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The Conservative Case For Universal Healthcare
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on’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.
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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 (http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS): While healthcare eats up nearly 18 percent of U.S. GDP, for
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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
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high healthcare costs.) Nor are healthcare results in America anything to brag about: lower life expectancy, higher infant
mortality (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/) 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
(http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2015.303157)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
(https://www.usatoday.com/story/opinion/2014/04/20/medicare-part-d-prescription-drug-prices-negotiate-editorialsdebates/7943745/): 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?
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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
(http://www.oecd.org/about/membersandpartners/). 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 (http://www.cbsnews.com/news/pollhalf-of-people-in-u-s-prefer-obamacare-over-gop-health-care-proposals/) of Americans approve of the recent GOP
healthcare bills. Other polls show even lower numbers
(https://www.usatoday.com/story/news/politics/2017/06/28/suffolk-poll-obamacare-trump-senate-health-careplan/103249346/). 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 (https://insiders.fortune.com/dont-only-blame-mylan-for-600epipens-6ad0065373e0) 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
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from-past-election-debates-1.2504919). None of these systems are perfect, and all are subject to constant adjustment, but
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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 (https://www.scientificamerican.com/article/martin-shkreli-who-raised-drug-prices-from-1350-to-750-arrested-in-securities-fraud-probe/), 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
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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 (https://www.forbes.com/sites/theapothecary/2011/10/20/how-a-conservative-think-tankinvented-the-individual-mandate/#3d5e4db36187) 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 singlepayer favorablecoverage (https://hbr.org/2017/07/is-the-u-s-ready-for-a-single-payer-health-care-system). 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,
recentlytold (https://theintercept.com/2017/07/19/trumpcare-is-dead-single-payer-is-the-only-real-answer-saysmedicare-architect/) 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
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now, an invigorating civil war is raging within the Democrats with the National Nurses
Union, the savvy practitioner-wonks of the Physicians for aACCEPT
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.
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