, is only a means, so you have to know what ends you mean to establish. But to make a sound aggregate argument, you need to examine each of the pieces separately before you aggregate them, particularly if not all of the pieces have buy in from the other side.
At this point, I'm simply trying to nail down some small priors before proceeding. Those priors are:
1) People don't have a right to money from society simply because they have gotten sick; to the extent that they have a right to health care, it is that they have a right not to die or suffer from lack of funds.
2) The distributive justice claims for single payer are, on the advocates side, stronger than the efficiency claims. They would prefer a single payer system that is less efficient than the current American system, to efficiency improvements in the current system that did not cover the 45 million uninsured people. I know (I KNOW!) you think that single payer is both more efficient and more just. I'm simply trying to establish a rank ordering of priorities.
These are the first building blocks of an argument about single payer. I don't actually think they're really controversial, if you stop thinking eight moves ahead. Does anyone prefer their efficiency claims to their distributive justice claims? Do you think that we should give Warren Buffett money for health care, not as a side effect of arranging the most efficient transfer of resources to the needy or otherwise deserving, but as a moral end in itself? Is anyone prepared to argue that Warren Buffett deserves a special bonus from society--tens of thousands of dollars worth of health care--just because he's old?
I don't think anyone does believe these things; or certainly not many people. People are treating fairly straightforward propositions as if they were trick questions. They're not. I'm just trying to frame the argument in a pretty neutral way.
People are also acting as if I believe that, by nailing down these first points, I have made some sort of comprehensive argument against single payer. Obviously not. Such an argument is far larger than a blog post could manage (which is why I'm doing it in baby steps). Thus, many of them respond "But single payer is awesome!", when I haven't gotten anywhere near a discussion of its relative awesomeness to other possible systems. At this point, I'm just trying to lay out the criteria by which we might one day evaluate its awesomeness.
Do you think that we should give Warren Buffett money for health care,
That kind of childish non sequitur is precisely the reason you are fighting a war on many fronts. I don't see how an intellectually serious or honest person can think that "If everyone has access to public financed health care, than rich people would have access to it!" is anything resembling a significant argument against universal health care. (Oh, I'm sorry, single payer. We get it.)
I keep reading from your supporters that you aren't stupid, so when I read something like that, I have to think that you are deliberately obtuse in order to avoid creating a coherent, honest argument.
But, single payer is awesome!
Oh, sorry, Freddie, you were saying?
People don't have a right to money from society simply because they have gotten sick.
I disagree. Now what?
(Of course, the sick people aren't getting paid; their health care providers are.)
(Also, the class of people who get more back than they put in are only: the chronically ill, the poor and unemployed, and the young who incur large bills before dying prematurely. Everyone else, pretty much by definition of how an insurance pool works, will pay in more than they get back.)
Your second prior -- The distributive justice claims for single payer are, on the advocates side, stronger than the efficiency claims is pretty insulting also. Whenever a pundit asserts that her opposition thinks a particular way about an issue, she's grossly oversimplifying.
How do you know how I weigh the importance of efficiency vs. morality? You don't.
Francis, in regards to your first comment, what if the moral question was rephrased in reverse? That is:
Is it immoral to means test recipients of a single-payer health care plan?
"I'm just trying to frame the argument in a pretty neutral way."
If a significant number of people are disagreeing with your priors, then wouldn't that be a sign that you are in fact _not_ framing the argument in a neutral way? At least potentially?
As for Henry's reversal of the first prior, it highlights an ambiguity in the prior that should be addressed.
Saying that "People have a right to money simply because they are sick." does not necessarily imply anything about the _amount_ of money one believes they have a right to.
So I could believe that people have a right to money simply because they are sick, but also believe that that right can be modulated with means testing.
What is a "single-payer" health plan? Does Megan know? If she does, why doesn't she define it? Is it simply a symbol for evil?
The world wonders.
So I could believe that people have a right to money simply because they are sick, but also believe that that right can be modulated with means testing.
Of course we already have a means-tested health care provision, Medicaid. But I keep reading commenters claim thats not enough. We need to (at least) mandate insurance for every man woman and child in America, regardless of their socio-economic status. I mean, isn't that the French plan? Isn't that the Mass. plan?
The fact is that the term single-payer health care implies that every person in America would have the government as their provider or insurer, regardless of their means. And that's a wealth transfer, no matter how you slice it. And that's where the morality get sticky, at least for those of us who don't support slavery.
"2) The distributive justice claims for single payer are, on the advocates side, stronger than the efficiency claims. They would prefer a single payer system that is less efficient than the current American system, to efficiency improvements in the current system that did not cover the 45 million uninsured people. I know (I KNOW!) you think that single payer is both more efficient and more just. I'm simply trying to establish a rank ordering of priorities."
I suppose there is a good chance that I don't know the people on my side of this argument as well as I think I do, but I believe you are completely wrong about this.
The attraction of single payer is that it keeps costs down. I would call this efficiency, though I suppose there is room to quibble. It is precisely because the current system is so grossly inefficient that prices have skyrocketted and people can't afford health insurance.
It is immaterial how moral or how socially just single-payer would be if it becomes economically infeasible.
There is too much mobility in health insurance for real long term cost savings to pay off. I had USHealth 7 years ago, and have Kaiser now. If USHealth invested in long-term savings in my health care, they were chumps. It is smarter for them to cut short term costs and ignore the long term. It is actually beneficial to any one insurance company for costs to increase for all health insurance providers. The higher medical costs are, the more insurance becomes necessary.
A single payer system has real incentive to make an investment in the long-term health of an individual. They will be paying the bills for that individual for life.
This is getting a bit boring, Megan. I say this as a real fan of your blogs.
I think you've convinced everyone who you'll be able to convince on this preliminary point. (I'm convinced; as you've noted, most objections seem to be obviously missing the point, sometimes deliberately.) Reiteration is not going to help.
You're interesting because your posts are so often unique. These aren't anymore. Let's move on.
Sometimes in policy debate, the negative team attacks with solvency and harms and disadvantages. Time permitting, they might even throw a counter-plan in there. The horror!
Freddie, are *you* being deliberately obtuse? The post does not present that it's wrong to pay for Warren Buffet's healthcare (which could be used to argue against single payer). We're not talking about whether the benefits of universal healthcare justify paying for Warren's heathcare. She's proposing that very few people, if any, think that paying for Warren's healthcare justifies single payer. This seems obvious if you'll resist flipping the claim.
Francis, it's understandable to be leery of letting your (perceived) opponent set the terms of the debate. But it's the only way to actually learn and advance the discussion. I, for one, would be happy to let you set the terms as long as you do so as specifically and clearly as Megan has done. Forget winning (this blog discussion isn't going to influence policy) and add something constructive.
jme, if you believe in means testing, then you largely agree with Megan's post. You may not agree with what comes next, but that's the point of having the discussion in steps.
I think it's a good idea to break an argument down into components - Beutler's quote is a baldfaced admission that he's out to win an argument rather than to have consistent and defensible opinions.
This Overcoming Bias topic is pretty convincing. If you're trying to convince someone, as opposed to trying to get them confused so they shut up, your arguments should be modular.
JME, but they're *not* disagreeing with my priors. People keep responding to some argument I haven't made as if under the impression that they are
addressing what I have said, which indicates that we are not disagreeing; we are misunderstanding each other.
Your point, for example. If you think that people have a right to payments simply because they are sick, and then talk about means testing those payments, then I think you are saying that people *don't* really have a right to payments if they are sick; they have a *right* to a basic standard of living that includes medical treatment.
The former is a nearly complete argument for single payer. But few people really seem to believe that we should transfer money to people who are sick, regardless of their other characterisics (such as need) simply because their age and/or sickness of itself gives them a legitimate more claim on others. In other words, many people believe that a means-tested healthcare system would be a bad idea, but few people would argue that it would be immoral to bounce Warren Buffett from the system.
The latter may well be an argument for single payer, but in order to be one, it has to be associated with other empirical and rights claims about single payer systems. By itself, it only indicates that we should, somehow, help the needy acquire medical care.
I actually don't think that these are really contestable propositions for most people. I think rather there is an assumption that I am somehow arguing in bad faith, and people are therefore refusing to concede even trivial points on the assumption that if they do, this will in some unforeseeable way count against them in future rounds.
And that's where the morality get sticky, at least for those of us who don't support slavery.
**shudders**
Christina said:
"The fact is that the term single-payer health care implies that every person in America would have the government as their provider or insurer, regardless of their means. And that's a wealth transfer, no matter how you slice it. And that's where the morality get sticky, at least for those of us who don't support slavery."
Well, sure. I was just trying to clarify the idea of sick people being entitled to money for health care. Specifically that we should be clear about what we mean when we say that.
1) People don't have a right to money from society simply because they have gotten sick; to the extent that they have a right to health care, it is that they have a right not to die or suffer from lack of funds.
First, I don't think this is sufficient. I think, for example, that kids in a sufficiently wealthy society have a right to straight teeth and 20/20 vision with glasses (or as close as they can get to it). People have a right to the kinds of preventive care that will allow them to participate fully in society, not be excluded from it. Maybe this is subsumed under your understanding of "suffer", but I'd want to make sure it is.
You still face the burden of explaining what you mean by "money from society". In a single-payer health insurance system, the money isn't coming from "society"; it's coming from the insurer. Wealthy people pay more money into the insurance fund, since it's based on progressive taxation. Everyone, poor or wealthy, faces on average roughly the same health care costs, which means the overall transfer is from wealthy people to poor people. So it's not clear to me what you mean when you talk about a right to "money from society". You can't establish first principles unless the principles you select match the real world in some way.
They would prefer a single payer system that is less efficient than the current American system, to efficiency improvements in the current system that did not cover the 45 million uninsured people. I know (I KNOW!) you think that single payer is both more efficient and more just. I'm simply trying to establish a rank ordering of priorities.
Why? I find it a weird question, I've never thought about it, and I don't think the answer I come up with would necessarily mean anything. I'm not even sure whether you should call me an "advocate of single-payer"; I think the very term "single-payer" needs to be disaggregated if it includes both the French system, with its large private component funneled through a single payment mechanism with the public component; the Canadian system; and the British NHS. I'm not entirely convinced which of these models is best, or whether they're better than the German/Scandinavian Bismarck system, which is really not single-payer but is universal.
Why do you want to make us think about this weird priority-ordering question? I mean, consider the movie "Gigli". Was it more important that the movie have less execrable acting, or a less idiotic plot? Or, a la David Brooks's column earlier this year: is it better that the US have a president who is dumb but honest, or smart but dishonest? Can you see why, if you believe that the current president is dumb and dishonest, such a question of priority-ordering seems like a deliberate sleight of hand?
1) People don't have a right to money from society simply because they have gotten sick;
This way of talking about the issue only makes sense if you’re evaluating a one-time transfer of wealth. In the context of a social contract, it’s just nonsensical.
to the extent that they have a right to health care, it is that they have a right not to die or suffer from lack of funds.
Really? Because this is a pretty radical form of egalitarianism… if it’s immoral for anyone to suffer in any way due to lack of funds, then any sort of health care rationing would be immoral by definition. Moreover, the health care system would have to provide absolutely equal health care to everybody, regardless of wealth. The only way to guarantee this level of equality would be to outlaw the private provision of health care all together. Even a lot of liberals wouldn’t go this far!
2) The distributive justice claims for single payer are, on the advocates side, stronger than the efficiency claims. They would prefer a single payer system that is less efficient than the current American system
Again, this is the wrong way to talk about it. Even if such a tradeoff were to exist, it would make no sense to assess the merit of making that tradeoff without first understanding the magnitude of the tradeoff. It would be like talking about whether a particular car was worth buying, without having any idea what the car cost.
Megan said:
"If you think that people have a right to payments simply because they are sick, and then talk about means testing those payments, then I think you are saying that people *don't* really have a right to payments if they are sick; they have a *right* to a basic standard of living that includes medical treatment."
Huh. I agree that when most people talk about 'a right to money for health care', what they really *mean* is 'a right to a basic standard of living that includes health care', and that the money is simply a means to an end.
But it makes no sense to me to believe that people are entitled to health care but *not* entitled to the money to pay for it. Wouldn't that be self defeating? So I don't see how you could attribute that belief to me, unless you think I'm inherently self-contradictory, in which case you probably shouldn't even be talking to me, I guess.
"But few people really seem to believe that we should transfer money to people who are sick, regardless of their other characterisics (such as need) simply because their age and/or sickness of itself gives them a legitimate more claim on others. In other words, many people believe that a means-tested healthcare system would be a bad idea, but few people would argue that it would be immoral to bounce Warren Buffett from the system."
I've read this like 5 times and I can't make heads or tails of it. I honestly have no idea what you're saying here, so I'm not sure how to respond.
So instead of responding to this stuff I don't understand, I'll make these quick comments:
1.) I'm not really interested in how many people on each side believes/uses a particular fact/argument. I'm interested in what *you* think, Megan (and also what Ezra thinks)!
2.) I think that if someone says, "I don't agree with your prior," you should probably take them at their word, at least initially. It's possible they just don't understand your point, but in that case the fault may be equally split between the reader and writer. Obviously, this isn't true for everyone, but *I* really am (honest!) trying to understand your argument.
3.) I guess our disagreement on prior (1) revolves around the fact that I believe that people are entitled to a basic level of health care and I believe that this *implies* an entitlement to the money necessary to pay for it. Is it that you don't think that one implies the other?
4.) I disagree with prior (2), but on technical grounds. Saying "The distributive justice claims for single payer are, on the advocates side, stronger than the efficiency claims," is essentially a judgement on arguments you presumably have already considered. So that's not really a *prior*. That's a conclusion that you've reached, and that others might disagree with.
5.) Finally, I think it's cool that you're using Bayesian terminology here. I'm looking forward to your discussion of how to formulate the likelihood function and lots of pretty graphs of Gibbs sampler chains! ;)
And that's a wealth transfer, no matter how you slice it. And that's where the morality get sticky, at least for those of us who don't support slavery.
If you really believe that, then what are you doing wasting time posting here when you could be plotting the overthrow of an immoral, slaveholder government which permits the transfer of wealth from moral persons like yourself to undeserving parasites?
Go forth and revolt, Christina! Tarry no longer! There--a police officer waits for you. He's an oppressive agent of the slaveholder state. Charge him! Don't stop even if he takes out his gun and threatens to fire. Remember, your cause is righteous!
Ooops, you're dead. Ha ha ha.
Megan,
Perhaps if you did a post about the relative merits (or the lack) of socialized medicine, and compared socialized medicine with single payer you might eliminate some of the spurious arguments.
Socialized medicine would likely not have the regressive transfer payments to which you object. Since it would be paid for by taxes, rather than premiums, it would be every bit as moral as our tax system.
I eagerly anticipate such a post.
Hi Megan,
You write:
"People don't have a right to money from society simply because they have gotten sick; to the extent that they have a right to health care, it is that they have a right not to die or suffer from lack of funds."
I think perhaps you misconstrue moral arguments for single payer schemes by focusing too narrowly on what rights the sick may have or lack, and what claims or entitlements they may have. There's much more to morality than just rights and entitlements. I suspect that when people try stop the efficiency debate by saying, "but think about all of the sick people!" they very well may have in mind a view which I believe you share: that society has an interest in helping its sick and dying, and that this interest is among the most morally important interests that it does have, up there with securing its members against the predations of the wicked. Further, securing this interest does indeed justify some trade-offs for efficiency. In that sense, just showing that the status quo is slightly more efficient than a single payer alternative cuts no ice against the moral argument in question. So: I think your priors are more or less true, but the first is beside the moral point.
I also detect in the background a moral argument against wealth transfers to secure the relevant interest. The idea seems to be: if the sick have no right to wealth transfer from the well for healthcare, then it is unjust for society to effect the transfer. This claim seems implausible, unless it could be shown that the wealth of the well has a just pedigree. If my grandmother stole someone's watch and bequeathed it to me, then it does not seem to me unjust for the state to tax the watch to secure society's interests even if no one else presently alive has a right to those taxes. As a matter of fact, there is simply no reason to think that actual present accumulations of wealth have a just pedigree.
- Louis
McCardle's argument is disingenuous. Positioning the argument as a matter of inherent "rights" is silly. It's a matter of what kind of society we choose to create, and what kind of rights we agree to support with out money.
We all support the right of free speech, but we don't agree to pay for one another's speech. We do support socieity's obligation to pay for universal education. You could of course argue that people don't have a right to other people's money simply because they are ignorant, but this is utterly besides the point. As a society, we have agreed that ignorance is bad for society, and so we have agreed to provide money for universal education through high school, and huge subsidies even beyond that. No one disputes any more than kids have a right to an education, not because they are "entitled" by their own ignorance to an education, but because we have agreed to grant that universal right for the sake of society as a whole.
And granting the right of universal education has, indeed, benefitted not merely poor kids and families, but all of society. Likewise, we can grant the right of universal health care for the same reason: not merely because it benefits the poor, but because it benefits all of society. Many societies have reached this conclusion, and often to the betterment of those societies. That we have not has nothing to do with some abstract notion of whether being sick gives you the right to other people's money, but whether giving the unviersal right to health care betters society as a whole, in the same way that giving universal rights to education benefits society. Putting the burden of proof on sick people to explain why they deserve your money is no different than putting the burdern of proof on poor families as to why they deserve your money for basic schooling.
In other words, it's a way of abstracting the argument for the purpose of ridiculing the notion that anyone is deserving of any benefits from others. Looked at on an individual basis, it will always seem absurd. Looked at on a collective basis, however, it makes great good sense.
Immoralist: There is a simple reason I don't take to the streets as you suggest. I think it is far better to wage a battle of words in civil society and advocate change via persuasion than to take up arms against the government like Tim McVeigh and his ilk.
My (hyperbolically stated) point is simply that to force people to give up the fruit of their labor for the benefit of others, is wrong, the same way forcing imprisoned young women to have sex with strangers is wrong. I don't care if the benefit is to corporations, horny men, or people who fail to plan. I think it's morally wrong.
My (hyperbolically stated) point is simply that to force people to give up the fruit of their labor for the benefit of others, is wrong, the same way forcing imprisoned young women to have sex with strangers is wrong.
The easy rebuttal is that you, personally, also benefit from having a portion of your wealth taxed to pay for the healthcare of others, because the likelihood of you getting sick because of someone else not having adequate care decreases in a system where all receive good care. But I don't want to go the easy route with you. I want to attack, Ayn Rand-style, your entire premise:
You, me, each and every one of us, benefit tremendously from the forced transfer of others' wealth, and to say with wet blanket that it's "wrong" to give up any portion of such for the benefit of all is to posit a government funded only by tariffs or total anarchy as the only morally defensible state of affairs. Consider:
Do you think it's morally wrong that you are taxed to pay the salaries of law enforcement who protect others besides yourself?
Do you think it's morally wrong that you are taxed to pay for the public education of others besides yourself?
Do you think it's morally wrong that you are taxed to pay for water treatment facilities that ensure safe drinking water for others besides yourself?
If your answer to any of these questions is "no," why not? You might answer that since you also derive the benefits of that taxation, it's okay. But not all that you put into the system is paid back exclusively to provide for your benefit; much of it goes for the benefit of others. And if your only justification for paying into the system is to help yourself, well, there are probably other, more efficient and cheaper means besides taxation of getting the services you want.
You could pay mercenaries to protect your person, or you could train yourself in self-defense.
You could educate yourself, or pay someone else to educate you.
You could treat your own water, or pay someone else to do it for you.
There. All the services you need, and no taxation. "I've got mine, Jack, so screw you."
But the only way this state of affairs can exist is in a system in which there is no taxation or any other means of the government taking money from one person and giving it to another.
If you can find such a government in today's world, please move there posthaste.
Whatever. This whole conversation is a ridiculous waste of time.
Still making abstract moral claims about completely undefined things called "single payer" that are meant to address a problem you haven't identified? Wasting time.
Why don't you look at some numbers, lay out what you take to be the problem, lay out some alternative solutions and discuss them honestly? You are an econoblogger, or whatever, right? Why don't you do some of that for a change: work, like with numbers and showing how they might relate to one another?
Why are you even talking about health care - is the problem that people are not getting care, or that they are paying too much, or that they don't have insurance, or that the system as a whole is dysfunctional, or something else? Are you talking about how to provide health care to everyone, to some people, to no one, or are you not talking about providing health care at all? Seriously, what are you doing?
I have no real idea what you're talking about, and you certainly haven't made it clear, but I am already sure you're opposed, and I am sure that you're going to call "moral" whatever reasons you eventually cite for holding your opinion. Ok, so you've made the preliminary moves clear - oppose something by asserting moral superiority. Neat. And?
Are you paid for this?
I'm with cs on this. You start out after stating the two pressing concerns with undefined single payer: efficiency and morality of transfer payments. As you say: 'These are the first building blocks of an argument about single payer. I don't actually think they're really controversial,'.
The transfer payer argument is highly controversial, as the discussion shows. I agree with those who say you do not understand the nature of insurance. Pooling of risk does not involve transfer payments. Period. Transfer payments play no role in this discussion. It is a frivolous argument.
Moving beyond defining 'single payer', I would appreciate a working definition of 'health' and 'disease'. Are these just things found in nature? Or does human intelligience play some role here? What are they how do they relate to 'health care'? Which also needs a definition. I also think it would be useful to use standard medical concepts, rather than literary ones. Medicine uses all sorts of ideas to describe disease. Mangeable condition is one. So is infectious. Etiology is the really important one here: it describes how diseases develope.
And having a clear understanding of where diseases come from, how they get here and what they do over a period of time might lead us to a point where we could look at options. Until this is established, we are stumbling around in the dark.
I support Universal Access from a Libertarian self defense and rational self interest point of view. And I got caught up in the whole field when AIDS came along. There is a whole world of information out there on the subject of disease. People who inform themselves of this could refrain from making dumb remarks.
Perhaps a post on why you see a vague 'single payer' as resulting in 'transfer payment' would help. It would also be really useful if you could explain what 'health care' consists of. And what you do not include there.
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