Humoring Megan
I meant to write this post yesterday, but then... well then I didn't. I do want to humor Megan McArdle just briefly, however, because I think doing so will elucidate a key, widely understood difference between liberals and libertarians.
Megan's basic premise is this: Health care as an issue has an efficiency aspect and a moral aspect. It's legitimate to argue about both aspects individually. I, Megan, am pretty sure--though I don't know why, but it's a strong, gut feeling--that liberal arguments about the greater efficiency of universal health care are wrong. If I'm right--that universal health care would be much more problematic in the United States than it has proven to be anywhere else in the world--then I'll further assume that liberals would still want everybody to be covered because, really, they don't care about that efficiency stuff anyway.
Megan "would like to hear from a large number of single-payer advocates who will say that if the American system could be proven to provide higher quality care per dollar on average than other industrialised system[s], then they would be content to leave 40 million people uninsured." And this is about as a clear window into the mind of a libertarian you'll likely ever see. Let's leave aside for the moment the fact that efficiency arguments about health care also include arguments about broad economic productivity, allocation of medical services, and data management, and pretend that none of those metrics will improve if America goes universal.
What I think she'd actually find if she asked a bunch of liberals about this is pretty obvious. If adopting a universal system meant that health care quality would drop to dangerous levels, or that health care costs would soar to such an extent that they'd imperil the entire American economy, then I imagine a lot of liberals would agree that we might be stuck with a lot of uninsured people. But that, of course, would be because such poor efficiency would create new moral imperatives (millions more in poverty, say, or a bunch of people dying as a result of poor health care). But if, on her one quality/dollar metric, we found that health care efficiency in a universal system was only slightly lower than it had been with 40 million uninsured, then, yes, I imagine most liberals would still want universal health care. Libertarians like Megan, on the other hand, are willing, it seems, to throw those 40 million under the bus if it means saving one penny per unit quality. And she should own that without reverting, as she finds so annoying, to moral claims about transferring wealth from the young and healthy to the old and sick.
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Well, my gut speaks a different language. Logic sometimes helps. Here it is key. Beware of those who conflate universal coverage and single-payer universal coverage.
The argument on efficiency regarding universal coverage on health insurance - single payer being just one flavor - must be conducted without hard historical data, since US models for universal coverage don't exist and few are willing to accept the developed world's other universal systems as models, and boils down to removing the obvious inefficiencies of private, lightly regulated, government incentivized approaches. We have met the enemy and its for-profit, cherry-picked health insurance that leads to good things (profits, mostly) for insurers and bad things for sick people and well-people who will be sick because of no preventative car. Profits are a tax and so are administrative and advertising costs of private insurance. They add nothing to efficiency or effectiveness.
As long as insurance companies can choose their customers or refuse payment for certain common conditions we will have an inefficient health care system because that's the nature of the beast. Exclusion, cherry-picking, and payment refusal means uninsured citizens. Full stop (to pick up McMegan's schtick). And the evidence is already there. Our costs are between 50 and 100% higher today, even with exclusionary policies.
I don't need to humor McMegan since she's not in my social circle, and so I can say what I believe to be true: she's really not a very nice person when she believes that there is no right to health coverage for preventative and reparative medicine. Can she point to something in our founding documents that indicates her prejudices are correct? On the contrary, the Declaration and Constitution are there to read and they fully contemplate common action to improve citizen welfare.
Things come to mind that are examples of 'rights' that our founders thought were the reasons for instituting governments: life, liberty and the pursuit of happiness. Good health and means to regain it through medicine is directly the object of government that seeks to promote 'the general welfare'.
I don't feel that the libertarian premise that individual action is inherently superior in most contexts is consistent with a contemporary reading of the purposes of government, and I won't grant that premise, and argue on her grounds, which I view as stunted moral thinking and dishonest policy argumentation.
I know what you mean, Jim. But I think it's worth pointing out that granting libertarians everything they assume highlights the radical nature of their philosophy.
I try to take the gloves off, even when I know the people :)
I'm a little confused by Meagan's arguments, which seem to miss several points. Or maybe they're buried in there somewhere.
1.The single payer concept has little to do with universal health.
2. There will never be efficiency in U.S. healthcare, and all attempts to make it more efficient are driven by either greed or misguided regulation.
3. All attempts to make health care efficient will result in limiting access (logistically or otherwise) or cutting people out altogether.
4. The infrastructure of medicine in the U.S. has largely been gutted. To add 40 million people (many whom have suffered from "deferred maintenance") to the "rolls" cannot be supported by the system unless it is strengthened by the addition of physicians, nurses, hospitals (in some areas) etc.
5. Meagan says care should be provided if it was "promised." I would refer her to thousands of campaign speech by thousands of candidates - if that is the criteria she chooses to provide care.
6. Including Warren Buffet in her argument is aburd.
7. This issue has more to do with decency than libertarinism. I fear for a society whose values and priorities are so distorted.
You're completely right Jeff. And Ezra has addressed a lot of these major problems with her posts at his place. My purpose was to show that, if you ignore the weaknesses that you point out (or grant them, or whatever) it shines light on an underlying idea that's pretty tortured.
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