Seven Years Until Single-Payer (3/3)

After reading your reply to my original post, I realized you are right and I probably should have shared my answer to my own question: Is healthcare a right?

My answer is no, but I need to clarify what I mean by the word “right.” To me, there are only two types of rights: the natural rights of the Declaration (e.g. life and liberty) and the legal rights spelled out in our Constitution (e.g. free speech and owning firearms). When I say “no” to my question, then, I mean that I see no natural right to have one’s fellow citizens provide healthcare, and I am aware of no Amendment that mandates the same.

That’s different, though, than asking whether the perception that healthcare is a right exists and thinking about what that will mean for the country. It’s also different than asking if healthcare should be a right. To both of these questions, my answer is a qualified yes. I think Krauthammer is correct in his assessment of the state of public opinion on this matter. I also think, as you have pointed out, that it is a common belief among Americans that no one should die in the streets for lack of medical care. As you say, we are not letting that happen now, and we would not let it happen in the future. Thus, healthcare should be a right because it de facto already is.

Are these two views contradictory? No, because the devil is in the details that we are debating — namely “who pays?” Here, you engage is a little liberal fantasizing. You imagine an America where everyone shares in the cost of common healthcare services and the rich pay more than the poor because they can afford it. Kumbaya. Of course in the real world, the rich over-pay for services they don’t use, and the poor over-use services for which they don’t pay. Like all socialist schemes, public-funded healthcare is really just a way to steal from the rich to give to the poor.

That said, it’s legitimate to argue that the rich should give this gift to the poor. It’s just problematic for a country of free people with a capitalist economy. I think of places such as Dubai, where healthcare (first-rate healthcare, I am told) is free for every citizen. Why? Because sheikhs control the people and the economy, and they are fabulously wealthy. Or let’s consider Cuba, where the healthcare is also considered to be among the best in the world. This is probably the closest county to the liberal fantasy you invoked. Everyone funds this healthcare, and everyone uses it — because everyone is equally poor.

At least Dubai and Cuba are honest about it. The people know under what system they are choosing to live. One could even argue European socialism is honest with its citizens in that they understand the “Robin Hood” mentality is at the core of their nation’s economic philosophy. In America, conversely, the conversation is wholly dishonest. Politicians pretend we can continue to be a capitalistic society at the same time we continue to adopt socialistic policies. Ultimately, that is why healthcare is a horrible mess. We can’t live a lie. We have to choose.

In suggesting this issue is a math problem that can be solved, you are falling victim to the same lie. The problem with healthcare is not that no one smart enough has tackled the equation. The problem is the current equation is unsolvable if the main variables that must be balanced are X (capitalism) and Y (guaranteed healthcare).

Actually, there may be a way to balance X and Y — but it would never sell politically (variable Z). That solution is to formalize the two tiers I mentioned earlier; that is, the (upper) tier that pays for services it doesn’t use and the (lower) tier that uses services for which it does not pay. This is essentially the way it works in Hong Kong. There are free government hospitals for which every taxpayer pays but no one with money uses. Then there is a robust market for paid medical services that, thanks to capitalism, are significantly more affordable than similar services here.

Incidentally, I think you neglected Asia when you claimed single-payer (by which I assume you meant socialized forms of medicine) are the “world’s default.” Besides Hong Kong, I think of Singapore and a quote from the “Sage of Singapore,” former prime minister Lee Kuan Yew:

We have arranged help, but in such a way that only those who have no other choice will seek it. This is the opposite of attitudes in the West, where liberals actively encourage people to demand entitlements with no sense of shame, causing an explosion of welfare costs.

You asked me what I think should happen with regard to healthcare. The above quote is my answer … or perhaps just my Libertarian fantasy. I imagine an America where the (truly) poor have free access to healthcare at government-funded facilities where the doctors are good but not the best, the accommodations are acceptable but not private or luxurious, and where you might have to wait long hours to be seen or even wait days and weeks if your condition is not a priority. Meanwhile, everyone else — i.e. those with any kind of money — never have to use those services because there is robust capitalism driving down prices for private care. In other words, I imagine Hong Kong.

I think we’ll need another series of exchanges to get down to why Hong Kong’s system is politically infeasible, but in short I believe that neither the populace nor the providers of care would accept the implications of such a system. That’s why I see single-payer as a much more likely outcome with the “who pays” question answered as I described in my first post.

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