The point is that you don’t have any idea what each individual poor person values. Neither do I, nor anyone else for that matter. Only each of the individual people know their own preferences. Thus, rather than imposing our perceptions of their preferences on them, why not just give them cash rather than health care and allow them to spend it according to their preferences? If you want to make someone better off, it is better to give them money and allow them to choose how to allocate it rather than giving them a specific good/service that you think they do/should value.

Re comparative outcome numbers of USA and others: (1) our poor infant mortality numbers are actually caused by our cutting-edge care. We try to save preemies that other countries abandon. We lose half these battles. But they go into our numbers, whereas the countries with “better” obstetric statistics never include them at all. Thanks to James Taranto of opinionjournal.com for pointing this out. Kristof of the NY Times has recently repeated his earlier error on this one. The *lack* of travel to, say, Bratislava by expectant American mothers is an obvious signal here.

(2) Our life expectancy averages are affected by our high murder rates. It’s hard to see which element of the current health care debate is going to work these particular numbers down. (Thanks to Forbes Magazine on this one.)

1. Public insurance does not have to make a profit as a private system does. So it can cost less.

2. Medicare actually costs (the taxpayer) less than private insurance plans cost their clients.

3. Many European countries have universal public health care plans, all of which are significantly less costly per capita than current US (public and private) medical expenditures, with lower rates of infant mortality, morbidity and mortality generally.

4. Steve’s argument applies equally well to public schools (not to mention tuition-free university education, and government-supported daycare, which work well in several European countries).

This is the best exchange of ideas I think I’ve ever seen on a blog.

Congratulations.

Well, you and I have different ideas of how the government should operate. When it comes to taxation, and services, I don’t really place any limits on where government can operate. I’d like them to pay for it via progressive taxation, so I’d rather they not deficit spend. Beyond that, so long as they are accountable to the electorate, any minor damage done can be undone. As for mandates, I think they should be more careful. Obviously the things you’ve mentioned are extreme. However, if they were to slightly tax junk food, and subsidize gym memberships I might be okay with that so long as they could show me that the dead weight loss is outweighed by the cost of the externality.

The bottom line is that traditionally we trust critical services to the government. Anything we really need to trust, they provide, be it defense, education, law enforcement, emergency services, water delivery, etc. Further, the argument that private services can not compete with public services is bogus, there are private schools, poland springs, Xe services, etc etc etc… Since I place health care in roughly the same category of service, I see no problem with having the government offer some competition in providing that service. Giving basic preventative medical care to 30M people that don’t have it is almost certainly worth whatever dead weight loss we’re risking.

I don’t feel, for instance, that because the postal service exists, somehow my freedoms are being stripped away.

Thoughtful post, but you fail to touch on the perhaps biggest problem: the high cost of malpractice insurance, which on the one hand leads to unnecessary testing (driving costs up further) and on the other hand is unavoidable as long as you don’t include tort reform to limit extremely large financial settlements and practically ensures that a trial lawyer service industry arises, as they make their living off a percentage of high-value settlements.

If the Obama Administration and the Democratic Congress want to remove the profit motive from health care – which is the gist of current legislation – then I say we might want to remove the profit motive from legal representation in malpractice suits first to see how that can reduce unnecessary testing and extremely high insurance costs as well.

Unless that is done, any reform is doomed to failure: we are, if anything, opening up liability for US taxpayers to cover malpractice cases. That way lies true madness…

Also, I think you’re a bit too optimistic about how much of the money saved from Medicare cuts would go to the poor. You said it yourself–the government sucks and rarely helps or care about the poor.

Think about it. The presence of a pet in the home will keep the seniors active and cheerful. And dying at home will reduce a great deal of the onerous cost of end-of-life hospitalization.