The Morality of a Single Payer Health Care System


Yes, the court’s decision was remarkable. It implies that Dr. Hirano and others would inflict harm on the child, as if he’s some third world quack pushing Laetrile.
The Gard case is one of my greatest fears of government controlled healthcare: a significant loss of rights, parental and individual.


And you know as well as I do that the necessarily heavy tax burden on many Americans will exclude that right.

I’m a progressive and I don’t say that. I see nothing wrong with everyone getting a base level of care paid for and those who can afford it can get more or better care on their own. I don’t think that is unfair.

Perhaps you won’t, but you do know the strong radical egalitarian tendencies in the progressive movement.


Bureaucrats do not tolerate dissent.

They have these MASSIVE policy and procedures manuals … and that is what they follow.


Yep. Their way is the right way, and alternatives should not be considered or allowed.


This is true, but it represents parental authority and autonomy. Gard’s treatment would have been outside government control.


The Charlie Gard case has everything to do with medical ethics and little to nothing to do with medical payment systems; this can be seen by the fact that the UK wouldn’t allow the treatment even if it was funded privately. The UK courts and doctors determined that pursuing further heavy medical treatment for Charlie Gard would be unethical because it had little to no chance of improving his quality and duration of life, and if it did prolong the duration it would not improve the quality. Add to this the fact that Charlie would be undergoing disruptive medical procedures as he died and you have a case for preventing the family from pursuing the procedures for Charlie.

Now I don’t agree with every aspect of their determination, but I understand that it wasn’t about the type of payment system involved. If Charlie had been in the U.S. and his parents had said they wanted to remove him from the hospital so that they could take him home and “beat the evil spirits out of him”, he would have been kept out of their care under the same ethical principles. That we don’t consider “beating evil spirits out” to be in the same category as the medical treatments Charlie was to be subjected to has to do with our position on the validity of experimental medicine and hope in extreme cases, not with our notions of private versus public payment of medical bills. Were the UK a private pay system the same ethical constraints would have applied.

Peace and God bless!


They would have rejected the attempt to remove Charlie from the hospital because there would have been clear intent to cause harm associated with the removal.

And the medical payment system does have to do with the ethics here, because a nationalized healthcare system requires that the government force everyone to play the game to pay for those who can’t cover their own costs, which means that if someone bilks the system (it’s a bureaucracy; somebody’s going to bilk it) then I have to pay for it, and if someone wants to get an abortion paid for by the American NHS equivalent we’re dealing with in this hypothetical situation, then there’s nothing I can do about it.


All that “play the game” really requires is that everyone pay for the system with their taxes. It is a feature of some single-payer systems that doctors cannot do business outside of the system for direct payment from the patients. But that feature is not a necessary part of nationalized health insurance. Some systems do not have that feature. And if Charlie’s parents had been living under one of those systems, they could have gotten him moved at their own expense (which they were prepared to do.) The part about the government deciding it would cause Charlie harm is a separate issue and is not a necessary feature in any such system.


And this has nothing to do with a single-payer system and everything to do with the medical ethics of the country in question. The exact same scenario could arise in a private payer system. We have states in the U.S. that can even force medical treatment of children against the will of their parents. It is all about medical ethics.

This has nothing to do with Charlie Gard, nor medical ethics.


It has to be a feature of nationalized health insurance one way or the other (whether via taxes or the no pay, no play system) because otherwise only the poor would have any reason to participate, and since they can’t afford to pay for it (otherwise they’d just pay for care themselves), the system shoots itself in the foot.

And again, what happens if the government decides that a “basic level of care” includes something morally objectionable, like contraceptives (as has already happened with Obamacare) and abortion (which has several precedents in other nations)? And what happens when people abuse the system and I’m forced to foot their bill?


In a private system, the government doesn’t get to decide. The parties in the contract do.


Incorrect. In the U.S. a child can be forced to receive medical care against the wishes of the parents, and a child can be “protected” from medical treatment that is deemed unethical.

While Charlie Gard may have been permitted in the U.S. to receive the medical treatments his parents sought, it would have nothing to do with who got the bill and everything to do with such treatments being considered ethical for a child in Charlie’s condition. Even so there are still limits to what can be done as a medical treatment, especially to a child, in the U.S.

You are talking about an entirely different matter than what occured with Charlie Gard.


We are talking about two different kinds of “participate” that do not have to go together. One kind is participating by paying for it. And in that sense you are right. Unless everyone is forced to “participate,” only the poor would have any reason do it. Nationalized health insurance would fall apart without that.

The other kind of “participate” is to take advantage of the benefits - use only the doctors they recommend - get only the treatment they recommend, etc. In the UK, apparently this kind of participation is also mandated. But it does not have to be so. In principle, there can be a system of nationalized health insurance (as opposed to nationalized health care) that everyone must pay into, but nobody is forced to utilize beyond that. A good example of that idea can be found in state-sponsored public education in the US. Participation in the sense of paying for it is mandatory. Usually it is through property taxes. Everyone pays. But no one is forced to send their kids to public school. They can send their kids to private schools if they pay for it themselves. And of course they still have to pay their school taxes for the schools they do not use. It has worked that way for a long time in the US. Why can’t nationalized health insurance work that way too?


In the present system, doctors have choices. If they think what they will be paid by Blue Cross is unfair then they can align with Aetna, United Health, Cigna, etc.

Under single payer, do the docs have other choices than to accept what some government bureaucrat’s idea is of fair?


They can go outside the system and not take government insurance.


Private pay and private insurance could certainly still exist.


Except that the taxes even into the 4th and maybe 5th lowest quintile of earners will have to be so confiscatory as to leave most people without the means of paying for it, other than the ruling class, of course.
Now, if under single payer, each individual gets a voucher to buy private insurance, then it would be possible.


People are able to afford supplemental insurance in France, whether through work or privately. The taxes are higher, obviously, but not so much that people can’t afford to live. The doctors and hospitals charge less, however, and there is less luxury even while there is faster and more comprehensive care.


That is effectively what Obamacare is now.


No it’s not. The vast majority of Americans are not even insured under ACA. And many in the individual market pay for their own.

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