Here’s the problem with a single-payer health care system, according to Megan McArdle.
McArdle says there are three reasons you might want to transfer money from one group to another: the recipients are needy, they are unlucky, or they are deserving. A single-payer health care system transfers money from the young to the old, and the old are neither needier, unluckier, or more deserving than young people.
It’s true: old people are, as a rule, more affluent than young people, and arguably they are no more unlucky or deserving.
But McArdle’s argument still falls apart in a number of places. First of all, it’s unclear to me that a single-payer universal health-care system would result in a massive transfer of wealth from young to old. After all, older Americans are already covered by Medicare. The young and healthy are already paying for the old and sick’s health coverage. Adding universal coverage for everyone would actually transfer money from old to young, since the old people would have to pay for more of young people’s health coverage.
But McArdle could be arguing from universal principles: Medicare itself is morally wrong, and a universal health care system would be just as wrong. Fine. Then are the young, poor, and healthy unfairly burdened with providing health care for the old, rich, and sickly? Perhaps, if these were actually two separate problems. If there was one country, “Youngoland” that was constantly financing “Oldova”‘s health coverage, then the inhabitants of Youngoland should be morally outraged.
But the fact is that all young people hope eventually to become old people. When they’re old people, they’re going to need more health care, so the trade-off for paying for universal health care when they’re young is the assurance that the health care will be there when they need it.
Finally, McArdle misses the point of insurance altogether. We want insurance because we want to protect ourselves against catastrophe. The higher the proportion of people in the insurance pool who actually face catastrophe, the higher the insurance rates. If we exclude healthy people from the pool of people paying for health insurance, then the price for sick people necessarily increases. If we charge different rates for different levels of health, eventually we don’t have insurance at all: the sickest people would have the highest rates. At that point, you might as well just go to the doctor and pay him/her directly.
Perhaps McArdle is arguing against the concept of insurance entirely. But I suspect she’d be in the minority of Americans. Most people want to know that their health bill will be covered if they get sick.