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.


  1. “…a repudiation of George W. Bush, John McCain, and various scandal-plagued Republicans in Congress…”

    There is more than enough material for scandals among the Democrats if someone had the balls to make a noise loud enough to generate scandals. Rangel, on his own, could rightfully produce a half-dozen. Sir Barney, the Baron of Buggery is another. Then there’s Dodd and his mortgage, Pelosi and tuna fish, Reid and his land deal, and dozens more. -jh

  2. Actually, "Conservatives did run health care" for quite some time. Thanks.

  3. Whether you kill them at 80 or 8 weeks in eutero, for starters it is still a violation of the Hippocratic Oath.
    If there is Choice, what in the name of all that is holy are we choosing? Elimination of another 45 million Democratic voters and taxpayers? Maybe we wouldn't have need of illegals coming across our borders to take their jobs? I'm just asking honest questions to further air out the subject.

  4. I am reasonably certain that virtually all proponents of universal health care are completely unaware of the all the features and benefits and risks that would involve all Americans including the inevitably of take aways. If the Senate does not disallow a public option that over 80% of American citizens and medical professionals disavow, those of us who want to work on the system we have will experience takeaways that will be massive in scope first off,our plans and our level of treatment. After that politicians,lobbyists, and insurance companies will go to work on the remainder who were the original high flyers off government insurance for all.It is going to be just like the Election when the voters thought they were going to get the change we have not latched on to yet.

  5. I was in a cocktail party for a NY representative Tim Bishop last year, before the election. He was talking about how if his party, the Dems, ruled both legislative houses and the White House, and had a filibuster-proof majority in the Senate, they would go ahead and ram all their programs through, with nothing more than a look and a sneer at the other side of the aisle.

    I was at another cocktail party for someone who wants to run for state senate in NY next year, and the main plank of her platform was to be able to gerrymander the districts so that there were no Republican Representatives from NY. These are people with no couth, and no concern for a party that will still represent half of the American Public, give or take 5%, for the foreseeable future. They have no interest in a solution that everyone can live with.

    Again in this cocktial party today, what was very heartening was that they either had no clue, or took no heed to the fact that their party got pummeled in almost every race across the country in this month's elections, as a mandate against these strategies. I truly hope they don't figure it out until after November 2010.

    I digress...The reason why the presence of a public option is anti-competitive is that the Government option will increase taxes on every person and corporation to pay for the administration of the public insurance, which will in turn lower the cost of the public option below the fair market rate of the private insurances that have to pay for that administration. Like the Democratic strategies above, this is not playing fair, but in this instance, they are playing with one of the most important parts of each and every one of our lives, at the most critical parts of our lives. You just can't have a public option.

  6. Oh, and then, they apparently are going to tax you for any insurance policy that offers better services than the public option, and they will tax you on the benefits these "Cadillac Plans" give you, when you get them! So if you are fortunate enough to keep your much better private insurance, they are going to make you pay! I'm in shock every time I hear another of these points in the Pelosi bill. I guess I shouldn't be by now.

    And did you hear about dog insurance being in this bill? Apprently that is in there too...

    Does anyone here know if these things I'm hearing are right?

  7. I find it strange that I have not heard anybody point out the obvious irony that the advocates of totalitarianism in medical care call what they are pushing just now a "public option". Of course there is no question of whether they advocate making PAYING for their scheme optional. Of course we will have to pay for it, the only thing that is optional (for now at least) is whether we will put up with the services the government demands. Calling it "optional" is just a bit of Orwellian euphemism.

    It is nice that at least there's on person on the left who can see that handing totalitarian powers to their enemies would be very bad, but it's too bad even she doesn't seem to see that having them herself would be just as bad. I hope that her arguments can at least drain away a little bit of taste on the left for totalitarianism, but I'm not holding my breath.

  8. Fortunately, Ms. Mahar is not familiar enough (this is quite apparent from reading what she says here) with how the singlepayer systems proposed in various bills in the US work. May I suggest she do more research to learn PRECISELY how the American singlepayer systems in bills like S703, HR676, and the state bills work.

    Had Ms. Mahar bothered to do sufficient research, she would have learned that the single payer systems proposed maintain competition through the current private delivery system. As well, no "President" or any other non-medical entity makes such decisions re whether or not to cover something in the proposed single payer systems.

    Finally, as an activist in the single payer movement for longer than many who are likely reading this blog, Ms. Mahar is no big name in the movement. In fact, we never heard of her until this blog piece.

    Sounds like astroturf to us... BEWARE you who are genuine single payer supporters...

  9. As a member of the political left, I can assure you that I have not changed my position in regards to a single payer health care system. I do not like the bill that recently passed the US House. House Resolution 676 is the bill that I support!