The Conservative Case for Universal Healthcare

The American Conservative ^ | July 25, 2017 | Chase Madar

[Colonel Kangaroo]

Don’t tell anyone, but American conservatives will soon be embracing single-payer healthcare, or some other form of socialized healthcare.

Yes, that’s a bold claim given that a GOP-controlled Congress and President are poised to un-socialize a great deal of healthcare, and may even pull it off. But within five years, plenty of Republicans will be loudly supporting or quietly assenting to universal Medicare.

And that’s a good thing, because socializing healthcare is the only demonstrably effective way to control costs and cover everyone. It results in a healthier country and it saves a ton of money.

That may seem offensively counterintuitive. It’s generally assumed that universal healthcare will by definition cost more.

In fact, in every first-world nation that has socialized medicine–whether it be a heavily regulated multi-insurer system like Germany, single-payer like Canada, or a purely socialized system like the United Kingdom–-it costs less. A lot, lot less, in fact: While healthcare eats up nearly 18 percent of U.S. GDP, for other nations, from Australia and Canada to Germany and Japan, the figure hovers around 11 percent. (It’s no wonder that smarter capitalists like Charlie Munger of Berkshire Hathaway are bemoaning the drag on U.S. firm competitiveness from high healthcare costs.) Nor are healthcare results in America anything to brag about: lower life expectancy, higher infant mortality and poor scores on a wide range of important public health indicators.

Why does socialized healthcare cost less? Getting rid of private insurers, which suck up a lot money without adding any value, would result in a huge savings, as much as 15 percent by one academic estimate published in the American Journal of Public Health. When the government flexing its monopsony muscle as the overwhelmingly largest buyer of medical services, drugs and technology, it would also lower prices-–that’s what happens in nearly every other country.

So while it’s a commonly progressive meme to contrast the national expenditure of one F-35 with our inability to “afford” single-payer healthcare–and I hesitate to say this lest word get out to our neocon friends–there is no need for a tradeoff. If we switched to single payer or another form of socialized medicine, we would actually have more money to spend on even more useless military hardware.

The barrier to universal healthcare is not economic but political. Is profligate spending on health care really a conservative value? And what kind of market incentives are working anyway–it’s an odd kind of market transaction in which the buyer is stopped from negotiating the price, but that is exactly what Medicare Part D statutorily requires: The government is not allowed to haggle the prices of prescription drugs with major pharmaceutical companies, unlike in nearly every other rich country. (Both Hillary Clinton and Donald Trump pledged to end this masochism, but the 45th president has so far done nothing, and U.S. prescription drug prices remain the highest in the world.) Does anyone seriously think “medical savings accounts” with their obnoxious complexity and added paperwork are the right answer, and not some neoliberal joke?

The objections to socialized healthcare crumble upon impact with the reality. One beloved piece of folklore is that once people are given free healthcare they’ll abuse it by going on weird medical joyrides, just because they can, or simply let themselves go because they’ll have free doctor visits. I hate to ruin this gloating fantasy of lumpenproletariat irresponsibility, but people need take an honest look at the various health crises in the United States compared to other OECD (Organisation for Economic Cooperation and Development) countries. If readily available healthcare turns people hedonistic yahoos, why does Germany have less lethal drug overdoses than the U.S. Why does Canada have less obesity and type II diabetes? Why does the Netherlands have less teen pregnancy and less HIV? The evidence is appallingly clear: Among first-world countries, the U.S. is a public health disaster zone. We have reached the point where the rationalist santería of economistic incentives in our healthcare policies have nothing to do with people as they actually are.

If socialized medicine could be in conformity with conservative principles, what about Republican principles? This may seem a nonstarter given the pious market Calvinism of Paul Ryan and Congressmen like Reps. Scott Perry (R-Pa.) and Mo Brooks (R-Ala.), who seem opposed to the very idea of health insurance of any kind at all. But their fanaticism is surprisingly unpopular in the U.S. According to recent polling, less than 25 percent of Americans approve of the recent GOP healthcare bills. Other polls show even lower numbers. These Republicans are also profoundly out of step with conservative parties in the rest of the world.

Strange as it may seem to American Right, $600 EpiPens are not the sought-after goal of conservatives in other countries. In Canada, the single-payer healthcare system is such a part of national identity that even hard-right insurgents like Stockwell Day have enthusiastically pledged to maintain it. None of these systems are perfect, and all are subject to constant adjustment, but they do offer a better set of problems–the most any mature nation can ask for–than what we have in the U.S.

And virtually no one looks at our expensive American mess as a model.

I recently spoke with one German policy intellectual, Nico Lange, who runs the New York outpost of the German Christian Democrats’ main think tank, the Konrad Adenauer Stiftung, to get his thoughts on both American and German healthcare. Is socialized medicine the entering wedge of fascism and/or Stalinism? Are Germans less free than Americans because they all have healthcare (through a heavily regulated multi-payer system), and pay a hell of a lot less (11.3 percent of GDP) for it?

Mr. Lange paused, and took an audible breath; I felt like I had put him in the awkward spot of inviting him over and asking for his honest opinion of the drapes and upholstery. “Yes,” he said, “we are less free but security versus freedom is a classic balance! National healthcare makes for a more stable society, it’s a basic service that needs to be provided to secure an equal chance for living standards all over the country.” Even as Mr. Lange delineated the conservative pedigree of socialized medicine in Germany–“You can certainly argue that Bismarck was a conservative in founding this system”–I had a hard time imagining many Democrats, let alone any Republican, making such arguments.

Indeed, the official GOP stance is perhaps best described as Shkrelism than conservatism, after the weasel-faced pharma entrepreneur Martin Shkreli, who infamously jacked up the price of one lifesaving drug and is now being prosecuted for fraud. (Though in fairness, this type of bloodsucking awfulness is quite bipartisan: Heather Bresch, CEO of Mylan corporation, which jacked up the price of EpiPens from $100 to $600, is the daughter of Senator Joe Manchin (D-WV), who defended his daughter’s choice.)

But GOP healthcare politics are at the moment spectacularly incoherent. Many GOP voters have told opinion polls that they hate Obamacare, but like the Affordable Care Act. And as the GOP healthcare bill continues to be massively unpopular, Donald Trump has lavished praise on Australia’s healthcare system (socialized, and eating up only 9.4 percent of the GDP there). Even in the GOP, this is where the votes are: Trump’s move to the center on questions of social insurance–Medicare, Medicaid, Social Security–was a big part of his appeal in the primaries. The rising alt-Right, not to hold them up as any moral authority, don’t seem to have any problem with universal Medicare either.

It will fall on “reform conservatives” to convince themselves and others that single-payer or some kind of universal care is perfectly keeping with conservative principles, and, for the reasons outlined above, it’s really not much of a stretch. Lest this sound outlandish, consider how fully liberals have convinced themselves that the Affordable Care Act–a plan hatched at the Heritage Foundation for heaven’s sake, and first implemented by a Republican governor–is the every essence of liberal progressivism.

Trump’s candidly favorable view of Australian-style socialized healthcare is less likely a blip than the future of the GOP. Republican governors who actually have to govern, like Brian Sandoval and John Kasich, and media personalities like Joe Scarborough, and the Rock, will be soon talking up single-payer out of both fiscal probity, communitarian decency, and the in-your-face evidence that, ideology aside, this is what works. Even the Harvard Business Review is now giving single-payer favorable coverage. Sean Hannity and his angry brigade may be foaming at the mouth this week about the GOP failure to disembowel Obamacare, but Sean’s a sufficiently prehensile fellow to grasp at single-payer if it seems opportune–just look at his about-face on WikiLeaks. And though that opportunity has not arisen yet, check again in two years.

The real obstacle may be the Democrats. As Max Fine, last surviving member of John F. Kennedy’s Medicare task force, recently told the Intercept, “Single payer is the only real answer and some day I believe the Republicans will leap ahead of the Democrats and lead in its enactment,” he speculated, “just as did Bismarck in Germany and David Lloyd George and Churchill in the UK.” For now, an invigorating civil war is raging within the Democrats with the National Nurses Union, the savvy practitioner-wonks of the Physicians for a National Health Program, and thousands of everyday Americans shouting at their congressional reps at town hall meetings are clamoring for single-payer against the party’s donor base of horrified Big Pharma executives and affluent doctors. In a few years there might even be a left-right pincers movement against the neolib/neocon middle, whose unlovable professional-class technocrats are the main source of resistance to single payer.

I don’t want to oversell the friction-free smoothness of the GOP’s conversion to socialized healthcare. Our funny country will always have a cohort of InfoWars ooga-boogas, embittered anesthesiologists and Hayekian fundies for whom universal healthcare is a totalitarian jackboot. (But, and not to be a jerk, it’s worth remembering that Hayek himself supported the socialized healthcare of Western Europe in one of his most reasonable passages from the Road to Serfdom.)

So even if there is some banshee GOP resistance at first, universal Medicare will swiftly become about as controversial as our government-run fire departments. Such, after all, was the trajectory of Medicare half a century ago. You read it here first, people: Within five years, the American Right will happily embrace socialized medicine.

Chase Madar is an attorney in New York and the author of The Passion of Bradley Manning: The Story Behind the Wikileaks Whistleblower.

[usconservative]

And that’s a good thing, because socializing healthcare is the only demonstrably effective way to control costs and cover everyone. It results in a healthier country and it saves a ton of money.

Don't have to read any further. Just look north to Canada to see how they excessively tax alcohol as one example to "control costs, cover everyone" and "save a ton of money."

Try buying a case of beer in Canada and see how much one pays as compared to here in America.

All those taxes on beer? That's to pay for their healthcare.

All the taxes on income? To pay for their healthcare.

And that list goes on, and on, and on!

Anyone who thinks socialized medicine is effective needs to simply look across the pond at a 11 month old child that was DENIED life-saving treatment early on and was condemned to death in the UK by the NHS.

Charlie Gard, The Face of Socialized Medicine.

[wastoute]

Exactly. If you think healthcare is expensive now, just wait until it’s “free”.

[Interesting Times]

Chase Madar is an attorney in New York and the author of The Passion of Bradley Manning: The Story Behind the Wikileaks Whistleblower.

This tells you everything you need to know.

[wastoute]

Anybody who believes you can meet an unlimited demand with a limited supply needs to go back to Econ 101.

[nclaurel]

Think that U.K. Healthcare includes dental? Just looking at the teeth of even the royals makes that scary.

[Buckeye McFrog]

To their credit most Canadians I have met have been honest enough to admit that their health care is not “free”. They pay enormous taxes for it.

[usconservative]

Oh I know most Canadian’s are honest about it, I know a few. It’s the dumbass liberal Americans who think it’s “free” north of the border ..... idiots.

[mjp]

American conservatives will soon be embracing single-payer healthcare, or some other form of socialized healthcare.

conservatives will not want to give the gooberment control of our lives which it will have if it controls health care

[dforest]

Yes, the NWO wants Universal healthcare in every country so they can control all people.

We saw how they handled the Charlie Gard case.

He gets death.

Many in the GOP are world government types. I am sure they have been promised a lot of cash to make it happen.

They no longer care about the people as you can see.

[SoCal Pubbie]

Of course. I was simply stating that if there is no direct monetary impact on individuals for medical treatments, then use of the healthcare system will go way up. The only ways to control costs will be to remove profit (and high salaries) from both medical technology companies and individual doctors, and withholding care. The former will mean fewer new drugs and treatments with less competent doctors, and the latter will mean more patients will die awaiting treatment.

[Personal Responsibility]

“...American conservatives will soon be embracing single-payer healthcare...”
“...But within five years, plenty of Republicans will be loudly supporting or quietly assenting to universal Medicare.”

Using “Conservatives” and “Republicans” interchangeably is wrong. Most Republicans are not conservative.

[kingu]

It is estimated that health care will actually end up being 20% of the GDP next year.

So here's the unasked question; if some magic bullet legislation goes through and we shrink healthcare from 20% of the GDP to just 10%, and the sub-prime mortgage collapse only slashed the GDP by 4%, what will the economy look like?

And a second question: Once healthcare is slashed nearly 50%, will every other country in the world's healthcare costs rise to fill the void in all that cash we pumped into the system which pays for most medicine development?

And the last question: Aside from the initial reductions in cost, every single national health care program has gotten progressively more expensive. It is just easier for countries which we protect to dedicate more and more of their national budget to cover - as we do not have that cushion, how do you keep national healthcare going more than a decade?

[Leep]

Well, Hitler was a right-winger according to lefties?

[arthurus]

Much more effective and far cheaper to accomplish all those dreamy things is completely untethering Medicine and Insurance from the Federal Government. When those become competitive businesses, access and medical progress will increase to levels only claimed and unattainable with SP. With SP costs are "contained" by denying people medical care for rational government reasons and the quality must decline as it is already declining as the best and the brightest are less and less inclined to go into medicine and the best in the field are retiring from the field or going offshore. It is what happened in England and in Canada and has begun here.

With SP the common folk have an equal chance to be turned down by a bureaucrat for treatment if we are deemed to be non productive, and the bias toward favored minorities will disappear, too. When the USA goes to SP R&D will end for the most part as the funds will be in competition with Defense and Welfare and Roads and Graft & Corruption and the development of new drugs will end, including the development of new antibiotics to replace the declining extant drugs. It will not be quick and the percentages of people succumbing to their maladies will gradually increase as the antibiotics become less and less effective.

America is the sole reason there is medical R&D anywhere in the world. America still grants patents to new drugs and allows the inventors to recoup their investment with patent prices. No other country does that and they all clone new inventions for their own societies or force the inventors to sell at generic prices. Even the ruling class will not notice the loss until the capability for R&D is gone and not easily recoverable, probably not recoverable at all because the Ruling Class can only conceive of rebuilding it with strict management and control.

SP will complete the transition to stagnant and declining Socialism. Politics will be all about this minority or that minority being promised tweaks and favors to right a perceived wrong in the system or get special consideration for this group and that one. The oligarchs will continue to get the very best of medicine but that will also be in continual decline which they won't even notice because the level of medicine will be so much higher for them than for the "masses." Perception is relative, even for them.

[alloysteel]

Outcomes of “single payer” adoption -

1. All innovation in advancements in treatment of conditions both common and uncommon comes to a screeching halt.

2. “Death panels” which have final authority to choose to suspend or reduce care to palliative treatment only, when the continued life of the patient must show some “economic benefit” measured in “Quality of Life in Remaining Years”, a measurement that may be highly subjective.

3. Delays in the treatment of conditions, leading to deterioration of the condition over time, that change what would have been an easily treated ailment into a life-threatening crisis or even inducing early death.

4. Rules which make it a punishable offense to seek treatment from another unauthorized source, and for which any future participation in any aspect of the single-player scheme is expressly forbidden.

And these are just the more egregious of the bad outcomes of adoption of this system. Longer range, the quality of the medical professionals is sure to decline, as fewer and fewer applicants see much of a future in becoming a medical professional, as the returns on the time invested diminish to the vanishing point, in terms of a sense of dedication, and emotional reward for efforts expended, let alone the economic aspects of a much reduced level of remuneration.

[onedoug]

Tell everyone, that American RINOs will soon be ruining healthcare for the nation.

[FlingWingFlyer]

I don’t think Chase’s elevator goes all the way to the top. He even thinks he’s a “conservative”. A “conservative” what, I don’t know.

[momincombatboots]

He said it saves money and lives.. after that, I stopped reading because Charlie Gard wasn’t the exception, he was the rule.

[Terry Mross]

If it takes as long to see a doctor as long as it takes to read this rambling, boring article, we won’t need to see one we’ll be terminal.

[Jim Noble]

After last night, is this the wave of the future?

Well, I've been posting something quite similar to this for more than a year.

Let me condense and translate into ConSpeak™.

The taxpayers, through their representatives, have both the right and the obligation to direct how their hard-earned dollars are to be spent. Medicare, by promising to pay without limit for all "reasonably necessary" things erected a giant industry to discover and to deliver those things, none of which were perceived as necessities in 1965, all of which are in 2017.

Since at least 1992, and probably since 1986, this enterprise has been financed through debt, money printing, and a corrupt engagement with the insurance industry. The taxpayers want a return to regular order, where the government has a budget such that it is possible to know, and to predict, what things will cost.

But, with taxpayer payment without limit for new and useful inventions, by God, they keep coming. And the recipients of these things, since they have by now monstrous co-pays and other financial obligations arising out of the corrupt government engagement with the insurance industry, believe they are "paying for it", when, in reality, the taxpayer is (one way or another) on the hook for at least 90% of the river of cash that sustains the system.

It has to stop. It will stop with collapse (most likely) or with some form of "national health care" which will at last have a fixed cost per year.

If we are lucky, there will be a robust private option. If we are unlucky, we will have a Soviet system where private care only exists for the nomenklatura.

Either way, a crisis is right around the corner. The choices are: keep borrowing and printing until everything collapses OR have a national system with a fixed budget, hopefully with more for those who want it and can pay for it.