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A Fiscally Conservative Argument for Universal Health Care

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With problems ranging from millions uninsured to unsustainable liabilities, there are many obstacles to resolving the health care crisis. The passage of the Patient Protection and Affordable Care Act (Obamacare) along partisan lines has been a savior for some and a nightmare for others, generally indicating that it’s less than ideal.

The United States is one of the few developed countries that doesn’t offer some sort of universal health care and yet, even discussing such a system generates partisan bickering.

The debate is not new. Serious proposals for national health insurance or an individual mandate date back to the Nixon administration with some curious twists and turns.

A far cry from a simple mandate, Obamacare has generated a great deal of controversy and doesn’t provide universal coverage; in fact, it’s clear there are winners and losers.

As an aside, I am one of many people who has seen his private coverage skyrocket in price followed by cancellation and ultimately been left with a choice of only grossly overpriced or lousy coverage.

It seems no surprise that we haven't arrived at a good solution when the debate is largely characterized by hyperbole rather than fair-minded analysis.

It seems no surprise that we haven’t arrived at a good solution when the debate is largely characterized by hyperbole rather than fair-minded analysis. The GOP won Politifact’s “Life of the Year” in 2010 with their claim that Obamacare was a total government takeover of health care (not true, although enough to make it worse for many people). President Obama punctuated that by winning the award in 2013 when he claimed “if you like your health plan you can keep it.”

There have been many problems with Obamacare including companies exiting various markets due to heavy losses or leaving altogether and providers refusing to take exchange plans. State exchanges and co-ops are facing financial problems even as questions have arisen as to whether they should be necessary when there is a federal exchange, yet Healthcare.gov has had its own share of serious issues.

For the right, the government’s sphere of influence, particularly at the federal level, should be very limited and anything beyond that is either an overstep of federal authority or a step toward socialism. There is also an inherent belief that the government is ill-equipped and not trustworthy enough to entrust with our healthcare.

Obamacare and the VA seem to confirm that suspicion although Medicare has high patient satisfaction. Some Obamacare critics believe the failures were premeditated in order to torpedo private insurance while supporters of single-payer believe the law simply didn’t go far enough.

Let’s be clear about one thing: health care is NOT a right. Anything that depends on the labor or property of others is not something we are entitled to; however, that does not undermine the reality that it is a basic human need, one step shy of air, water, and food. We should seriously consider the importance of making sure everyone has access to affordable care and how much we want treatment to be based on profit.

Consider the words of the Irish president Michael D. Higgins:

“Frankly the idea that a person would not have one job, but would have two jobs, or three jobs and work all the light hours that are there and still not be entitled to the basic protection of fundamental care is so outrageous…the idea of there being a social floor, below which people wouldn’t fall, that’s the future. I think even the poorest people in the great country that is the United States should be entitled to basic health care.”

Entitlement is not a popular word but we alone must decide what is the most workable system for the highest percentage of Americans as we “promote the general welfare.”

The Constitution delineates the duties of the federal government and anything else is the responsibility of the states, but the Founders could not have envisioned aspects of our society today that necessitate some involvement at the federal level. If we interpret the Constitution absolutely there is no place for the FAA or NASA and at the time of the Founders, medical care wasn’t even in its infancy.

While many conservatives will object to the idea of any kind of universal health care or a public option, there are also compelling pragmatic arguments to be made if common sense is prioritized over ideology.

1. Government at some level may be needed to play a part in health care and other programs where there are deficiencies in the private sector.

James Kwak, co-author of White House Burning: The Federal Debt and What it Means to Youobserves:

“…the big issue,…is whether the government can provide equivalent service at lower prices. For the vast majority of consumer goods and services, it can’t. That’s why we buy our phones and computers from private companies like Apple, not from government agencies.

 

The usual argument against a federal health insurance program is a blind assertion that the government can never provide services that rival the private sector. That’s what you learn in Economics 101, therefore it must be true. But real economists have known for more than half a century that health care doesn’t behave like ordinary consumer goods.”

We already know that the military and some other areas such as environmental protection would be logistically challenging if left completely to the private sector. Health care may be as well.

2. The government is already involved in health care on a widespread basis.

Medicare, Medicaid and the Veterans Administration, among others, are involved in providing medical care to a large number of U.S. citizens and the FDA is a powerful regulatory agency. Investigating the viability of covering everyone is not that big of a stretch. While the VA has had its share of problems, Medicare works fairly well for patients.

3. Universal health care is not, in and of itself, “socialized medicine.”

The only socialized medicine we currently have is the VA where the government owns the facilities and employs the providers. Universal health care could be more along the lines of public-private partnerships such as partially socialized health insurance or individual mandates.

Usually the objection to socialism includes pointing out how much better the private sector works. Even before Obamacare, what percentage of people were truly happy with their coverage?

In addition, the government is needed to provide some things the free market has no incentive to provide. There is a compelling argument to be made that basing medical care entirely on the profit motive is likely going to produce the kinds of winners and losers that are hard to justify on an ethical basis.

4. While no system is perfect, there are countries with good outcomes.

Opponents of universal health care routinely point to flaws in countries such as Canada and the United Kingdom.  However, other countries such as Israel, Taiwan, and Australia not only have lower costs of care but higher patient satisfaction.

5. Universal health care is not provided “free” and is not a handout.

Unless someone is very poor or disabled and likely receiving disability or Medicaid benefits already, the tax base can be broad. This could be via a transaction tax, meaning everyone would pay including the underground economy and those who are at an age where they might forego coverage. The insurance pool would therefore be 100%, an actuarial benefit.

6. We could end the existing problem of providing care for people who never pay.

Taxpayers currently foot the bill for unpaid emergency room visits, not to mention for Planned Parenthood and other low cost providers. It makes sense to set up a system that is more comprehensive but simpler. The non-payment of medical bills is a major driver of cost increases.

7. Countries with UHC spend less than half of what the U.S. spends on health care per capita.

We currently spend more per person and as a percentage of GDP than any other advanced nation in the world. In Australia, the program is funded by the Medicare Levy, currently set at 2% of a person’s taxable income with graduated exemptions for low earners and families. This also funds national disability insurance.

There is an additional levy of 1.0-1.5% for individuals on incomes starting at $88,001 for individuals and $176,001 for families (approximately $64-129K USD).

8. A public option does not have to eliminate private insurance or private pay.

Those of greater means can always afford things others cannot but as of 2014 over 47% of Australians also retain private health insurance even though they are entitled to free treatment in public hospitals. They receive a rebate credit toward 30% of their insurance premiums, increasing to 35% or 40% for people over 65. The Swiss system, which we’ll look at below, is based entirely on buying insurance from private companies.

9. Universal health care does not mean no personal responsibility.

It is not reasonable to expect people who work to stay healthy or those who are ill through no fault of their own to bear the brunt of paying for others who are self-abusers. The system could be structured so that people who live healthy lifestyles are properly incentivized compared to those who are morbidly obese, use tobacco or abuse alcohol or drugs. As our current system seems to have no effective way of dealing with this problem, any sort of accountability in this area would be an improvement.

10. Any program does not have to be run entirely by the federal government.

States can be involved in administration and as with Medicare and the Australian and Swiss systems, private insurance can play a major role.

Avik Roy has written extensively about the Swiss health care system. Individuals are responsible for their own insurance and since companies are allowed to compete nationwide, the Swiss shop for the best deal. The insurers are nonprofit and over 99% of Swiss citizens are covered.

Skeptical? We should be. The United States is not Australia but they spend a smaller percentage of the annual budget than we do and considering that covers everyone and our military budget dwarfs theirs, that’s pretty amazing.

Switzerland is also very different — a very small country with a population accustomed to a higher standard of living and willing to pay more for quality. Regardless, the principles are worth considering. More recently, Roy has put together his own proposal for “near universal coverage,” Transcending Obamacare.

It should be common sense to investigate options to learn what works—and what doesn’t. That would generally be a good proposition for anything we do: finding ways to not isolate our conversations to more government or less government but rather, prioritizing and better government. Further, we must address why the cost of health care is so much higher in the U.S. or it won’t matter how it’s distributed.

The point is not a blanket endorsement of universal health care no matter what the circumstances, but rather to learn what best practices we can adopt. To continue sticking our head in the sand is frankly…unhealthy.

Photo Credit: simez78 / shutterstock.com

Join the discussion Please be relevant and respectful.

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482 comments
Mark Wier
Mark Wier

Craig Berlin I couldn't agree with you more. We have to protect every right the Constitution, that we collectively uphold as law, dictates. Nothing is free. Freedom has many costs. First and foremost is the sacrifice to protect each persons rights.

Marc Delgado
Marc Delgado

Craig you're a contradiction, human rights are subjective but for the most part we ALL AGREE on them? Every man, woman and child has the right to live and if one should fall ill, if treatment is available, then should receive it, why get caught up in the details of laws and constitutions, you're overthinking it, I don't know if you're trying to sound smart or just can't grasp simplicity

Jess Cortese
Jess Cortese

Craig. Both. Obama and congress waste billions on funding waste. Americans could easily have great healthcare for Low cost if we Americans raised up and made congress serve us VS us serving them

Craig Berlin
Craig Berlin

I think it could be a plan to provide basic or catastrophic care...the only problem with that is where do you draw the line?

Craig Berlin
Craig Berlin

Anthony Mora Constitutional rights are only subjective insofar as they need legal interpretation but for the most part, they are spelled out in black and white. The definition of amendment is irrelevant both as a general word and as it applies to the Constitution.

Craig Berlin
Craig Berlin

Marc Delgado Personal insults are the last bastion of someone who has no facts to support his argument. Human rights ARE subjective and for the most part, we all agree on them; for example, we almost entirely agree that child abuse is a violation of human rights. However, health care as a human right or other services provided to citizens ARE the subject of much controversy. That is indisputable. More importantly, as I've said repeatedly above, not everything has to be a "right" in order to be a priority. THAT is common sense.

Craig Berlin
Craig Berlin

Mark Wier I disagree. When we are born with rights such as life, liberty and the pursuit of happiness, they don't depend on anyone else except insofar as we need to protect ourselves from those who would infringe upon them. What exactly is it that others must provide that we are entitled to and once you've admitted to that, where does it end? The Constitution spells out that the foremost duty is the protection of individual rights and personal property. But the bigger point is that they don't need to be a "right" in order to be a priority. We may collectively agree that we need to pay taxes, for example, for a variety of things and in most civilized societies today, health care is one of them.

Autumn Boucher
Autumn Boucher

Yes but it has to be quality. None of this waiting list stuff when you need surgery.

Jessica Cannon
Jessica Cannon

Our right to a trial by a jury of peers depends on the labor and property of others. As does our right to an education, to have the fire department show up, etc etc. Not a very informed position.

Shawn Young
Shawn Young

Now think about this. No its not a right to force people to help other people to live.. That's a practice that they worked hard to get or daddy paid for it.. We are saying that the same level of health care for all citizens through a single payer system. That all citizens pay for. That's cheaper than what all of us are paying now. And the doctors would gladly help us because they are getting paid. And the economy is not getting held back because of outrageous bills that aren't getting paid.. Because there is no work to be found for older ppl with certain medical conditions and history's. We need this health care to help the common man get out of the black hole called health insurance and healthcare debt.. You need to look at the bigger picture!

Anthony Mora
Anthony Mora

*life, liberty, and the pursuit of happiness. It's not "life if you can afford it" It's not "life if you're a dependent" It's not "life if you vote a certain way" It's just "life"

Anthony Mora
Anthony Mora

Constitutional right are extremely subjective. Look up the definition of "amendment"

Russell Leonard
Russell Leonard

I think we should have a federal health care plan that covers just a few things. Above that, people would have get their own insurance or through their union. Things should be about 90% the way they were BEFORE Obama care. Make a ballot with a bunch of individual items to say yes or no to and let the people decide. Let us VOTE for what is covered. Personally, I think it should be for most pediatrician care, for adults - colds, flus, pneumonia, broken bones.... So the majority of the population is covered for the majority of minor issues that interupt being at work. Maybe initial consequences of things like car accidents. Major medical, lifestyle choices... NO!

James Evans
James Evans

Neall West not anarchy but chaos where money is the ruler and the ability to pay is the form of natural selection. Anarchy would be a community run through direct democracy with municipal,cooperative and mutual institutions. These communities throughout the country would form a federation with no state lines no federal government just people in communities and those communities working together. I personally believe in single payer full coverage medicare within our current system but I'd eventually like to see us move to what I described when we are all voluntarily ready for it

Johnny Ritchie
Johnny Ritchie

It is only a right in civilized country's, where civilized and intelligent people are Leading. Birth is fairly important,,,but most will survive natural birth, right? For those who do not survive,,,God's will, right? The USA at one time worked to ensure Doctor's and Hospitals where available, even in our most rural area's. Now the Hospital's which were opened within the USA civilization, after decades, and Century's, are being closed. Tennessee has had five Hospitals close, the last I read. Some Republican States are racing for the bottom, of civilization. Schools, education, roads, bridges are suffering with crime and prison populations increasing. Civilization decreasing. The trends are even going towards shorter life spans, vs longer,,,,,just like in the good days, they remember, prior to civilization.

Kathie Lahti
Kathie Lahti

Healthcare is a concern for many, but, the current Affordable Healthcare Act, which requires enrollment or fines is far too intrusive. There are many young people who not only do not choose to pay for healthcare at the current rates, but, do not require the healthcare at the current costs. Hell, I, at 63, on a good insurance plan don't need to go to the Dr. enough to get beyond my yearly deductible. It is cheaper for a large portion of people to pay the fine than have a plan in place.

José Roberto Orellana
José Roberto Orellana

It isn't a right yet, but it should be, especially after big corporations feeds the world with poison aka. Monsanto

Sharon E Wynkoop
Sharon E Wynkoop

Keep America second rate by voting republican! I want to be better so I will never vote republican! Younare right some people do not need a college education but if we want a new generation of doctors , engineers, scientists, mathmeticians, etc we better make college affordable or fall behind while the rest of the free world sends their kids yo college for free! That is investing in our future not a free ride!

Josiah Lawson
Josiah Lawson

just ask any other 1st world country, lmao. it isn't rocket science.

Josiah Lawson
Josiah Lawson

And lives would be saved--but even from a libertarian viewpoint in which money is much more sacred than life or happiness, it's still a smart movie.

Josiah Lawson
Josiah Lawson

The whole point of the article is that it saves everyone money in the long run.

Noah Callen
Noah Callen

> We aren't entitled to other people's things. > We still believe it is moral to take money from people to pay for things that we are not entitled to

Beyond-The-Spectrum
Beyond-The-Spectrum

Ken, the government isn't "taking over everyone's lives." Spoken like a true adherent to the Lunatic Fringe. Funny how government is "intrusive" when it comes to your perception of health care. But people like yourself want to leverage the power of government to legislate social policy (e.g., who can marry whom, under which terms people can choose end their lives, and a woman's decision to terminate her pregnancy). THEN its not "government intrusion. GTFOOH!

Caleb L. Smith
Caleb L. Smith

Nothing man made is set in stone. Hypothetically if Congress tried to pass an amendment that took away our free speech and 2/3 of the house and the senate passed it and 3/4 of each state approved of it then it would be the law of the land. Also health care can be handled by the government if the people so choose. There are a lot of people in this nation who want universal health care, we can make it happen.

Judy Parker
Judy Parker

Then Becky you pay for everyone to have it.

Judy Parker
Judy Parker

Hey Ruth we don't care if other people have good healthcare. Just don't expect somebody else to foot the bill.

Judy Parker
Judy Parker

No Caleb Smith the Constitution cannot be changed. It is the supreme law of the land. It's original intent cannot be changed.

Judy Parker
Judy Parker

Caleb the Constitution is set in stone. You can make amendments that enlarge on the rights laid out by the Constitution but you cannot change its intent. Healthcare is to be handled by the states not the government. It is not a power given to them.

JudyParker
JudyParker

The government needs to stay out of our personal lives period. They can't even run the country. Any power not delegated by the Constitution should be handled by the state. And no the government does not need to be involved in healthcare. The constitution does not allow for it and it is the supreme law of the land.

Kurt Dietze
Kurt Dietze

Agree, it is not a right. Civilized man seeks the betterment of fellow man/woman, not just self. Not to leave a question with a question, but where does that leave us as a nation?

Ken Williams
Ken Williams

Ben Hardin yes we should take care of those who cant afford healthcare, that simply doesn't give license to the government to take over everyone's lives and force the cost up which is exactly what has happened. This is no different then government taking over the funding of higher education and these cost are going up faster now then healthcare. Government isn't the answer it is the problem and creating a bigger more intrusive government is only going to make things worse.

Kevin Langan
Kevin Langan

When more than half our budget is spent on the military it is really more a question of priorities.

Kevin Langan
Kevin Langan

Isn't food mostly a product of the property and labor of others?

Ken Williams
Ken Williams

Yes Beyond you are a mental midget and there is no cure for that.

Jimmy Mac
Jimmy Mac

Hmm who says everyone needs to go to college for one? Two who says you need to get into the most expensive college you can find and rack up enormous amounts of debt? You can: learn a vocational trade much cheaper. Go to community college first for a lot less money and learn the basics. But you call everyone else greedy while demanding free college tuition

Jimmy Mac
Jimmy Mac

Hmm the biggest supporters of big pharma seem to be democrats who voted in favor of Obamaxare

Beyond-The-Spectrum
Beyond-The-Spectrum

Anyone who still believes or invokes the "Communist Boogey Man" is far more ignorant than me! Aspects of health care are measurable. "The best is the world" judgement is purely subjective. Mental midgets

Mike Miller
Mike Miller

Who are you to begin your entire thesis with such a biased and absolute statement? Nothing is this black and white and most knowing and thoughtful people will agree. It is in fact a right in all other major industrial countries so I ask, in the words of the great philosopher Rodger Daultry, Who The Fuc$ are You?

Nicolas Golato
Nicolas Golato

Absolutely. What people don't understand is that by guaranteeing everyone a minimum of healthcare ( there will always be a place for premium care if you want to pay for it) everyone wins. Right now people without insurance flood emergency rooms for minor colds, people who can't afford healthcare miss more work, are more likely to be on disability and drain our economy.

Eric Redfield
Eric Redfield

Health insurance companies only exist in there current form because of government involvement in the industry. They made it expensive. They made it shitty. They passed the HMO Act of 1973. Richard Nixon, passed a Democrat bill, to force insurance companies to behave in the manner that you guys are pissed off about! Then everybody yelled at the government to fix it and now we have the Affordable Care Act?!?!? What the hell is wrong with you people?!?!? Now you guys expect this corrupt as hell government, that prints its own money on a daily basis to beat up rich people and take a modest amount of money compared to the amount that they print yearly, and expect them to fix anything about health insurance and medicine or anything else? You guys think I'm living in utopia in my head and I say it's the exact opposite. You know what they say about doing the same thing over and over again and expecting different results, right?

Sharon E Wynkoop
Sharon E Wynkoop

The federal healthcare system can reign in big pharma and the exploitive medical corporate group that overcharges Americans. They will lower costs . Americans should not go bankrupt getting healthcare or sending their kids to college! Why are we the only nation where this happens? RepublicanGREED. NEVER VOTE REPUBLICAN,

Marc Delgado
Marc Delgado

Human rights are not subjective, it's common sense, which Craig seems to be lacking

Marc Delgado
Marc Delgado

It's not a right, but it's a basic human need? 6 of one, half dozen of another? Wtf

Jimmy Andreoli
Jimmy Andreoli

It's interesting but one thing that is absolutely incorrect in this article is stating high satisfaction for Medicare. That's a load of junk right there. Medicare is extremely difficult for Acute patients with constant denials and much fighting for rights and benefits. It is not a good system for anyone needing treatment more acute than common ailments. I would hate to be forced into Medicare with all the limitations that they have on my medical conditions (bilateral below knee amputee). A friend of mine is waiting up to a year for repairs on her power chair for them to approve. In the meantime she is stuck without mobility. Sounds great and satisfied right? (Not). That's one thing I strongly disagree with in this article. Medicare is not satisfying patients.

Don Anderson
Don Anderson

A right, or not, healthcare in today's economic climate is an absolute necessity. Simply put we have regressed to an exploitive employment policy wherever we can and it is in humane to tell anyone they must die because they cannot afford preventive healthcare. It does society in general no favor to pick up after the fact costs as we have in the past and are now doing.

Michael Carrasco
Michael Carrasco

Ken Williams I disagree with you. I don't believe that you find rights in nature. A right is something that exists because government exists. And those rights change all the time. Homosexuals just earned the right to get married. It did not exist before. It may have been morally unjust to deny them the ability to get married but they didn't always have a right floating around in the ether. It was granted to them. And rightly so in my opinion.