Goldstein: Single-Payer? It’s Already Here

In the national debate on healthcare law, we should look to a familiar format.

by Matthew Goldstein | 9/28/17 1:00am

If the Biblical sacrifice of Isaac were written today, Kentucky Sen. Mitch McConnell might stand in for Abraham, and instead of the voice of the angel of God above, the faithful might read of the cries of disabled activists dragged in flex-cuffs from Congressional hearings. And our progenitor of nations, spared from certain death, is not Isaac but the Affordable Care Act. After the congressional GOP’s third abject healthcare failure, this is not the least apropos comparison, though it may verge slightly into the poetic.

Don’t be surprised when another duo of senators or particularly ambitious House members stick their names on some new embarrassment of a bill and christen it with the tired “repeal and replace” moniker, or some variation thereof. In fact, expect it. But the propensity to pop up surprisingly isn’t the only thing these policy abominations share with Sloth from “The Goonies.” They are fundamentally deformed, and their failure reflects a wider acknowledgment that the future of American healthcare will look less like an oligarchic nightmare and more like — dare I utter the words? — single-payer.

The conversation around socialized medicine is saddled with emotional and cultural baggage packed during the Cold War and zipped up by explanations of patriotism that serve to perpetuate the survival of interested institutions through the exclusion of some groups. Socialism can’t be American, because Americans aren’t socialists. Et cetera. But most participants on the right-hand side of the healthcare conversation miss two facts. First, single-payer healthcare just isn’t socialism. Industry, rather than the state, can retain control of industry even if the bills are paid out of a state-maintained pool of tax revenue. A doctor who receives her check from the federal government is not thereby that government’s employee — at the very least no more than she is your employee for having deposited the copay you handed the receptionist on the way out of her office.

Second, and more importantly, we in the United States already use and support programs analogous to single-payer healthcare. Our taxes pay for firetrucks. A deduction from your paycheck funds the services that keep your air and water clean. Police departments across the country pay their officers out of a city-, county- or state-level pool of taxpayer money. Call it single-payer protect and serve. We don’t think about these services because they have been so deeply and so long ingrained in the definition of a state’s duties to its people. They are common sense; you call 9-1-1, a police car shows up. You leave your oven on a bit too long, the fire department puts an axe through your ceiling. But you develop prostate cancer, and nobody comes knocking. You are born with a muscular-degenerative syndrome, and your only guaranteed meeting is with a bill.

We demonstrably think that we have a right to the establishment and maintenance of an adequate police force to protect us from harm. Why, then, do we question single-payer advocates’ arguments that we have a right to adequate healthcare to do the same? Opponents of so-called socialized medicine argue that they, “the Hardworking American,” should not have to pay for government services afforded to their neighbor, “the Freeloader.” Yet the squad car does not differentiate between the freeloader and the hard worker. The fire hydrant gurgles just the same for the prince as for the pauper. If one is to laud the fact that the cop serves the common good, one cannot then lambaste the proposition that the doctor do the same.

Nor can the opponent of single-payer healthcare hold that the police perform a more immediately necessary or important function. Almost 34,000 deaths in the United States each year are attributable to gun violence, an ill it is reasonable to think the police are there to prevent. But nearly two-thirds of those deaths are suicides — not always under the purview of law enforcement. Minus accidents and suicides, the number of gun deaths falls to about 12,000. Now compare that with the list of the most successful annual American serial killers: heart disease, with around 634,000 fatalities; cancer, with 596,000; and chronic lower respiratory diseases, with 155,000. Together, these outnumber non-suicide gun deaths nearly 14 to one. And hospitals, doctors and urgent care providers are singularly situated to help. Nothing even the most well-equipped police force could handle enters the top 10 causes of death in the United States each year.

It is likely that without the police, the kind of anarchic violence they now prevent would match or outpace the current leading causes of death. But this fact does not bode poorly for the advocate of single-payer healthcare. If anything, it’s an acknowledgment that the state can provide relatively efficient services to remedy social ills, balancing the expectation that every citizen pay their share with the assurance that each who has will reap the rewards when it comes her turn. If “repeal and replace” is to work, perhaps a worthier replacement is a system we’ve already agreed to use.