The Morality of a Single Payer Health Care System

[JonNC]

That would also be a form of single-payer. When you get sick, the government could give you a voucher to cover any reasonable cost for your treatment. You could take that voucher to the doctor of your choice and get treated. But that is probably not what you meant, is it? You were thinking the voucher would only be enough to cover the premiums for the average person in reasonably good health. You were probably not thinking about a voucher that would be sufficient to get someone care who has a pre-existing condition and whom no one would willingly insure for the cost of that voucher.

So, now that you’ve impugned my motives, let’s talk about pre-existing conditions. A large voluntary association would work just like healthcare through the workplace. They would negotiate with insurance companies and other providers to get the lowest rates for ALL members, unlike authoritarian government care that decides who gets or doesn’t get care through denial of services or queuing.

The problem of the individual market, made dramatically worse by ACA, is that it is individual.

 

[LeafByNiggle]

…, let’s talk about pre-existing conditions. A large voluntary association would work just like healthcare through the workplace. They would negotiate with insurance companies and other providers to get the lowest rates for ALL members, unlike authoritarian government care that decides who gets or doesn’t get care through denial of services or queuing.

You said you wanted to talk about pre-existing conditions. So where is the discussion of pre-existing conditions? Looking that the model proposed here, large associations would negotiate package deals with insurance companies. Even when negotiated though a large employer, insurance companies still want to know the risk status of their insured. If a plan is agreed to between insurance companies and a large association, the insurance companies are not going to stand idly by if a bunch of high-risk people are added to the pool after that. They will object. It will probably be written into their contract with the association. Newly insured will have to be approved by us. Or else the large associations themselves will monitor the risk status of the newly insured. Either way, a person with pre-existing conditions is not going to have an easy time joining one of these associations. So I would say that the problem of pre-existing conditions has not been addressed.

The problem of the individual market, made dramatically worse by ACA, is that it is individual.

The ACA is not a single-payer system. That is why this particular problem arose. It is a Frankenstein of subsidized health care masquerading as private insurance. No wonder it has problems.

 

[JonNC]

Through voluntary associations, the association negotiates for the entire membership, even those with conditions.

**. Paul’s proposal to “allow any individual, including self-employed individuals, to form associations for the purpose of purchasing group health insurance” would go a long way toward solving this policy dilemma. If people could form their own associations and purchase health insurance as a group, the pre-existing conditions problem would mostly go away, because insurers would negotiate rates with the group knowing that some people might join over time with pre-existing conditions. The costs are built into the initial price negotiated and spread out amongst all those in the association. This is exactly how many employer-sponsored health insurance plans work today.

Church groups, advocacy organizations, charities, golf clubs, and virtually any other group of people could theoretically negotiate an association health plan under Paul’s provision, allowing like-minded people to take care of each other and providing those being insured with greater negotiating power.

Also worth noting is that if more people purchase insurance plans through non-employer private associations, it would help resolve the many issues that arise when people lose their jobs, providing greater health insurance stability. **

https://www.google.com/amp/www.foxn...-could-revolutionize-u-s-health-care.amp.html

 

[o_mlly]

There are a lot of things we all want to see done right, such as the elimination of abortion. But is it right to hold hostage the health care of those we can provide for until we get what we want?

How many murders may one morally permit in order that others access health insurance? Answer: None.

 

[LeafByNiggle]

There are a lot of things we all want to see done right, such as the elimination of abortion. But is it right to hold hostage the health care of those we can provide for until we get what we want?

How many murders may one morally permit in order that others access health insurance? Answer: None.

You are assuming that one has the power to prevent these murders. Unfortunately we don’t have such absolute power. So in an effort to prevent these murders, you would deny some people health care, only to find that neither goal gets accomplished.

 

[LeafByNiggle]

Through voluntary associations, the association negotiates for the entire membership, even those with conditions.

A negotiation made to provide for pre-existing conditions would have to take into account the number of such people, the extent of their needs, and the proportion of the insured that they represent. The insurance companies would insist on that.

After the deals are made, anything that changes the makeup of that risk pool would necessitate additional negotiations. The insurance companies would insist on that too. They don’t want to be committed to insuring an unknown proportion of very sick people. If they did not have provisions in the contract to allow them to renegotiate when the risk pool changes, they would be so committed. So that is not going to happen.

Either way, if the very sick people were not in the risk pool at the beginning, they are not going to get in without the insurance companies demanding to raise the rates for everyone. And if they were there in the beginning, the insurance companies would not have negotiated a very favorable rate because they would go out of business if they willingly insured a large pool of very sick people.

In conclusion, you can negotiate for low rates or you can provide insurance for people with serious pre-existing conditions. You cannot do both at once.

 

[JonNC]

Three things are possible in healthcare: low price, quality care, universality. You can get, for the most part, 2 out of 3. With government run healthcare, you get universality,but it won’t be good, and it won’t be reasonably priced.
If you have a large association, you have the best chance of getting good care, coverage for everyone in your group, and a price that will be better than in an individual market, and those with conditions get coverage, and they will get coverage because they are part of the association along with their family members.

There’s one more thing you get: no government interference in your healthcare

 

[LeafByNiggle]

Three things are possible in healthcare: low price, quality care, universality. You can get, for the most part, 2 out of 3. With government run healthcare, you get universality,but it won’t be good, and it won’t be reasonably priced.
If you have a large association, you have the best chance of getting good care, coverage for everyone in your group, and a price that will be better than in an individual market, and those with conditions get coverage, and they will get coverage because they are part of the association along with their family members.

There’s one more thing you get: no government interference in your healthcare

It is good that you acknowledge that the health associations cannot provide universality. Many people, including, I think, our current Pontiff, believe universality should not be so lightly discarded.

 

[JonNC]

It is good that you acknowledge that the health associations cannot provide universality. Many people, including, I think, our current Pontiff, believe universality should not be so lightly discarded.

I’m trying to find where I lightly discarded universality.
Some people don’t want it. Some don’t need it. And universality doesn’t matter if people can’t afford the care ( like ACA), or its lousy (VA).
So I’m most concerned about people getting good care st a good price without government interference, because government has consistently made things worse

 

[LeafByNiggle]

LeafByNiggle:

It is good that you acknowledge that the health associations cannot provide universality. Many people, including, I think, our current Pontiff, believe universality should not be so lightly discarded.

I’m trying to find where I lightly discarded universality.

That is affirmed in this very posting of yours.

Some people don’t want it. Some don’t need it.

Of course some people don’t need it. They aren’t sick. That is nature of insurance. People who are not sick pay for health care for those who are. The fact that some people do not “need” much health care is no argument against providing it to those that do need it.

And universality doesn’t matter if people can’t afford the care ( like ACA), or its lousy (VA).

I am not arguing about the ACA or any specific implementation of health insurance. I am only arguing about the morality of single payer health care as a general concept. I argue that it is moral. I don’t think you have made the case that every such system is doomed to be unfordable or provide lousy care. (Note that the VA is not a health insurance program. It is a total health care system, including doctors, etc. If the care is lousy it could be because of that.)

So I’m most concerned about people getting good care st a good price without government interference, because government has consistently made things worse

And thus you have discarded universality.

 

[Brendan]

It is fully Christian charity whenever one willingly supports the arrangement. In my experience there are very few who argue against progressive taxation. Governments have sought support for such arrangements and it has been given. It may not be as perfect as you would wish. But it is achievable, effective and widely embraced.

Not quite true, it builds resentment in the one taxed and a lack of gratitude in the recipient.

St John Chrysostom, Doctor of the Church, stated it well

"Should we look to kings and princes to put right the inequalities between rich and poor? Should we require soldiers to come and seize the rich person’s gold and distribute it among his destitute neighbors? Should we beg the emperor to impose a tax on the rich so great that it reduces them to the level of the poor and then to share the proceeds of that tax among everyone? Equality imposed by force would achieve nothing, and do much harm.
Those who combined both cruel hearts and sharp minds would soon find ways of making themselves rich again.

Worse still, the rich whose gold was taken away would feel bitter and resentful; while the poor who received the gold form the hands of soldiers would feel no gratitude, because no generosity would have prompted the gift. Far from bringing moral benefit to society, it would actually do moral harm. Material justice cannot be accomplished by compulsion, a change of heart will not follow. The only way to achieve true justice is to change people’s hearts first — and then they will joyfully share their wealth."

 

[Rau]

Lovely quote but hardly descriptive of the well endorsed progressive taxation systems operating in most of the world. And in those places, the distribution of wealth remains highly skewed with little to no evidence of the rich feeling bitter and resentful.

But who would object to an alternative where the spontaneous generosity of the rich saw the poor helped up and cared for via well run initiatives? There is also a wise saying about not allowing “the perfect to become the enemy of the good” (Voltaire).

 

[DarkLight]

I don’t think the purpose of progressive taxation is to make everyone equal, but to give everyone a chance.

I’ll mention my situation again. I have a lot of medical conditions that either I was born with, or developed when I was just over 18. I’m young, plus I had to take some time off of work/education because I got too sick, so I’m still considered an entry-level worker.

What I want is enough support that I can get the care I need to stay working and be able to improve my own life. The latter to me means also that I’m able to have enough time when I’m not working, and enough extra resources, to be able to educate myself or look for a job where I can work my way up (a lot of entry-level jobs, there really isn’t much advancement without an appropriate degree). I don’t want to be equal to the richest person, but I want to be able to work to improve my own life despite all the extra problems.

 

[o_mlly]

You are assuming that one has the power to prevent these murders. Unfortunately we don’t have such absolute power.

Since human beings have no absolute powers one cannot assume a particular power.

The relative power one has as a US citizen is to voice one’s opposition to the murder of the innocent. “The only thing necessary for the triumph of evil is for good men to do nothing.” - Edmund Burke

So in an effort to prevent these murders, you would deny some people health care, only to find that neither goal gets accomplished.

The issue is not health care but health insurance. No one can be denied emergency health care - The Emergency Medical Treatment and Active Labor Act (EMTALA) . The indigent have Medicaid.

Their is a small percentage of of individuals who are not Medicaid eligible and do not receive health insurance through their employer and have not maintained continuous health insurance and have preexisting conditions. That group is the target of a single payer plan. How many must this small group be to justify one more infanticide?

 

[DarkLight]

I think the argument is more that, given the current state of things, denying people healthcare doesn’t really actually do anything to reduce the number of abortions. They’re already happening.

 

[JonNC]

=“LeafByNiggle, post:371, topic:447347, full:true”]
That is affirmed in this very posting of yours.

No. It is actually a recognition and respect for individual rights. Some people don’t need it because they can self-insure.

Of course some people don’t need it. They aren’t sick. That is nature of insurance. People who are not sick pay for health care for those who are. The fact that some people do not “need” much health care is no argument against providing it to those that do need it.

It isn’t an argument for or against people getting it. I think everyone should provide for their healthcare. I do, and have for decades. But if someone can self insure, or foolishly chooses not to have it, they are supposed to be free individuals, a novel idea to some progressives.

I am not arguing about the ACA or any specific implementation of health insurance. I am only arguing about the morality of single payer health care as a general concept. I argue that it is moral. I don’t think you have made the case that every such system is doomed to be unfordable or provide lousy care. (Note that the VA is not a health insurance program. It is a total health care system, including doctors, etc. If the care is lousy it could be because of that.)
I have seen no evidence that it is moral that a free people should be forced to pay tax for something that may include immoral activities. To say you support single payer means you support your tax money for abortion,sex change, abortifacients, and government confiscation of a right and making it a power.
I see no evidence that a system that will - MUST ! - require doctors to make their services available at a fee not of their choosing and provide services they may find immoral. That is immoral

And thus you have discarded universality.

I have discarded tyranny. Forced universality is not consistent with a free people

 

[Brendan]

Rau,

Of course people resent it. How many people do you know that get excited in April over how much their money will be helping people, even at the expense of ignoring deductions that they would otherwise be eligible for.

Not too many, if there are any at all.

And how many welfare recipients have expressed gratitude to the taxpayers for supporting them? Again not too many.

That is why taxation is not charity. It generates no good feelings by those who pay, and no sense of gratitude from the recipient. There is no giver and no gift involved.

 

[Rau]

I guess I just don’t see see others like me (who are better off than most) moaning that their %taxation is higher than those who struggle with the basics of life. It is simply widely accepted as a good thing, in lieu of the perfect.

 

[LeafByNiggle]

The relative power one has as a US citizen is to voice one’s opposition to the murder of the innocent. “The only thing necessary for the triumph of evil is for good men to do nothing.” - Edmund Burke

People should voice their opinion. But that voicing of their opinion need not take the form of “I’m going to sit here and hold my breath until I get my way!”

The issue is not health care but health insurance. No one can be denied emergency health care - The Emergency Medical Treatment and Active Labor Act (EMTALA) . The indigent have Medicaid.

Many people think it is a good thing that one does not need to become indigent if they get sick. But given the choices just laid out, that often happens.

Their is a small percentage of of individuals who are not Medicaid eligible and do not receive health insurance through their employer and have not maintained continuous health insurance and have preexisting conditions. That group is the target of a single payer plan.

Universal coverage means universal. There is no reason anyone should be excluded, no matter how small a group they represent. In fact, the smaller the group is, the easier it is for the majority to cover their costs. So why make an issue of it?

How many must this small group be to justify one more infanticide?

Giving someone life-saving health care is not causing infanticide.

 

[Rau]

Worth noting that universal healthcare need not be structured as “single-payer” though it may well operate that way for the most needy.