A Conservative Argument for Single Payer

From this week's issue of The Week, an honest conservative argument for Single-Payer Health Care.

A conservative case for single-payer health care by Mathew Walther

The GOP's latest health-care push is a magic show featuring the same malnourished rabbit being pulled from the same shabby top hat Republicans have been reaching their fingers into for years before pronouncing their now-familiar incantations.

Abracadabra! they always say. Allowing companies to sell insurance across state lines! Alakazam! Block-granting — is there an uglier formulation in the English language? — Medicare to the states! Presto-chango! Medical malpractice reform! Hocus-pocus! Health savings accounts! And for my last trick, keeping the expansion of Medicaid but not paying for it!

For Republican members of Congress and the kinds of people with whom they tend to be well acquainted — defense contractors, up-and-coming fracking magnates, lawyers, purple-tied megachurch pastors — all of that sounds very convenient. For millions of other Americans, the reality is very different.

What is a 25-year-old making burritos at Chipotle for Heritage Foundation bros at $12 an hour supposed to do with the chance to funnel an unlimited amount of his meager wages into a tax-free health-savings account? Pay the rent with catheters? If he saved diligently for two or three years, he might be able to buy himself half a blood test. A colleague whose friend recently decided to open a health-savings account was forced to upgrade to a premium version of TurboTax in order to fill out the proper forms, which cost her $25 more than she had managed to put away during the previous year.

In the grand sweepstakes that is America's health-care system, I am one of the winners. My family is covered by a premium plan for which my employer pays every month without deducting so much as a penny, pre-tax or otherwise, from my paycheck. We have negligible co-pays and a whopping $500 deductible. Having two children at one of the best midwiferies in the D.C. metro area cost us virtually nothing out of pocket. If, like most Americans of my age and class, I went in for yearly check-ups, I could actually get the insurance company to pay me!

But even we have had our fair share of hang-ups. When my wife was pregnant with our first daughter, she went in for a routine ultrasound. Months later a bill arrived for something like $1,000. When I called the insurance company, they told me to disregard it because there was no out-of-pocket charge. Copies of the erroneous bill continued to pour in every few weeks regardless. Eventually they crossed paths with a much smaller bill for a second ultrasound that we were supposed to pay, but who could tell the difference? Somehow it escaped our attention and ended up with a debt collector, another black mark on a young family's credit score. This sort of thing happens to responsible people every day.

Nearly everyone agrees that our semi-private insurance-driven system is mad. It makes all the logistical sense of having the clerk at the Shell station file a claim with Geico every time you put gas in your car. The Affordable Care Act exacerbated everything wrong with the present arrangement by creating a permanent carve-out for insurance companies. Millions of Americans were left feeling the way villagers would have if the Magnificent Seven had shown up at the last minute and thrown in their lot with the bandits.

Meanwhile, conservatives insist on getting rid of the only good part of the legislation: the expansion of Medicaid. This is not because it hasn't worked but because it conflicts with Republicans' increasingly ethereal principles. Put aside for a moment the question of whether it would be desirable to return to those halcyon days when simple country doctors gave big bills to the rich, smaller ones to ordinary people, and treated the poor gratis. Is it even possible, much less feasible? No one, not even Tea Party members during the movement's heyday, has been clamoring at the door to get rid of Medicare. Even if their wildest dreams came true and they managed to get government out of health care altogether, what would happen to people in the meantime while their hypothetical army of altruist medicos mustered its forces?

The solution should be obvious. Single payer is the only way forward. The U.S. government should provide health insurance for every one of its citizens.

Already I hear the chorus of well-rehearsed objections from the right. Who's going to pay for it? Please. Every other wealthy country in the world ensures universal health-care coverage, and we are spending far more than any of them to let people above the bottom and well into what remains of the middle fall through the cracks. What about innovation? they say, as if Costa Rica, with a GDP smaller than New Hampshire's, were not a leader in the treatment of diseases such as pancreatic cancer and a destination for innovation-seeking medical tourists from around the world. (It is curious how this objection never seems to spring up in the case of the military. Should we privatize that too, lest we fall behind the denizens of the SeaOrbiter in the quest for better fighter jets?)

Single payer just isn't "conservative." Of course it is, at least if the word still means anything. Conservatism is about stability and solidarity across class boundaries, not a fideistic attachment to classical liberal dogma. When Winston Churchill's Conservative Party returned to power in the U.K. in 1951, they did not attempt to dismantle the National Health Service established six years earlier by the post-war Labour government. They tried to do a better job of running it. Conservatives in this country should get used to the idea of being prudent stewards of the welfare state, not its would-be destroyers.

Then there is the old concern about "rationing," with which I must admit to very little patience, probably because, like the claret-soaked Tories of old, I am not myself terribly interested in health. I have no doubt that if America were to adopt a single-payer system, those with sprained ankles or runny noses would indeed face longer lines. This is a good thing. Health is not the be-all end-all of human existence, and half the reason care costs what it does is that providers across the country know that they can charge BlueCross whatever they want when wealthy suburban mothers bring Dylan in after soccer practice for X-rays, MRIs, CT scans, and goodness knows what other radiological marvels, when what he really needs is a $1 ice pack.

Putting the government in charge of health care would restore it to its proper place in our lives. If conservatives' worst fears turn out to be justified, then visiting the doctor will become a very occasional half-day-long exercise in mandatory tedium, like going to the DMV or having your passport renewed. I do not visit the clinic down the street for aches or minor ailments, much less stop in to see my non-existent family physician to engage in morbid speculations concerning the potential diseases to which I might one day succumb — and neither should you.

"In the long run we are all dead," Lord Keynes said. To quote a marginally more cheerful writer, "There is nothing better for a man, than that he should eat and drink, and that he should make his soul enjoy good in his labor." There are a thousand more important things in life than fussing about health. Exercise if you want — or don't. Have a nice lunch; order a drink or two; smoke; relax with a ball game or a good book. If you're sick, go wait in line. You'll be glad not to get a bill four months later.