Well, I was bouncing around through the Net, when I ran across this post by Megan McArdle. She has written for The Economist, and her blog is at TheAtlantic.Com. She makes some statements about moral arguments for a national health plan, and specifically for a single-payer national insurance plan.
She poses this as a transfer of wealth from the young (as a class less likely to be sick, but also less wealthy) to the elderly (as a class more likely to be sick but also more wealthy). In her argument she undermines her own categories, acknowledging that the young and healthy will, unless they die young, eventually become old, and presumably less healthy. At the same time, she refuses to reach the obvious conclusion of that problem: that her arbitrary classes have more in common than they have that distinguishes them.
And since that is the case, arguing about wealth transfer is misleading. Indeed, it misses the fact that such wealth transfer is already taking place. Wealth is transferred from those who have insurance of whatever form (private or government funded) to those who don’t. Institutions cost shift, raising charges for those who can pay to cover the expenses of those who can’t. The same thing happens in any other industry, really: the local convenience store has a certain latitude in the budget to pay for losses due to shoplifting and accidental damage. In health care, the costs come from unreimbursed care provided to those without insurance. In health care, the wealth transfer takes the form of higher charges from health care providers, leading both to higher insurance premiums and higher co-pays.
She does acknowledge one moral argument for a single player health plan: “no one should die, or suffer unduly, because they don't have the money to pay for treatment.” Well and good; but she misses several other considerations.
First, while a single-payer plan is the most common model to be raised, it isn’t the only model. There are mixed models of government involvement with private insurers to provide universal coverage.
Second, her model is still based on paying to treat pathology rather than to prevent it. It has been amply demonstrated that the cost of paying to treat illness is significantly higher than the cost of primary care to prevent it.
And it is this last that highlights my greatest concern about many economic arguments against universal coverage for health care. Most of the arguments seem to have no sense of investment. They don’t consider long term savings in public health that prevents illness (including such concerns as the pandemics we are all anxious about these days), or that keeps the healthy working and productive. It seems to me to reflect some of the worst of our recent economic swings: it’s all about short-term profits instead of long-term value.
Read Ms. McArdle’s article. She is at least interested in moral discussion about universal health coverage. She’s interested in getting beyond the political expediencies of “Everyone should be taken care of,” or, “Yes, but not out of my wallet.” We need to bring such discussion to the public sphere. We just need to do it better.