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.
If readily
available healthcare turns people into hedonistic yahoos, why does Germany have fewer 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
santerÃa 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.
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.
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.
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.
