Single-payer in America would represent the greatest possible disaster in healthcare that our nation could achieve. Why? It wouldn’t be like England’s NHS, a pseudo-military organization of entirely government employees. It would be a cost-plus system of Aetna and Lockheed Martin employing our doctors. Is there any doubt about this? How in the hell else would single-payer ever get passed?
Part of the reason why liberals never seem to reckon with this reality of American politics is because they’re magical thinkers. The institutions of healthcare would be managed by the upper middle classes who generate liberal political culture. They are invested also in the institutions of “democracy”. Contrary to all the evidence, liberals are committed to the belief that America’s institutions are democratic. The degree to which corporate influence stifles the voice of the people is only the degree to which we haven’t passed a solid campaign finance reform bill – that’s all. Liberals staff the institutions of democracy – the government bureaus, the polling places, the media and professional outlets that interact with them and so forth. Their professional and civic lives couldn’t be possibly fraudulent. Not overall. That would mean their reality and worldview might not be valid. The privileged upper middle class couldn’t possibly ever accept that possibility.
But, the voice of the people in its best-organized expression: the AARP (h/t Scott Horton), couldn’t possibly stand up against the lobbying dollars of Lockheed Martin (and also their hit squads – I digress). Single payer in America would be a cash cow. They’d probably construct it as an insurance scheme so that they can use it to perform wealth transferring (poor to rich) accounting tricks just like they did with the derivatives market. Can you imagine?
If this wasn’t the surest reality that could be, I’d support single-payer healthcare. Not worrying about healthcare costs would give me personally a lot of freedom. And while I’m sure that a true free market in healthcare would be more cost-effective than the best run government program, I am absolutely confident that my American peers (you know, the other market participants upon which the market depends to exist) will never ever support any real escape from the current political dysfunction surrounding healthcare. Free market healthcare would be the best, but I can almost guarantee that it is socially and politically impossible to achieve. The next best system would be a “sincerely well-run” government system. But that will also never happen in America, so save me from Uncle Sam having my medical history. Imagine that nightmare.
Imagine, what if you’re sick because of using illegal drugs? Can you be taxed for being overweight, since the government has a complete picture of everyone’s health records? Forget the soda tax, hello fatty tax. The ACLU would surely advocate for medical privacy. But folks, how good will that be when the government runs the entire system? Yikes. It’s worse than the invasion of privacy that comes from the IRS.
So there’s another reason to reject single-payer. Not that the NSA doesn’t already have all of our medical records. Not that a more public and consented to invasion of privacy wouldn’t be worse.
As a libertarian, I’m for free market healthcare. As a libertarian who lives in a market comprised of American liberals and also American conservatives, I have no choice but to admit that a single-payer system would probably be more ideal. As someone with the most elementary honest understanding of American politics, I have to reject any support of single-payer in actual reality. And given the behavior of the national security state recently, I’d say that opposing single-payer on privacy grounds alone should be one of our top priorities.
Life’s complicated isn’t it?
I think the best answer is a state-by-state system. Let New England make their own single-payer system. Let the West Coast make their own separate single-payer system. If they want. Let those who want a free market do it. Maybe Kansas and Nebraska will actually make a decent market for healthcare.
I could rebut any criticisms of my plan. Wouldn’t everyone move to New England? Well, why haven’t they anyway? Don’t you have to have work somewhere to move there? People who go to college in a state in which they aren’t a resident have to go through a pretty difficult process to prove residency and get resident rates of tuition. Benefits could work the same way, and probably already do. And anyway, so what if people move somewhere because the healthcare is better? Isn’t that what liberals are all about?
But, this plan would never work. Good luck disentangling Medicare. Moreover, no matter how convincing you are, no matter how good this plan would be for progressives and their political goals, they’ll never support it. Why?
“The poor blacks of Mississippi would get screwed.”
Because nationalist, New Deal programs are the utter validation of the liberal worldview that middle class comfort and safety are natural conditions. Only greed and selfishness artificially prevent people from having access to these human rights of privileged life. New Deal programs are nothing other than taking power and profits away from greedy people who never should have been given them. Liberals in America will never back away from this perspective, because to do so would be ideological self-immolation. Liberals would cease to exist, if they changed in a way that allowed their preferred outcomes to actually come into being. (no I don’t mean if your programs popped into existence liberals, I mean what you have to do to get the polity to implement your programs in actual reality – and libertarians don’t support policies, we support principles; liberalism is an ideology of policies, those that favor upper middle class cultural perspectives, and isn’t really principled)
Some liberals believe that if they get sick and die, it will because of Republican greed. I sort of feel that, at this point, if I get sick I’ll just probably die. So, mostly, I’m left feeling as if I just sort of hope I don’t get sick. Paying for insurance, however, is certainly making me broke.