Megan McArdle has been writing a series of epically point-missing posts about health care that seem specifically designed to annoy. The latest really got me, though. Megan is flabbergasted – flabbergasted! – to hear that one thinks that the government should help the sick:
If we should give money to sick people regardless of need, is it because being sick sucks and we’re giving people bonus payments for having sucky things happen to them? If that’s the case, why don’t we give people bonus payments for, say, being really ugly, or being severely socially awkward, both of which seem at least arguably worse than, say, having chronic asthma.
Also, if they deserve money just for being sick, why give them the money in the form of healthcare? Wouldn’t a cash transfer be even better? Then the people who wanted to be treated could spend the money on healthcare, and other people could spend the money on something they valued even more than healthcare. It seems like a Pareto improvement in net happiness over a simple single-payer system.
There are a whole number of things wrong with this. The hypothetical in the first point is beyond silly. The difference between giving a sick person medicine and giving a socially awkward person money is that the medicine will get rid of the sickness, whereas I’m pretty sure money is an, at best, unreliable cure for social awkwardness. Inasmuch as we’re interested in alleviating suckiness, it should be pretty obvious that universal health care is a much more sensible policy than welfare payments to ugly people.
Megan again ignores the fact that medicine cures illness (a minor point in discussions of health policy, I know) in her second argument. When choosing between a cash transfer and medical treatment for a sick person, one is operating under the presumption that the person deserves one of these two things because they’re sick. Hence, it’s pretty absurd to argue for an option that wouldn’t necessarily reduce said sickness over one that most certainly would.
But the thing that annoys me most about Megan’s argument here is that she seemingly forgets that sickness is bad – not just sucky, bad. It just doesn’t cause discomfort. It hurts the economy, through disabling and/or killing workers. In communicable cases, it endangers everyone in contact with the sick person. Etc., etc. Combatting individual illness is a public good – not just a helpful action for the patient in question. The government has a legitimate interest in combatting it, not for welfare purposes, but for the entire public’s economic and medical well-being.