“Single Payer” Myths from Left and Right
by D.J. McGuire
Amidst the wailing, gnashing of teeth, celebrations, and everything in between because the United States Senate has – literally – voted to let itself keep voting on health insurance today, I thought it might be a good idea to address some of the problematic myths surrounding the “single-payer” idea.
To hear American social democrats tell it, “single payer” will at last slay the evil profit motive from health care and ensure better health for all. Republicans, by contrast, view it as a gateway drug to a Venezuelan dystopia.
Neither are close to the truth these days.
We’ll start with the myths on the left.
Myth: Single payer removes insurance companies and the profit motive from health care. It certainly may look that way, but it reality, government replaces the insurer – and in many ways, becomes the insurer. Like any private, for-profit firm, insurance companies look to maximize revenue and minimize cost for higher profits. When government gets involved in health insurance (as it has in the United States since 1965), it does the same thing. It’s harder to see because health insurers within government usually can’t control revenue in the way private insurers can, but both act to minimize costs. State governments didn’t consider Certificate of Public Need regimes for health providers until they were partially on the hook for Medicaid. Suddenly, getting Americans to spend less on health care was a big deal for state governments. Why? They were minimizing their losses – and the only difference between minimizing losses and maximizing profits is on what side of zero one resides.
Indeed, one aspect of nations with government-near-monopoly health insurance is how much citizens start acting like shareholders. You would see repeated sensationalist tales of UK subjects supposedly taking advantage of the National Health Service if you read the Daily Mail – then again, I read it so you don’t have to (or at least that’s what I tell myself).
Myth: Single payer is a widely accepted model around the world. Part of the problem behind this one is the confusion behind “single-payer” (which actually conflates two systems: the government-as-provider system heralded in the UK, and the government-as-insurer model best known as that of our neighbor, Canada) and “universal health care” (which includes the “Bismarck model”, found on much of continental Europe). The “Bismark model” doesn’t involve a single payer at all, but rather a multitude of non-profit “funds” that get much of their incoming money from premium payments.
In addition, even in the UK and Canada, the government is not the absolute provider or insurer. Over one in ten Britons rely on private health insurance as a supplement to NHS (and as of 2015, that number was actually rising – Guardian). Meanwhile, prescription drugs – key drivers of political angst in America – are not fully covered by government insurance in Canada (Vancouver Sun). Moreover, in the two most western Canadian provinces, even government insurance still requires a premium payment from citizens.
In short, what many on the left consider a standard-issue health policy in the rest of the world…doesn’t really exist anywhere else in the world. Still, the left is hardly alone in confusing myth for reality in health care and health insurance.
Myth: single-payer is a fast track to socialism and the end of freer markets. There was a time when this myth was an understandable fear. Clement Atlee’s government in Britain built the NHS as it was gobbling up whole industries – and the trend largely continued through the 1970s. Meanwhile, Canada’s slow motion nationalization of health insurance coincided with a leftward surge of its own after World-War II. Neither Tory party seemed interested in even slowing it down. Americans on the right took note.
The situation looks very different in 2017. Using the Heritage Foundation’s Index of Economic Freedom as a guide, one finds that both Canada and the UK have greater economic freedom than the United States. We are presently tied for 17th, with Denmark – that’s right, Bernie Sanders-endorsed Denmark (the other Scandinavian favorite of social democrats – Sweden – is right behind both). The nation known for the National Health Service also has a partially private passenger rail service, fully private water/sewer services, and a for-profit post office.
Myth: single-payer, government-run health systems sap national will and desire for military strength. I call this the Mark Steyn theory, as he is the one I know best to sound the alarm on this. Again, it might have made sense when he expressed the concern most loudly – about his own native land (Canada), when Prime Minister Jean Chretien refused to join efforts to liberate Iraq and barely checked the box in helping liberate Afghanistan.
However, this myth barely lasted longer that the Chretien Ministry itself. Canada’s next Prime Minister (fellow Liberal Paul Martin) brought his nation’s troops up to the frontline in Afghanistan fighting. Conservative Stephen Harper sent Canada’s military into Iraq to battle Daesh. He was defeated by Justin Trudeau, who promised to reduce Canada’s presence there, but not eliminate it. Meanwhile, the United Kingdom has been with us in nearly every major 21st Century conflict, while France – long pilloried for refusing to go into Iraq in 2003 – is fighting al Qaeda and Daesh nearly by itself (among NATO allies) in North Africa.
America owes itself an intelligent debate on health care. What we’re getting instead is a contest of myths about one subset of proposed solutions. Wildest dreams and darkest fears do not a successful policy make.
D.J. McGuire is the conservative Democrat on More Perfect Union podcast – and sometimes feels like he is the lone conservative Democrat in the country.