Sunday, November 15, 2009
The Left Rethinks Single-Payer Healthcare
Maggie Mahar, a well-known health analyst at the Century Foundation, published an interesting opinion piece in the Washington Post this morning, entitled, "If conservatives ran health care..."
In the piece, Mahar makes the case for choice and pluralism--that is, against healthcare universalism--as well as any conservative or libertarian. Indeed, Mahar makes her case so well that one must conclude that thinkers in both ideological camps, left and right, recognize that they have a huge stake in choice, and yes, dare I say it, competition. Because within choice and competition, we all, liberal and conservative alike, find freedom. Mahar begins:
If you're a progressive like me, and you're upset by the Stupak amendment, which bars federally subsidized insurance from covering abortions, consider this: What if we had a single-payer health-care system and someone like Jeb Bush or Sarah Palin were running the country?
Yes, that is a good question. Mahar continues, "A single-payer system would have put us at the mercy of whomever happened to take control of Washington." Exactly. And according to Gallup, conservatives account for 40 percent of the population, moderates for 36 percent, and liberals for just 20 percent. So because of that conservative preponderance, everything else being equal, those who take control of Washington are more likely to be on the right, or at least center-right, than on the left.
There is no one-size-fits-all that fits everyone comfortably. And if one size is made to fit all, as in a single-payer system for healthcare, then that one size is likely to lean right, not left--at least in a small "d" democratic country. Once again, Gallup tells the tale: for the first time in the history of Gallup asking the question, a majority of Americans count themselves as pro-life. Which is to say, a universalized single-payer system would probably be pro-life--majority rules. And such a pro-life stance would be popular with many Democrats, as well as Republicans--Bart Stupak, mentioned by Mahar above, is a Democratic Congressman from Michigan.
And of course, the recent elections have put the left on notice that America is very much a two-party system; yes, the Republicans took a severe drubbing in 2006 and 2008, but those results were mostly a repudiation of George W. Bush, John McCain, and various scandal-plagued Republicans in Congress, not proof of an enduring Democratic majority, to say nothing of an enduring liberal-left hegemony.
Thus Mahar quite reasonably calls for pluralism in healthcare:
So I want to hedge my bets. I want alternative insurance options, especially from nonprofits such as Kaiser Permanente. And I don't want to find myself locked into an insurance plan run by conservatives -- or Democrats -- who feel they have a right to impose their religious beliefs on my access to care.
Universal systems, if they contain even the slightest bit of coercion toward others, are only appealing if you are sure that your side will win--and you are absolutely confident that your side should win. Every time. We can aim to be universal and absolutist on a few things, such as the rights and dignity of the individual, although even that's not always easy.
But as a rule, it's hard to spread universalism to very many areas of human activity. And of course, if you are not sure that your side will win the fight, then the last thing you want is universalism.
In addition, if you are are willing to concede that the opposition might have a good point or two, or at least should have the right to be wrong, then you will logically also be against a universal system. Indeed, even if you simply think that checks and balances are a good idea--the constitutional equivalent of compartmentalization--then you should oppose universal systems.
We learned this lesson in the 20th century, as we successfully opposed coercive universalisms, aka, totalitarianism. And in the 21st century, it's gratifying to see that the lessons of choice and freedom are deeply imbued on both sides of the aisle.
This does not mean that Mahar is a conservative: As she makes clear in the piece, she supports "the public option"--which most on the right see as a Trojan horse aimed at achieving a single-payer system. So the battle over healthcare visions is hardly over.
But as Mahar also makes clear in her Post piece, she supports the existence of private-sector alternatives, such as Kaiser Permanente, and would not want to see them done away with. If healthcare disputants can agree that the ultimate solution for healthcare should be a public-private mix, then we have made at least some progress.
Posted by James P. Pinkerton at 2:16 PM