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Health Care: A Lesson in Practical Philosophy
...I suspect that Holbo, and many of my interlocutors, are made intensely uncomfortable by the idea that their root assumption--that they are on the side of reducing human suffering and lengthening lifespans--might be wrong. There are a bunch of ways you can deal with this disturbing possibility. You can scream at me. You can posit a highly speculative world in which government and academia suddenly, and for no apparent reason, get a lot better a inventing devices and mass-market drugs than they have so far proven. You can claim, falsely, that government and academia already do all the work producing useful drugs. You can assume that slashing pharma profits 80% will have no impact on their behavior, or at least, only change the behavior you want to change.

Or you can bite the bullet and say, we should save lives now at the expense of lives later. There's philisophic justification for that choice. But that opens up a whole can of worms about things like global warming. It helps if you phrase it aggressively: "How dare you suggest that someone should suffer now when we can treat them, so that someone who's not even born yet can live?" and don't think much about the equally inflammatory alternative formulation: "How dare you suggest that billions and billions of people suffer and die for the sake of a few uninsured Americans right now?" Geometric progressions are a bitch. So is figuring out the right discount rate for the lives of future world citizens, as William Nordhaus and Nicholas Stern can attest....

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I'll close by returning to the practical question. If my objection is just "practical", he says, then why don't I include the good that could be done by a national health care program if it worked? Well, I have. I've acknowledged that at least some people would have to be better off under such a system (and others worse off, and I can't begin to calculate which group is larger) But as I said at the beginning, geometric progressions are a bitch. If the innovation spurred by the private sector could save 1% of the people who currently die each year, the number of people we'd be killing along with the private sector would necessarily be hugely larger than the number of people we'd save by implementing such insurance, since the most grotesquely exaggerated estimates released by interest groups pin the latter figure at around 0.8% of deaths in America (a much smaller number than the number who are estimated to be killed by access to the system--nosocomial infections and treatment side effects). That's even before you consider the people in other countries who would be saved by these advances. When I talk about the utilitarian calculus of weighing the good of current uninsured against the good to people who are currently, and in the future, untreatable without further innovation....