Why Not Provide Medicare To Everyone In The World?

The Selfish Leftist Heart” pointed out that Medicare for All (“MFA”) is a misleading moniker for proposals that provide health insurance coverage for only a select, relatively wealthy group of people who happen to live in America. “The Immorality of Medicare For Less Than All” explained how (1) MFA supporters give themselves too much credit for being empathetic when they sanguinely and uncritically condone proposals that deny billions of poorer people their “human right”[i] to healthcare, and (2) if the first point was brought to their attention, many of them would switch their demands to “Medicare For Everyone in the World” (“MFE”). The post ended with this: “However, neither MFA for Americans only nor everyone in the world is a moral proposition” and a promise to explain why that is true in this post. This post will sort out what is immoral about MFE.


Author’s Note: An essential premise for the following argument that support for MFA is immoral is the following:

No matter how positive the benefits of a policy are (e.g., every poor person in the world getting all the healthcare they need would be immensely positive), the policy is, nevertheless, bad if its negative consequences are greater than its positive consequences. Supporting proposals that do more harm than good is immoral.


Why not MFE? In a word, math.

About 7.75 billion humans are alive today.[ii] The sum of the annual GDP[iii] of every country totals about $87 trillion.[iv] That means that humans are producing goods and services of a mere $11,225 per person per year ($30/day). Over the long haul, humans cannot consume more goods and services than they produce. So, the average consumption per person per year cannot sustainably exceed $11,225. If some people consume more than that amount, there will be less than that amount available to be consumed by others. Just under one billion people live on less than $2/day (which is about one billion fewer than were living at that level in 1990).[v]

The average per-person consumption (which includes the consumption of healthcare) of Americans in the bottom 10% is over $15,000 per year.[vi] So, if world GDP were redistributed so that consumption by all the people of the world were equalized, the amount of consumption of “poor” Americans would fall about 25% from what they currently consume, i.e., MFE would mean more healthcare coverage for billions of desperately poor people, but vastly less healthcare for all Americans, including the about 11 million “poor” Americans to which MFA would provide healthcare coverage. Because food and shelter are higher human priorities than healthcare, the resources people would have to consume healthcare would be what is left over after sufficient resources are used to obtain food and shelter. Consequently, what would be available American poor people for healthcare would fall by more than 25%.

However, having healthcare coverage does not mean that healthcare, much less high-quality/timely healthcare, can be obtained. The infrastructure to deliver timely healthcare to most poor people in the world does not exist even if there were sufficient medical professionals to provide healthcare to everyone. Significant doctor shortages exist across the even wealthy parts of the world.[vii] Those shortages exist with billions of people having little to no access to healthcare. Nationalized healthcare systems typically impose long wait-times, do not provide the latest drugs if pharmaceutical companies refuse to slash their prices to near the cost of production (which drug companies will not always do), and decide not to provide healthcare when a bureaucrat determines that the cost/benefits analysis is not in the patient’s (or bureaucrat’s) favor. Passing a law to provide something does not magically cause the thing to materialize.

On the contrary, demanding the production of more of something (e.g., healthcare) typically causes the price of the thing demanded to rise. This is because the currently available volume of things is that which is economically feasible to deliver at the existing market price. In order to fund the motivation and means to produce more of the thing, the cost of the thing must rise.[viii]/sup> Demanding more healthcare be provided means either that the cost of healthcare will rise or the production system will become uneconomic/dysfunctional. For example, if providers are ordered to produce healthcare at a below-market price the number of people willing to stay in the healthcare business and the number of people deciding to enter the healthcare business will fall.

A man-made law cannot change the natural laws of economics any more than a law banning hurricanes would change the incidence of hurricanes. (Unsurprisingly, laws that ignore the natural laws of economics usually create more damage than hurricanes, albeit of a different sort.)[ix]

Given these realities, providing the level of healthcare that is available to America’s poor to all the poor of the world would require more money than the world can produce.

No moral person who is aware of reality could support the MFE. The same is true of MFA. Let’s sort that out in the next post.

[i] Healthcare is not something to which people have a human right. More on that in a future post.

[ii]World Population 2019

[iii] “[GDP] represents the total dollar value of all goods and services produced over a specific time period, often referred to as the size of the economy.

[iv] See, “Global GDP (gross domestic product) at current prices from 2014 to 2024 (in billion U.S. dollars).”

[v] See “Poverty.”

[vi] See “Finance and Economics Discussion Series Divisions of Research & Statistics and Monetary Affairs Federal Reserve Board, Washington, D.C.,”pg. 39.

[vii] See “Europe faces a shortage of doctors,”U.S. faces 90,000 doctor shortage by 2025, medical school association warns,” “Poor salaries and overwork led to shortage of doctors in China,” “Dubious cure for doctor shortage. ‘The number of doctors per 1,000 people [in Japan] is 2.2 — about two-thirds of the average level in industrialized economies.,” “India suffering critical shortage of doctors…”

[viii] See “Wealth” and “Income Inequality Is More Than It’s Cracked Up To Be.”

[ix] The discussion in this paragraph highlights a major confusion that confounds the public debate about “the cost of healthcare.” Providers of healthcare incur costs to research, invent, develop, produce, and deliver healthcare and consumers of healthcare incur costs to purchase healthcare. These two kinds of “healthcare costs” have few things in common and, in many respects conflict with each other, yet when people argue for or against MFA, they mindlessly draw no distinctions between the two. This adds major irrationality and confusion to those debates. The topic is well worth sorting out in a future post.

The Immorality of Medicare For Less Than All

The Selfish Leftist Heart” pointed out that, despite presumed morality of their proposals and their apparent sincerity, viable American politicians never actually propose what they say they are proposing, “Medicare for All” (“MFA”). Instead, they propose MFA only for people who reside in America, all of whom are wealthy compared to the billions of vastly poorer people around the world (but, of course, those people cannot improve politicians’ election prospects).

With some exceptions,[i] few, if any non-politician Americans clamor for MFA in order to gain personal benefits (though many personally do benefit from supporting MFA,[ii] while others support MFA from immoral, fallacious or misguided reasons[iii]). On the contrary, many, probably a majority of those people believe they will have to pay some part of the cost of MFA. They are happy to sacrifice for the goal they presume to be laudable. Their motivation is typically a belief that they are supporting a good cause, i.e., MFA is the moral thing to do. (Although a review of a couple of pages of search results produced no article in which the author(s) actually attempted a moral argument that supports the morality of their stance. Rather, the authors merely asserted MFA’s morality and proceeded on the strength of their unsubstantiated premise[iv]—in so doing they also revealed that they do not understand what “moral” means.[v]) Nevertheless, in order to sort out an important issue about MFA, let’s assume that someone has made a case that MFA for Americans is the moral thing to do. What about the billions of poorer people left out in the cold?

It is commonplace for MFA supporters to condemn those who do not support MFA as having insufficient (if not no) empathy. If, however, empathy is the reason to support MFA for those who cannot afford healthcare, how can those condemners justify limiting their empathy to the lucky few who happen to reside within America’s borders, i.e., people who already have much more access to healthcare (e.g., ambulance services, world-class hospitals and doctors and many charitable organizations) than the bottom few of billions in the world? If funding MFA by fleecing millionaire and billionaire is a morally acceptable way to achieve the glorious goal of MFA, how can good people morally deny the “human right” to healthcare to the more desperate billions of poorer people in the world? Are the MFA proponents vastly less empathetic than they believe themselves to be? Are they tribalistic, America First people? Are they just pretending to be empathetic? Do they have no heart? Whatever the reason, if asked about their heartlessness toward poorer people, supporters of MFA for Americans only would have some explaining to do.

On the other hand, I’ve never seen MFA champions asked/challenged about this conundrum, and I suspect that the vast majority of them have never considered how constricted and discriminatory their empathy must be to support those proposals. (Full consideration of a topic is typically not a strong suit of champions.) Confronting this issue would surely create cognitive dissonance. How might they deal with the dissonance?

My guess is that most of them would respond by attacking the questioner, but some would grapple with the issue and ultimately relieve their cognitive dissidence (from realizing that they have been supporting a racially discriminatory and insufficiently empathetic proposal) and restore their empathetic self-image by switching their demand to “Medicare For Everyone in the World.”  After all, it was not long ago that no American politician would dare insist that America’s MFA cover U.S. inhabitants who did not follow U.S. immigration law to get here. Recently, when enough leftists realized that excluding “illegal aliens” from MFA caused cognitive dissidence, leftists began insisting that “undocumented immigrants” be covered, and Democrat politicians jumped to the front of that parade.[vi] If leftists believe, as many do, that healthcare is a human right and MFA is the moral thing to do, is there a reason to believe that they would not assuage their cognitive dissidence and restore their empathetic pose by demanding MFA for everyone in the world? I think not.

However, neither MFA for Americans only nor everyone in the world is a moral proposition. Let’s sort out why that is true in the next post.

[i] The 30.4 million (11.3%) U.S. inhabitants who do not currently have healthcare coverage expect to directly and immediately benefit. See “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2018.” [The 11.3 % figure adjusts the 13.3% figure presented in this report (which was the percentage of uninsured Americans younger than 65) to take into account the 15% of Americans who are covered by Medicare.]

[ii] Many, perhaps most, people who support MFA gain from combinations of the following:

  1. The dopamine rush from believing their support is doing something moral/noble,
  2. Reducing the risk that they will be vilified, shunned, derided, ridiculed, or fired from their job by the mob that favors MFA,

[iii] Some of the supports of MFA believe they will gain from some or all of the following reasons:

  1. They believe their desire for revenge against you name it, (e.g., drug or insurance companies, political opponents, the millionaires and billionaires who they believe will pay for it, all of the above) will be satisfied,
  2. A belief in the promises of politicians that MFA will lower their own cost of health insurance, and
  3. A reduction in their risk of destitution and lack of healthcare if they lose their job or otherwise run out of money.

[iv] See  “Ady Barkan makes a moral case for single payer at first-ever Medicare for All hearing” and “Bernie Sanders: Why We Need Medicare for All.”

[v]     Consider the following claim in WE CAN AFFORD TO HAVE HEALTH CARE FOR ALL IN THE U.S:  “The core argument in favor of universal health care is the moral one, especially for people of faith. 26-year-old Alec Smith of Minnesota died in 2017 because he could not afford insulin. That is immoral.” In light of Webster’s definition of “moral:”

1      a: of or relating to principles of right and wrong in behavior : ETHICAL

//moral judgments

b: expressing or teaching a conception of right behavior

//moral poem

c: conforming to a standard of right behavior

//took a moral position on the issue though it cost him the nomination

d: sanctioned by or operative on one’s conscience or ethical judgment

//a moral obligation

e: capable of right and wrong action

// moral agent

As you can see, “moral” has to do with a person’s behavior. The moral “argument” made about Alec Smith in the above quote was “That is immoral.” Who in the story about Alec Smith did the immoral act, and what wrongdoing was committed by that person? The correct answers are no one in the Alec story engaged in immoral conduct. If the cat, who has no capacity to be moral or immoral, or misfortune caused the woeful outcome, the outcome cannot be is immoral—outcomes are not acts.

[vi] See “Where Democrats Stand.”