My position on healthcare isn’t ideological, it is based on the evidence. For years and years I’ve listened to anarcho-capitalist arguments against it and looked into their claims in good faith. For years and years the evidence I found didn’t support them. I used to oppose nuclear power, I was convinced by good evidence to support it; I used to be a protectionist, I was convinced by good evidence to be free trade; I used to think Sam Harris was a terrible person, I was convinced he was a very good person after actually looking into him; I was a Christian for the first 24 years of my life, I was convinced by evidence my beliefs weren’t true.
My point here is that good evidence has convinced me to change my beliefs, large and small. So it is not historically supported when people tell me I’m holding onto an idea just because I’m stubborn or ignorant.
On healthcare it is the opposite for most of its Right-wing opponents. They hypothesize about healthcare based on their ideology, but instead of taking the final step to test their hypotheses, they just declare the hypotheses true by virtue of them conforming to their ideology. If I engage them in good faith and provide them with the evidence I found, they either cobble together some excuse to focus on a bit of minutiae and treat it as the be-all-end-all justifying complete dismissal of my counter-evidence, or they simply dismiss it out of hand by virtue of it not conforming to their ideology.
Some have said that under a single-payer system, healthcare becomes completely political and subject to change with every new budget, and forces each healthcare sector to compete with the other for limited money.
However, looking at other countries, this concern seems to be founded on very little. For example, Canada has single payer, and it has the 25th best health (compared to the US’s 59 rank) according to the Legatum Prosperity Index. Detractors are worried about single-payer making government worse, but its governing rank is 10; the US’s governing rank is 21. This indicates that whatever negative effects government-run health insurance and the government itself have on each other are either minuscule or able to be mitigated.
Opponents of single-payer claim that a single-payer system is far too expensive and limits access to healthcare by rationing. However, when you look at the data, you find that single-payer is actually cheaper, and rationing and wait times already occur in the Unites States’ non universal healthcare system. I’m sure there are more modern numbers than this (which I would love to get my hands on), but as of 2013 the Commonwealth Fund surveyed 2,002 American adults and compared the results to 10 other countries. Twenty-six percent of the Americans said they waited six days or more for appointments, slightly better than Canada (33 percent) and Norway (28 percent). These results were also much worse than in the Netherlands (14 percent) and Britain (16 percent).
Not only is the US little superior than Canada in regard to wait times, but the place with not only government owned health insurance but also government owned hospitals, the UK, was superior to most on the list. That is strong evidence against the argument that government can’t provide these things with better results than the approach of the US.
With respect to the hypothesis that single-payer is more expensive than that of the US, this is one of the most soundly disprovable claims. The US spends about 17.07% of its GDP on healthcare spending. Canada spends about 10.53% (much cheaper), the UK spends 9.76% (even cheaper). Critics of universal healthcare may want to look into data to see if their ideological hypotheses are true next time before assuming they are true simply because they are consistent with the critic’s ideology.
Critics of single-payer claim that instead of patients and doctors making key decisions, government bureaucrats get to make those life and death choices about the kind and amount of healthcare people receive. In reality, with the private insurance of America, bureaucrats in private insurance companies interfere with patients and doctors making those decisions just as much as government bureaucrats in single-payer healthcare systems. The difference is that in a single-payer system bureaucrats are at least ultimately answerable to voters rather than profit margins.
In sum, all the opposition hypotheses are false or so small as to be unimportant when comparing the efficacy of healthcare systems; universal ones of the type they’re criticizing and cherry-picking things about are clearly a net improvement over ours. I emphasize net improvement because obviously some things will be better in one system than another, but it is the overall cumulative effect that is most meaningful when deciding which is the best.
Importantly, I don’t care whether we implement single-payer only, single-payer and single-provider, or simply use tax dollars to cover everyone who doesn’t get healthcare privately. Europe and Canada have demonstrated that all those methods of universal healthcare would be superior. It matters little to me which one we actually implement. I’m not wedded to single-payer specifically.
As a final remark, if you are curious about my referencing of the Legatum Prosperity Index (LPI), I cite them because I’ve read their methodology and have evaluated it as excellent. I don’t just believe them because it confirms my bias. They consider many things, including Safety & Security, Governance, Personal Freedom, Investment Environment, Education, and Environment. The stats they look into for each of these components make sense. For example, with their Governance “pillar,” executive constraints, political accountability, rule of law, government integrity, government effectiveness, and regulatory quality are considered. The relevant factor here, health, considers behavioral risk factors, preventative interventions, care systems, mental health, physical health, and longevity.
Of course nothing is perfect and someone could probably reasonably come to slightly different results than Legatum. But it is highly unlikely a person could reasonably come to drastically different or opposite results results. There is even overlap to compare them to. On the topic of freedom the more conservative Cato institute has a Human Freedom Index (HFI; including personal freedom and economic freedom) which we can compare to corresponding features in the Prosperity Index. The LBI ranks Norway number 1 in personal freedom, the HFI ranks them as 6. The LBI ranks the US 22 in personal freedom, the HFI ranks them 26. Economically the LBI ranks the US as the 4th “open economy,” the HFI ranks them 5. Such results indicate consistency and validity.
As a final, final remark, I mentioned at the beginning of this article the many things I’ve changed my mind about. Me changing my mind doesn’t mean my opinions just change with the wind, it means I accept good arguments and evidence. Because it took good arguments and evidence to change my mind in the first place, I rarely totally reverse my stance again. Of course, I am constantly making my positions more nuanced based on new information; tempering potential zealotry with details that defuse zealotry. My ideas are hardly black and white. Despite most of my beliefs being firm beliefs at this point, I don’t assume to know everything or assume that situations don’t change. I’m a pragmatic and evidence-based liberal like Andrew Yang, not a zealot regressive leftist.