30 March 2010

Health Care Reform Distillation

I think if I had to distill my dislike for the Health Care Reform proposals -- not just the one we actually got, but the entire scope of the Democratic effort of the last year -- it would be that I do not understand why we should ask the healthy to subsidize the sick, or the young to subsidize the old.  That's what all these proposals are about at their core; the rest is implementation details and shell games.

I can understand asking the rich to subsidize the poor.  I may differ with most people on the Left as to how much of that we should be doing, and the particulars of how we should go about it, but in principle I understand why it's desirable.

Health is but one of many things that have a material impact on your well-being.  I'm not sure why we should have people who are well endowed on this one particular dimension of fortune pick up the bill for those less fortunate as measured on this particular dimension.

We don't ask the smart to subsidize the stupid, or the handsome to subsidize the ugly, or the ambitious to subsidize the lackadaisical, or the sociable to subsidize the introverted.  Or more properly, we do ask that of them, but only after taking stock of the affects that all of these dimensions of fortune have had on their circumstances.  When you add it all up, you get down to transfers from the rich to the poor.  I'm not sure why we pull health out and do that moral calculus separately because the result is directing a lot of the young and poor and the healthy and poor to give their resources to the old and wealthy and the infirm and wealthy.

PS See also Nick Gillespie: "Health Care Reform Endgame: Old People Matter More Than Poor People"

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