I've been meaning to get back to Megan McArdle and her anti-health care screeds for a few days now. Sadly, No! has reminded me about it. For the sake of some sort of coherence when looking at a phenomenon that is essentially incoherent, here is McArdle’s first attempt to “clarify” (and I use the quotes advisedly) her original post. Sorry, but on second reading, the first post is still largely junk, full of unsupportable assertions and faulty logic, not to mention the almost palpable sneer with which she invests the term “social justice.”
From the follow-up, here is the key blunder, stated clearly:
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.
And here it is restated later on, with the “morality” clause elaborated:
A gigantic single-payer system is a pretty blunt instrument; it transfers money from one group, the young and healthy, to another group, the old and sick. It does not distinguish much more finely than that between the deserving and undeserving within that class.A gigantic single-payer system is a pretty blunt instrument; it transfers money from one group, the young and healthy, to another group, the old and sick. It does not distinguish much more finely than that between the deserving and undeserving within that class.
No. It doesn't. We’re not talking about a wholesale transfer from one large class to another. That is simply a bald assertion with no foundation. This is so obvious that I can’t help but think it’s deliberate. (Nor can I believe I'm the only one to spot it -- someone must have commented on it and I've just missed it somehow. Please, tell me that's so -- my faith in the blogsphere's at stake here.) That, actually, is somewhat the system we have now with Medicare and Social Security (largely due to the fecklessness of the government in various incarnations), which, one hopes, a single-payer health care system would in some measure alleviate. This is also the basis of McArdle’s major straw man, that a single-payer system is designed to force the “young and healthy” to pay for health care for the “old and sick.” These are statements without intelligence or honesty. A single-payer system means that everyone pays in and everyone is entitled to benefits. Let me repeat that: everyone pays in, everyone gets benefits. What is so hard to understand about that?
I really don’t see where questions of morality come into it at all, except for McArdle's apparent need to determine who is "deserving" and who "undeserving." Like I'm going to take her word for it.
Looking at McArdle's follow-up to her original post, the reality gaps are pretty obvious.
1) Single payer transfers money from anyone who is young and healthy to anyone who is old and sick, regardless of their need for the money.
Sadly, No. (Sorry -- couldn't resist.) As does private insurance, which McArdle seems to desperately want to hold onto by whatever means necessary, a single-payer system means that every member of the insured group pays in (taxes, in that case) and every member is entitled to benefits. That's the way insurance of any kind works. Duh.
2) For this to be moral, the entire enormous class of people who are old and sick must have some justified claim on the money of the young and healthy.
3) The large class of old and sick people do not need the money; as a group, they are wealthier than the young, healthy people from whom we are transferring the money.
Given that McArdle has completely misrepresented the system to begin with, this is so much garbage. Nevertheless: It doesn't operate in terms of groups, at least not in terms of actual payouts. Insurance premiums are figured on statistical probabilities; one assumes a tax to support a single-payer system would be based on something similar (one does hope that, truly). Now, talking about the "entire enormous class" of old/sick people is more than a little disingenuous. It's not as though the government is going to be giving flat grants to old sick people as a class, so you really can't legitimately cast the question in those terms. Perhaps, as a group, the old sick people don't need the money, but 1) I'd like to see some breakdowns on the number of elderly who are at or below the poverty line, and 2) remember, when it comes time to pay for the care, we're not talking about groups, we're talking about individuals.
4) Therefore, we must look for another legitimate claim on society's resources.
5) Another such claim might be a fairness claim: the old and sick have been terribly unlucky, so we should pay for their health care even though they don't need the money.
6) This is not a good argument. Most of the old and sick are sick because they are old. Getting old may suck, but it is not unfair; it is inevitable. All of us will become old and sick, unless something even worse happens to us to make us dead. Some of the old and sick are just sick, and have never been healthy. But to calculate the relative deservingness of the whole group, we have to weigh the bad luck of those people against the bad luck of the currently young and healthy people who will, in the future, die young. As a group, there's no reason to think that the (currently) old and sick have had worse luck than the (currently) young and healthy, although obviously some members of each group are unluckier than others.
7) A third argument we might make is that the young and healthy should pay for the care of the old and sick because they have more responsibility for the problems than do the old and sick people themselves. This is self-evidently stupid. If even 100 people who are currently old and sick smoked and dranked themselves into early debility, while all the other old and sick people in America had absolutely no causal role in their own illness, this tiny aggregate responsibility for a few cases of lung cancer and cirrhosis would, to a near certainty, be larger than the responsibility the young and healthy bear for other peoples' ill health1.
8) Thefore, as a group, the old and sick have no moral claim to massive transfer payments from the young and healthy. This tells us nothing about any moral claims individual members may have. For example, veterans could be entitled to care, regardless of need, because they incurred some part of their current illness on behalf on the nation.
9) Arguments that we shouldn't let the worst off members of society die are not valid moral arguments for single payer. They are arguments in favor of giving health care to those who cannot afford it, a much more limited project.
More garbage. I seriously question the idea of casting this whole discussion in terms of "morality." It's the sort of thing only a libertarian could come up with, particularly if she's trying to stay in the good graces of the rabid right. This whole section is nothing but straw men, smelling of many day dead red herrings. In fact, the more I look at McArdle's "arguments," the less impressed I am -- it's just one big straw man, a single-payer program sewn from whole cloth to fit no particular reality, just McArdle's philosophy. I'm afraid I have to give more credit to BradRocket's "me, me, me" comment than I had at first figured. There certainly does seem to be a large measure of self-centered special pleading going on here.
There is another argument -- not on McArdle's side of the fence, however:
Let's try one simple example: you feel obligated to take care of your elderly parents, because it's traditional, they're your parents, and you love them and want to be sure they're OK. They also took care of you when you were tiny and helpless, so turn-about only seems reasonable. It's the basis of the traditional family, after all. I mean the real traditional family.
However, sometimes medical care can be very expensive, and you're afraid you won't be able to afford it if something serious happens. You don't want to jeopardize your children's future to take care of your parents -- not to mention your own life if you should need major medical care. If you go, who's going to take care of the elderly parents and the helpless children? That's a real quandary. So the government provides a program into which you pay premiums in the form of taxes, and everyone has the assurance of the care they need. It's called "spreading the risk," which is, after all, what insurance does, save that in the case of the government-run program, you have a much better chance of claims being honored, private insurance companies having become notoriously arbitrary in that regard.* You pay your share, everyone else pays their share, your parents are taken care of, anyone who needs medical care gets it (including you and your children) and you can (hopefully) afford to send your kids to decent schools. And they will, in their turn, be able to be sure you're being taken care of when you're old and sick.
What's so hard about that?
I have a distinct sense of McArdle feeling that, as a good libertarian, she needs to be against government-provided health care because she needs to be against government-provided anything, but she can't quite come up with a solid reason against it. So we have an argument on the basis of “morality” (which itself is a travesty -- what McArdle recognizes as morality is quite bizarre) which simply can’t be made to make sense, particularly since it relies on a fantasy version of universal health coverage.
And she can’t understand why everyone else doesn’t get it. Maybe they just aren’t as clever as she is. Or maybe they're cleverer than she thought.
Sorry, but even though McArdle takes a poke at those who objected to her first two posts on the subject, the more I read through these things, the more convinced I am that, if McArdle is a true example of libertarian thought, then it really is a morally bankrupt philosophy.
By the way, BradRocket does his own, quite effective take-down. Read it. And just to refresh your memory, I had some comments on McArdle’s first post on Asymmetrical Information here. (You can ignore the part about Philip Atkinson, although I still think they make good bedfellows.)
* There is also evidence, in the form of the S-CHIPS program and some parts of Medicare and Medicaid, that the government can run an efficient and effective program. Yes, even our government.
Update:
Someone did spot the holes -- the commenters at McArdle's blog. And quite thoroughly took her to task for it, on the same basis I outlined -- straw men, red herrings and all. Strangely enough, those who rose to her defense seemed mostly to rely on arguments centering on "knee-jerk liberal do-gooderism" and not much in the way of substance. And what, pray tell, is wrong with wanting to do good?
I feel much better now.
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