An exchange with a blogger who is apparently a philosophy student at the University of Virginia leads me to believe that many people are still misunderstanding my point about the morality of single payer healthcare. Many people responded to my first post by saying, "But we have a duty to care for the sick!" Trying to make myself very clear, I wrote 2,000 words explaining that even assuming, arguendo, that we have a duty to make sure people don't die from lack of health care, this is not a good moral argument for single payer. At which point I got more posts, including from said philosophy student, saying "But we have a duty to care for the sick!" Length having failed, let me try brevity:

1) Single payer transfers money from anyone who is young and healthy to anyone who is old and sick, regardless of their need for the money.

2) For this to be moral, the entire enormous class of people who are old and sick must have some justified claim on the money of the young and healthy.

3) The large class of old and sick people do not need the money; as a group, they are wealthier than the young, healthy people from whom we are transferring the money.

4) Therefore, we must look for another legitimate claim on society's resources.

5) Another such claim might be a fairness claim: the old and sick have been terribly unlucky, so we should pay for their health care even though they don't need the money.

6) This is not a good argument. Most of the old and sick are sick because they are old. Getting old may suck, but it is not unfair; it is inevitable. All of us will become old and sick, unless something even worse happens to us to make us dead. Some of the old and sick are just sick, and have never been healthy. But to calculate the relative deservingness of the whole group, we have to weigh the bad luck of those people against the bad luck of the currently young and healthy people who will, in the future, die young. As a group, there's no reason to think that the (currently) old and sick have had worse luck than the (currently) young and healthy, although obviously some members of each group are unluckier than others.

7) A third argument we might make is that the young and healthy should pay for the care of the old and sick because they have more responsibility for the problems than do the old and sick people themselves. This is self-evidently stupid. If even 100 people who are currently old and sick smoked and dranked themselves into early debility, while all the other old and sick people in America had absolutely no causal role in their own illness, this tiny aggregate responsibility for a few cases of lung cancer and cirrhosis would, to a near certainty, be larger than the responsibility the young and healthy bear for other peoples' ill health1.

8) Thefore, as a group, the old and sick have no moral claim to massive transfer payments from the young and healthy. This tells us nothing about any moral claims individual members may have. For example, veterans could be entitled to care, regardless of need, because they incurred some part of their current illness on behalf on the nation.

9) Arguments that we shouldn't let the worst off members of society die are not valid moral arguments for single payer. They are arguments in favor of giving health care to those who cannot afford it, a much more limited project.



1What about car accidents, flu shots, and the like? For this to be compelling, we'd have to have some evidence that the relevant failures are unequally distributed between the groups. But the elderly are worse drivers than teenagers, they're more likely to have inflicted secondary smoke on the young than the reverse, and so forth. Even if we could do the utilitarian calculus, it seems unlikely to run in favour of the old and sick.

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