Many of my commenters have responded to my posts on single payer by saying: but the young and healthy will someday be old and sick!
Why, yes, they will. But why is that a good argument for taking money from them to give to old sick people, on the promise that some future young healthy people will give them money?
Morally, I don't see how the fact that I will be old and sick gives currently old and sick people a moral claim on me. Had I known, a year ago, that I was going to move permanently to DC, would that have justified the DC government in taxing me last August, on the grounds that in the future, I would be a resident of DC?
As an argument for single payer, this is even worse; at least some of the people who would have benefitted from my taxes last August will be paying taxes this August to help give me roads. The transfer inherent in single payer, on the other hand, is largely non-overlapping. The class of currently old and sick people (Class A) is justifying a transfer from the class of currently young and healthy (Class B) on the grounds that a future class of young and healthy people (Class C) will eventually make a similar transfer? So can I demand that you buy me lunch, on the grounds that at some point in the future, someone, somewhere, will probably do as much for you?
Now, let's think about those transfers. One of three things must be true:
1) The transfers from Class B will be the same size as the transfers from Class B. This is lunatic; Class B could simply spend the money on themselves.
There is a question of what to do if you live in a society that has, for whatever reason, already implemented such a stupid scheme. Morally, I think it is obvious that you do not dump those who contributed to it in good faith; but morally, I think it decidedly unobvious that the right thing is to keep the thing going. In general, the current generation should minimise the binding committments it hands to future generations, not least because what if the future generation decides it isn't so binding?
2) The transfers from Class B will be bigger than the transfers from Class C. Given that Class A seems no more deserving than Class B, this seems straighforwardly immoral.
3) The transfers from Class B will be smaller than the transfers from Class C. This is more complicated, because economic growth enters the picture . . . but by what right does Class A claim resources from Class B by committing Class C to repay its claims, with interest?1 Particularly since current trends show health care expenditure growing much faster than the economy as a whole.
In other words, either we are trying to get rich by picking our own pockets, or we are unfairly taking from someone in order to give goodies to those who are now old and sick.
I want to emphasize something though: I'm talking specifically about a moral argument in favor of a single-payer financing arrangements. I'm not talking about "the morality of providing healthcare" or "the morality of caring for those who cannot help themselves". I think that the debate over single payer healthcare frequently features an underlying assumption that the old and sick are, by virtue of being old and sick, thereby automatically entitled to have someone else give them the rather large amount of money implied by a mandatory single payer subsidy. This seems unconvincing to me.
There are good arguments in favor of single payer, most of them having to do with market structures, which ultimately try to prove that we cannot accomplish moral ends that I think are at least arguably justified without erecting a giant single payer system. I find those arguments ultimately unconvincing, for reasons I'll elaborate next week. But I think they are at least arguable, unlike the premise that Warren Buffet is entitled to have his prescriptions paid for by my dry cleaner simply because Warren Buffet happens to be in worse health.
1But what about the budget deficit, I hear you cry? Yes, I quite agree. Except insofar as Classes A & B are using the money to secure the vital interests of Class C . . . by, say, fighting World War II . . . I'm against deficit financing. I don't think it mattes economically very much, but morally, I'm with you.