When I speak of Conservatives, I have to be mindful that my understanding of that way of thinking harks back to the serious thinkers involved in Conservative v. Liberal/Progressive debates of the 19th and early 20th Centuries, including the often subtle, nuanced, and very entertaining debates between William F. Buckley Jr. and Gore Vidal, and my sense that many who now call themselves “Conservatives” depart much in both ideology and rhetoric from those historical standards. Still, that is how they identify and in this discussion I will attempt to refer to values and understandings of the world that carry through that tradition, and how those might be interpreted in support of a single payer health system.
I choose that description, “Health System”, very intentionally, as meaning a comprehensive system of education and care to promote and, so far as possible, maintain a high general level of health in a population, as well as provide care for illness and infirmity. I see our current system as too generally a “sickness care industry.”
What is the history of national health systems, primaraly as developed in Europe late in the 19th Century and into the 20th? The first of these that I know of was created by Kaiser Wilhelm I and his Chancellor, Otto von Bismark. These two were not Socialists, or Communists, or Liberals, or Progressives, not by a long shot. They were empire builders with great ambitions to create a united Germany and make it a Great Power. They drafted young men into their army to build that power, but found that far too many of those young men were found to be medically unfit to serve. They had, in the terminology of our draft system, too many 4Fs. The King and his “Iron Chancellor” understood then that to have the great, powerful, and productive nation they envisioned, they needed healthy soldiers and sailors, and healthy farmers and workers to supply them, and healthy mothers having healthy children to carry that on into the next generation. Their solution was the beginning of a national health system, and it got results. Soon, the other rulers and parliaments of Europe noticed and the idea caught on for all the same reasons. One American President, Theodore Roosevelt, Mr. “Speak softly and carry a big stick,” got it too and proposed a similar system which went nowhere on Capitol Hill. The essence of the argument is simple; A healthy nation is a strong nation, and a sick nation is a weak nation. In other words, on a national scale, the healthier each one of everybody is, the better it is for everybody else, however that may be measured.
But, I hear the cry, “What about the cost, the huge, horrible cost and the immense tax increase?”
Currently our total collective spending on health care in the United State is approaching 20%, of GDP, that is 1/5 of the total value of all goods and services in the economy. Some of that huge river of money is coming from taxes, some from insurance premiums paid by businesses and individuals, and some paid by individuals in co-pays and to meet deductibles. We spend more per capita on health care than any other industrialized nation, and as a population have poorer health outcomes. Of course, when it comes to spending on insurance premiums, whether by individuals or businesses, or from taxes in the form of subsidies, the overhead, including profits to the insurance companies, ranges from a statutory 20% maximum in the ACA exchanges, to over 30% in the rest of the market. As a comparison, the overhead (the cost of running the program) of Medicare runs around about 3%.
The point is, the money is already flowing and being spent. A single payer system would redirect that same money, possibly less, possibly a bit more into (if well designed) a more efficient management with the power of a monopoly to negotiate prices. Yes, taxes would be higher, but we would not also be paying in all those other ways.
I know it is easy to find anecdotal stories of problems in other countries’ systems, some of which may be exaggerated or more the exception than the rule. The truth is that humans rarely, if ever design and implement any perfect or foolproof plan for any problem at large scale. Whatever we in this country do do about our heath care system it will not be perfect by any practical or ideological definition. The goal has to be that it is good enough. “Socialized Medicine” is a buzz word, but accurate in the larger sense than it is usually used. Health care is a vital and important part of our social system, a social and, however organized, a social activity in which we all participate in some way throughout life. The real question is how can we structure it to work best for all of us. To accomplish that task we, whatever our ideological preferences, need to go past the old buss words and epithets to what actually works for our people and nation. After all, that nation is We The People, all of us.