Since inequality shortens the lives of people on the bottom, the idea that health care should be equalized, leaving the rest of the distribution of income, wealth, and status unchanged, lacks a coherent basis.
But doesn’t that suggest reduced inequality as a policy goal?
Footnote Actually, it’s reasonable to think that health care is less positionally consumed than other goods. There are strong reasons for me to want my suit to be nicer than yours, my car flashier, and my house bigger and fancier. But I don’t want my visit to the dentist to hurt less than yours: I just want it to hurt as little as possible. So in medical care – unlike housing – it’s possible to accomplish a genuine Pareto improvement: to make someone better off without making anyone else worse off. That constitutes an efficiency argument for allocating resources toward health care and away from more competitively consumed goods.
But Cowen’s other point remains: since relative income and status influence life expectancy, the same argument that supports equality of access to health care – that you shouldn’t die of being poor – actually supports equality across the board.
And of course that’s the source of the basic dishonesty of the entire debate over ACA. The difference between the Heritage plan and Obamacare is about $200 billion a year worth of downward income redistribution. But neither side wants to make that point: progressives because white middle- and even working-class voters have been taught to regard “redistribution” as meaning taking from them to give to those below them and darker than they are, and conservatives because they’d rather argue about “liberty” than admit that they’re waging class warfare from above.