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When I try to formulate a sound moral foundation for having universal healthcare that all citizens pay taxes towards, I always get tripped up that we don't argue the same for food, water, and housing - all of which are required for a productive citizenry.

While we (in the US) subsidize food and housing for our poorer citizens, we do not for folks with the means to pay. Yet, when we talk about universal healthcare, everyone would be covered regardless of their income level.

Is comparing these necessities for life and productivity logical and if so, how can we logically argue treating one differently than the others?

  • I'm sorry, but what is or is not reasonable is a matter of personal opinion. We generally don't handle opinion based questions. – Philipp Oct 8 '19 at 7:41
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    While "reasonableness" of moral premises is a subjective criteria, how to provide goods and services can be made into a more objective (though controversial) question that can be answered with economics. – Joe Oct 8 '19 at 14:38
  • @Philipp, I changed the word 'reasonable' to logical which was the original intent - is it a sound/reasonable/logical 'apples to apples' argument to make or no? – CramerTV Oct 8 '19 at 15:15
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Food is not really a singular fungible resource. If we had some sort of universal food distribution system set to maximize "keeping people alive and healthy" while minimizing cost everyone would probably be drinking some sort of potato-soy based slurry. A similarly broad mandate for healthcare would be much less objectionable since there is a narrow range of options for most cases where we can very easily measure cost effectiveness.

There's also the fact that the distribution of both resources differs greatly even if both systems are ostensibly "private" in the US. Healthcare is distributed via insurance groups. The existence of multiple groups means that this is an industry with large amounts of administrative overhead (which can be reduced with monopolization). These separate groups also also suffer from the fact that many healthcare services have to be administered locally and no group has universal coverage across all possible service providers. Also, while something like food isn't fungible in that grain != meat on the open market, these things are treated as international commodities to an extent, there is an international market for lots of foodstuffs that manage to move across borders. The closest analog to this in healthcare would be drugs, which does not have access to a similar international market in the US. Something like insulin should be a fungible resource comparable to soy or wheat, but government regulations (backed in large part by regulatory capture from drug manufacturers) prevent its market price from reaching anything approaching what you can get in other countries.

Also referring to the examples given about distribution of water, public utilities are administered by local monopolies which are tightly regulated by the government. There absolutely are things like price controls or universal supply limits that can't be circumvented by having more money, that rolling brownout doesn't care that you're a millionaire, there is no premium subscription of electricity for you to buy. The fact that other countries have discovered that healthcare should be administered as a public good similar to utilities or transportation infrastructure isn't a fluke, it simply works out better that way.

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  • Thank you for offering an alternative 'necessity' (public good) for comparison. – CramerTV Oct 8 '19 at 15:26
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What makes healthcare different from food, water, and housing is that some people (and we can't know exactly who) will need far more of it than others, and far more than anyone but the richest can afford.

No-one is going to die if they don't get a mansion.

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  • "is that some people will need far more of it than others" - this also happens in the medical sector: some might need (and typically cannot afford) very expensive treatments for a difficult cancer or similar and others might die before ever reaching for a doctor. – Alexei Oct 8 '19 at 5:03
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    Wasn't that what I wrote? – Rupert Morrish Oct 8 '19 at 5:04
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A major difference between food, water, housing and medical services is that the need for medical services is quite rare when compared to the first ones. You virtually need food, water, housing all the time, while one can can go to a doctor 1-2 / year.

In this regard, the government is forced to tackle any policy to solve food, water and housing long before going for the more complex issue of medical services.

Referring to a "sound moral foundation" I think that one argument is that human life is very valuable and a system that allows preventable deaths to happen is not moral.

Of course, what preventable means is quite hard to explain. I live in a country that has a national health system, but I am lucky enough to also have a private medical insurance. If my doctor says I need a CT scan to further investigate an illness I can either choose to pay for it (partially or totally, depending on private insurance) and get it done in about a week or wait several weeks or months to get it done "freely" through the national healthcare system. In some cases these waiting times make a significant difference in terms of life expectancy.

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  • I did not realize there were the type of hybrid public and private health insurance markets you describe. I will have to look into that further. Thank you for educating me! – CramerTV Oct 8 '19 at 15:24

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