More on health care

A liberal colleague of mine, who identifies himself as an evangelical but stands squarely outside 2000 years of Christian tradition on matters of legal and political philosophy, is fond of the Wallisian argument that Christian moral teaching demands single-payer health care. Christians have a moral obligation, he thinks, to employ the state to ensure that disparities in health care are eradicated.

The flaws in this argument are too many to count. But it is important to respond to this sort of nonsense because many liberal Christians, eager for an excuse to vote for Barack Obama, are buying it.

First, this consequentialist account of political engagement simply does not hang together. It is entirely inconsistent with 2000 years of orthodox Christian teaching on jurisprudence and poltical philosophy. The Church has always taught a moral philosophy that is deontological and emphasizes the importance of the Eschaton values -- virtue, the Good -- relative to things of lesser and merely temporal importance, such as human conditions. In short, these Christian consequentialitsts stand squarely outside of orthodox Christianity. Perhaps that is not troubling to so-called "progressive Christians," but it should at least cause them to pause.

That aside, the assumption on which the argument is predicated -- that the justness or morality of a policy is determined by its consequences (the "moral goal," to borrow your oxymoron) -- is anything but self-evident, and liberal Christians have not bothered to demonstrate it. I would love to know they plan to get around the incommensurability problem, which in the last 50 years has caused consequentialist philosophers the world over to abandon consequentialism as untenable. So far, they aren't saying.

As a prudential and factual matter, their claims are simply wrong. "Progressive" -- statist and collectivist -- proposals have never, anywhere, at any time reduced disparity in healthcare (is it disparity to which they object or inadequacy?), reduced waste, or made anyone more healthy. Health care rationing in Canada is now so extreme that doctors are actually dropping patients from their practice lists. I suppose in that sense, Canada's statist system has reduced disparity: everyone is equally unable to obtain adequate health care.

An old joke about the Soviet economy went like this. After ordering his car at a local dealership, a customer inquired when it might be available to pick up. The dealer told him, "You can come by to get it on February 3, two years from now." The customer replied, "I can't. The plumber's coming that day."There's a reason why that joke is funny. It was true.

Indeed, most (though certainly not all) of the failures of the current health insurance system are due to too much state intervention and not enough freedom of market. If insurers were freed from disparate and restrictive state regulatory schemes, a national market would naturally emerge, increasing access and reducing costs.

The tradeoff would be that less affluent people would end up with "Wal-Mart" plans and more affluent people would end up with "Brooks Brothers" plans. In the minds of conservatives, that would be a good thing. Better a Wal-Mart plan than no plan at all. But liberals care more about disparity than about access, so they prefer a single-payer system that rations a smaller quantum of health care on more equal terms.

McCain's plan is, in the minds of conservatives, superior to the statist solution Obama offers for all of these reasons.