HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Saturday, September 1, 2007

Single Payer Debate

Meghan McCardle, a columnist for the Atlantic Monthly wrote a piece on her blog about health care and the morality of  health care finance that has attracted a bit of attention.  She writes,

Moreover, as a class, the old and sick have some culpability in their ill health. They didn't eat right or excercise; they smoked; they didn't go to the doctor as often as they ought; they drank to much, or took drugs, or sped, or engaged in dangerous sports. Again, in individual cases this will not be true; but as a class, the old and sick bear some of the responsibility for their own ill health, while younger, healthier people have almost no causal role in the ill-health of others.

Perhaps they deserve it by virtue of suffering? But again, most of them are suffering because they have gotten old, often in high style. The young of today have two possible outcomes:

1)  They will be old and sick too, in which case they are no less deserving of our concern than today's old and sick

2)  They won't ever get to be old and sick, which is even worse than being old and sick.

As a class, the old and sick are already luckier than the young and healthy. Again, for individuals within that class--those with desperate congenital conditions, for example--this is not the case. But I'm not sure it's terribly compelling to argue that we should massively disadvantage a large group of people in order to massively advantage another, equally large group of people, all to help out the few who are needy, or deserving, or unlucky.

What lovely sentiments. . . .  She writes further in her column in that she was surprised by all the feedback she received.   Ezra Klein has kindly decided to set her straight on why she might want to ree-think some of her positions here and here.  He writes,

"I would like to hear from a large number of single-payer advocates," writes McMegan, "who will say that if the American system could be proven to provide higher quality care per dollar on average than other industrialised system, then they would be content to leave 40 million people uninsured."  And I would like to hear from a large number of auto enthusiasts who will say that if the car I'm selling them can be proven to go really fast, then they won't care that it's missing two seats, a mufflers, half a door, and three cylinders.

The 45 million are not some puppies-and-rainbows issue we're talking about because they make us feel sad and draw frownie faces in the margins of our notebooks. It's not efficient to have 45 million people going without preventive care. I could name about 45 million reasons why this is so -- ranging from enhanced productivity to the cost-effectiveness of statin drugs to the young uninsured who should be in the risk pool -- but that's the fact of it. The reason policy reformers are so intent on pulling them into the system isn't because policy reformers are Really Great People, it's because their absence is mucking everything up, and causing gross inefficiencies for hospitals, clinics, Medicare, Medicaid, taxpayers, and themselves. . . .

But at least this straw reform movement which believes dogmatically in single payer for incomprehensible reasons and laughs at efficiency claims isn't around to menace us any longer. We can thank Megan for that.

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