Socialized Medicine: Inefficient and Immoral

As I have pointed out before, the monolithic support of “progressives” for socialized medicine has less to do with its economic or medical viability than with their need to feel morally superior to the hoi polloi. However, as Megan McArdle points out, the morality of government-run health care is open to considerable question: 

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 … 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.  

She believes that such transfers are justifiable only if the group receiving the wealth is needier and less fortunate than the class from whom the wealth is to be extracted. Moreover, it must be shown that the latter group is somehow responsible for the condition of the former. McArdle thinks single-payer fails to meet any of these criteria. 

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 … 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 … As a class, are the young and healthy more responsible for the bad health of the old and sick? Quite the reverse.

For my part, I prefer to discuss health care reform on the basis of efficiency. The objective data clearly demonstrate that government-run health care is wasteful and does a very poor job of resource allocation. Still, McArdle makes a good case that it is also immoral. 

[via Kevin, MD]

Comments 21

  1. Eric Renouf wrote:

    You’re simply wrong here. First factually you’re wrong. The “objective data” do not in any way clearly demonstrate that it’s more wasteful than private industry. Check out this report: http://content.healthaffairs.org/cgi/reprint/22/2/230.pdf which shows, among other things, that “Medicare has proved to be more successful than private insurance has been in controlling the growth rate of health care spending per enrollee.” This isn’t to say that it is universally better, but it is without question not universally worse and is not necessarily less efficient.

    As to the morality argument, I don’t think what you present here is very accurate either. For one thing, I do think we have at least some degree of moral imperitive to help those around us in need, even if in other ways those in need are better off than ourselves. We also don’t have to have played any roll in their current ailments in order to feel the need to help either. If those around us are being wronged we certainly should step in to help them. As with many moral actions it can even be looked at in a selfish light, of if I help them, they might help me when I’m in need.

    Kant’s argument that moral decisions can be determined by what would happen if it were made into a universal law can help us here. If someone is in need and you have the means to help, should you help or not? If we’re looking at it in the broad case then I think most people would agree that you should help the person in need, and therefore it’s the morally right thing to do. In a more specific case, if your neighbor makes more money than you do, but suffers a catestrophic illness that threatens him or her financially even if he can make a fully recovery, is it right for you to help him or her? Clearly there are at least times when it is the right thing, and so if we’re extending it to a universal law, then it must be the morally imperitive thing to do–other specific details not withstanding. Of course it’s possible to contruct specific time when it might be the wrong thing (like if the person in need is a “really bad person”) but that does not in anyway affect the morality of the general case. That just shows the difficulty with applying a general rule to a specific case.

    Posted 23 Aug 2007 at 11:18 am
  2. Jamelle wrote:

    The funny is that McArdle doesn’t make a good case for the “immorality” of “socialized medicine” at all. Direct action is only one of many potential obligations for care or in this case, wealth transfer. Let’s say we use a Benthamite utilitarian standard; what is “moral” then is whatever generates the greatest amount of happiness or utility. The dollars taken from the wealthy and “given” to those less fortunate (in any circumstance) will increase the “happiness” of the latter far more than the former. Or rather, for someone making a half million, $1000 isn’t much. For someone making $20,000, it’s a shit ton, and as such we have a moral obligation to take that from the former and give it to the latter.

    Posted 23 Aug 2007 at 11:18 am
  3. Catron wrote:

    Medicare has proved to be more successful than private insurance has been in controlling the growth rate of health care spending per enrollee.

    The divergence between Medicare and private insurance is due to the former’s price control strategy. While this strategy has indeed had an effect, it most assuredly has not been “efficient.? It has been responsible for the closure of hundreds of community hospitals and created physician shortages in most rural areas.

    I do think we have at least some degree of moral imperitive to help those around us in need, even if in other ways those in need are better off than ourselves.

    Isn’t this a “reverse Robin Hood? imperative?

    Posted 23 Aug 2007 at 12:20 pm
  4. Catron wrote:

    The dollars taken from the wealthy and “given? to those less fortunate (in any circumstance) will increase the “happiness? of the latter far more than the former.

    Ah, but we’re not talking about taking money from “the wealthy.? We’re talking about taking it from regular working stiffs.

    And to suggest that there is some moral obligation to take money from the guy making $500K and give it to the guy making $20K is like saying the latter has a right to my steak au poivre simply because all he has is a ham sandwich.

    Posted 23 Aug 2007 at 12:35 pm
  5. Matt wrote:

    “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 ”

    Doesn’t all health insurance do this? It pays the costs of the infirm from the premiums, and profits off the float of those premiums, of the healthy? Does she mean that all insurance is immoral?

    Posted 23 Aug 2007 at 12:56 pm
  6. Catron wrote:

    Does she mean that all insurance is immoral?

    Nope. It only becomes immoral when the government commands you to buy it. If you want to dive into the risk pool voluntarily, that’s a different matter.

    Posted 23 Aug 2007 at 1:27 pm
  7. Marc Brown wrote:

    Funny how you’re talking up an article that’s comprehensively trashed in many excellent comments on that site. The poster who talks about the erosion of the social contract between the generations has it right.

    As Dan Cobb says: ‘The fact that a person can pretend to be speculating out loud about why it is “unfair” for younger people to “subsidize” the health care of the elderly is, on its face selfish, self-absorbed, destructive of the social contract, and simply indicative of a personality that has been formed in a nation without any notion of citizenship –the participation in a societal organism that is larger than the four walls of one’s home –a cut throat selfish ethic.’

    The logical conclusion is to opt out of all state taxation – and out of society. The reason its immoral is that it denies all the behaviour built up over thousands of years in civilisations all over.

    Posted 23 Aug 2007 at 1:37 pm
  8. Matt wrote:

    So is the auto insurance that the govt. commands me to buy immoral? How about the professional liability policies that are required in some states?

    Posted 23 Aug 2007 at 1:45 pm
  9. Catron wrote:

    The poster who talks about the erosion of the social contract between the generations has it right.

    Sorry, Marc, Cobb’s “social contract” argument is ridiculous. In government-run health care systems, the people on the receiving end are often better off than those whose pockets are being picked to pay the bills.

    Posted 23 Aug 2007 at 2:20 pm
  10. Catron wrote:

    So is the auto insurance that the govt. commands me to buy immoral?

    Yep.

    Posted 23 Aug 2007 at 2:22 pm
  11. Matt wrote:

    So is it more moral to not require insurance, resulting in the taxpayer picking up more of the cost of damages from that auto accident than it is to require those minimal limits?

    I think the immorality argument is a weak one.

    Posted 23 Aug 2007 at 2:24 pm
  12. Marc Brown wrote:

    Better off people in the UK pay a lot more tax and national insurance contributions. And the vast bulk of the population are low and middle earners, who make most use of the NHS. The truly wealthy often use private medicine – and so they pay twice.

    Just to pick you up on ‘hoi polloi’ – it means the masses, who of course have most to gain from universal healthcare. Quite rightly, those who argue for it are indeed morally superior to the health insurers and hangers on who are desperate to carry on picking as many pockets as they can.

    Posted 23 Aug 2007 at 2:39 pm
  13. Jamelle wrote:

    Could explain how it is “immoral?” I have a feeling that you’re trying to make the claim that moral obligation extends only as far as one’s own direct action. But I don’t buy that at all.

    Posted 23 Aug 2007 at 2:54 pm
  14. Catron wrote:

    Those who argue for it [universal healthcare] are indeed morally superior.

    Thank you for confirming my theory on “progressive” motivation (and delusions of grandeur).

    Posted 23 Aug 2007 at 3:12 pm
  15. Catron wrote:

    Could explain how it is “immoral??

    To forcibly take money from one person and give it to another (whose need for it is no greater) is robbery. You can dress it up with euphemisms all day long, but it is larceny nonetheless.

    Posted 23 Aug 2007 at 3:21 pm
  16. Matt wrote:

    Except you’re not really taking it from that person and giving it to another. You are requiring them to purchase a service, a service they will utilize themselves. They may well use that money the day after they send their premium in.

    Do you argue all taxes are “immoral” even though they may go for a road you utilize?

    Posted 23 Aug 2007 at 3:33 pm
  17. Catron wrote:

    You’re not really taking it from that person and giving it to another.

    Of course you are. You’re forcing people into a risk pool that they may not want to participate in. Laws requiring people to buy insurance are the direct result of the very insurance lobby that “progressives” are always complaining about.

    Posted 23 Aug 2007 at 3:44 pm
  18. Matt wrote:

    Again, you’re not. You may well be utilizing that very dollar the next day. That’s the difference between it and robbery. When I rob you, you’re not going to be utilizing what I take anytime soon, or ever.

    The immorality argument is the weakest of all arguments against single payer. You can do better, and have. But you’re getting to the bottom of the barrell.

    Perhaps it’s time for you to start proposing concrete alternatives rather than simply playing the critic 24/7.

    Posted 23 Aug 2007 at 3:57 pm
  19. Marc Brown wrote:

    Out of interest, do you think there is such a thing as human society?

    Do you also advocate the existence of nation states?

    And if so, what morally – or even efficiently should that state extract from its citizens in tax dollars, and for what?

    Posted 23 Aug 2007 at 3:59 pm
  20. Catron wrote:

    My views on such things are similar to those of Milton Friedman and other so-called Minarchists.

    Posted 24 Aug 2007 at 1:07 pm
  21. Eli Nelson wrote:

    The framing of the health care debate is completely skewed. Life and survival are not data points in an economic analysis. Receiving adequate health care treatment is not about economic efficiency any more than receiving adequate police protection (or military protection) is a matter of economics. You can argue dollars and cents and use the dimensions of “greed” and “self-interest” to assign values to life and health, but these are merely attempts to normalize fundamentally non-quantifiable factors.

    Access to adequate medical care is a moral issue. If we can provide it, we should do it, even when (and maybe because) it hurts. When my children are sick, I care for them. When my parents are sick, I care for them. Not because it is in my economic self-interest to do so (although eco-pundits will find ways to quantify this on a macrosocial level, I’m sure). I do it because it is the moral thing to do. Money is not the irreducible currency of life. Much fuzzier things like “quality,” “satisfaction,” “fulfillment,” and “membership” are. Our satisfaction as human beings derives mostly from our emotions, and these are tickled only tangentially by matters of the wallet, but far more by the gratification of belonging to a well-functioning society.

    I wish we would all stop pretending that the money really matters. It is making us stray from the very things that make us human, happy, and wise. Our society has become sick with willful self-deception. It’s time to alter course.

    Posted 04 Jan 2008 at 11:14 pm

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