David: I found Megan McArdle’s piece very interesting (most things she writes usually are). Her argument about the immorality of a single-payer system’s transfer of resources is impressive. Yet she concedes a huge point that she shouldn’t:

A gigantic single-payer system is a pretty blunt instrument; it transfers money from one group, the young and healthy, to another group, the old and sick.

If that was true, one could argue that there is some morality in a single-payer system in that it transfers resources from those who are healthy to those who are sick. But it doesn’t.

In most single-payer systems, it isn’t all that difficult to get an appointment with a primary-care physician. But if you need something more, like a visit with a specialist, diagnostic test, or elective surgery, you’ll face the very real prospect of being put on a waiting list or a cancellation.

The end result is that single-payer systems tend to transfer resources away from those who are very ill to those with few to no health problems. That would be immoral enough if that result were incidental. But it is by design.

Any government-run system like single-payer is ultimately run by politicians. Politicians design policy to maximize the votes they get in the next election; meeting needs is a secondary concern at best. What does this mean for health care policy? John Goodman puts it best:

Why do national health insurance schemes skimp on expensive services to the seriously ill while providing so many inexpensive services to those who are only marginally ill? Because the latter services benefit millions of people (read: millions of voters), while acute and intensive care services concentrate large amounts of money on a handful of patients (read: small numbers of voters). Democratic political pressures in this case dictate the redistribution of resources from the few to the many.

Because of their desire to win reelection, politicians distribute resources in ways that will maximize the chances that they will get 50% + 1 the next time the voters go to the polls. If those who the doctor for a minor (or no) ailment in any given year represent more voters than those who have serious illnesses, then the resources will be distributed more toward the former. That makes single-payer a system that does damage by design.

And that makes it all the more immoral.