Recently, an article was written on Rightwingism by a Democratic socialist, going by the username of Mouthy Infidel, supposedly providing the case for “universal healthcare” as the title suggests. The article is actually supposed to be a case for single payer healthcare, but even calling it that would be a fallacy. Speaking of fallacies, this article is filled with them and provides a very uncompelling defense.
To clarify, most people aren’t against universal healthcare. Universal healthcare just means everyone has healthcare. A single-payer system is one where the government takes the entire bill and provides healthcare for everyone – being the single payer. This seems to be what Mouthy Infidel advocates for. So, in the hopes we can actually debate and frame the claims correctly, just replace “universal healthcare” with “single-payer healthcare” whenever Mouthy Infidel brings it up. I will also refer to it as single payer healthcare within my refutation.
Deaths from US Healthcare
Mouthy Infidel starts the article off with an issue largely claimed by Bernie Sanders and other progressives – that the current healthcare system causes a substantial amount of deaths per year. Mouthy Infidel states,
“These individuals are not alone, however. According to a Harvard study, approximately 45,000 people a year die from a lack of healthcare coverage.”
If only he and everyone else knew this actually isn’t true and the number is kind of in the air. We don’t actually know how many people die due to lack of healthcare. We do know it’s definitely not 45,000. The 45,000 number comes from a study that required a lot of bias and mental trickery to come up with. Megan McArdle writes,
“Those studies are very shoddily done, with parameters that somehow always conspire to produce the maximum possible number. In the first study, they set an absurdly low threshhold for what constituted a “medical bankruptcy”. In the second, they chose 2006, the year after the 2005 bankruptcy reform act had driven an unprecedented spike in filings. It seems pretty likely that medical bankruptcies were bound to be overrepresented in 2006, since most financial events are easier to see coming than illnesses. But even if you disagree–and the authors offered an incredibly wan explanation of why they did–it’s very clear that the people who filed in 2006 were not going to be a representative sample of bankruptcies in a normal year.”
Right off the bat Mouthy Infidel is making a very bad claim.
Canada’s wait times are pretty murderous too. The Fraser Institute published a study measuring the effect of wait times on mortality of women in Canada. The study finds the increase in wait times has resulted in between 25,000 and 63,000 additional deaths in females over a sixteen year period.
If you extrapolate the middle estimate to America’s population size this brings us to roughly 25,000 deaths a year. In this regard, it seems nothing is fixed by single payer healthcare. We only come to a likely increase of deaths. This also underexaggerates the death toll due to their single payer system as we haven’t even gotten into quality differences.
Debts and the Cost of US Healthcare
Mouthy Infidel then argues against the right wing claim that single payer healthcare would cost too much. He states,
“The most common objection you will always hear in regards to universal healthcare is that there is no way we can afford it. The US is over 20 trillion dollars in debt, so it comes as no surprise that many Americans are skeptical of a program such as universal healthcare which inevitably will cost the US trillions of dollars. However, in pointing out how much a universal healthcare system would cost, people only tell half of the story. What people don’t consider is how much our current healthcare system costs the economy. When measuring the affects a policy will have on the economy, it is not sufficient to merely examine the cost. Rather, to accurately determine the net effect, you have to examine the cost in relation to the benefits of said policy. For example, a recent Mercatus study found that one proposed single payer bill would cost a whopping 32.6 trillion dollars over 10 years. However, this same study found that in relation to our current system, these expenditures are actually significantly less than what we currently face. Specifically, the study found that medicare for all would actually save the economy over 2 trillion dollars over 10 years. Furthermore, an economic policy research institute study found that medicare for all would save the economy over 5 trillion dollars.”
Woah what do you know? The US government spends a lot on healthcare as is. It’s almost as if we don’t have a true free market system and the issues provided by our current system are largely based upon our current spending level and intervention in the healthcare market.
We have large fees for Medicaid and Medicare, which only increase as the general population gets older and larger. Demographic change only increases the burden of debt the nation has to pay. The single payer system would only save us money in relation to how much we currently spend which is no argument for a single payer system, just an argument against the current system.
I’ll explain the costs of healthcare soon; this point is very miniscule in the debate. For now, we can go to Mouthy Infidel’s next paragraph,
“Even if we didn’t have these studies showing us that universal healthcare would be significantly cheaper, all you’d have to do to draw such a conclusion is look at the fact that despite being the only industrialized nation without universal healthcare, we spend more on healthcare per capita than almost every other industrialized nation. For reference, US healthcare spending per capita nearly doubles the comparable country average when compared to a number of other nations (all with universal healthcare systems).
Largely, the reason the US spends so much more on healthcare, according to a recent JAMA study, is due to the administrative complexity and high costs of medicine and equipment among other things. These aspects of healthcare spending can be traced back to the motive of the healthcare providers in the us: to make a profit. Therefore, the reason a single payer healthcare system would be less expensive is mostly due to the fact that the government, unlike private healthcare companies, is not out to make a profit. The study finds, “In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes. Contrary to some explanations for high spending, social spending and health care utilization in the United States did not differ substantially from other high-income nations. Prices of labor and goods, including pharmaceuticals and devices, and administrative costs appeared to be the main drivers of the differences in spending.” Out of the 10 other countries studied, healthcare spending ranged from a low of 9.6 percent of the countries GDP, to a high of 12.4 percent. The US, on the other hand, was found to spend 17.8 percent of its GDP on healthcare. In conclusion, the idea that we cannot afford a universal healthcare system is completely baseless. In fact, the question should not be “how can we afford to enact universal healthcare”, but rather, “how can we afford not to enact universal healthcare?”
This argument misconstrues why healthcare is expensive in America, or that the price is so out of the average at all.
We spend more per capita in the government sphere of things which is obvious proof on its own the country is not running a free market system, something Mouthy Infidel later acknowledges. Something that would also be brought up here is the actual cost of premiums. This is a more interesting argument in the debate I would like to touch on.
Since at least the 1980’s, the amount of people (note: not the percentage of people, the actual amount of people) graduating from medical school has been stagnant. We have had the same amount of people graduate from medical school every year. Along with this, the population has grown over 100 million and people have gotten older, therefore requiring more care.
Milton Friedman pointed out this very same issue in 1992. The supply does not meet the increasing demand.
By simple laws of supply and demand, this is a very easy issue to recognize. I bring this up a lot in the article so I’ll refer to it as the “supply-demand issue of single-payer” simply because single payer offers literally no solution to this problem. I have yet to see a response to this problem in particular.
One claim could be made this is an argument for free college. Because if we made college more accessible, more people would be going to medical school and graduating and we could fix this issue. But a study by the OECD compares countries with free college and countries without free college and finds countries with free college have graduation rates only hardly above that of countries without free college.
This does not, however, mean there is no solution whatsoever to the supply-demand issue in healthcare. But the fix for it is the complete opposite of what Mouthy Infidel is advocating for.
Obviously, we can decrease the demand. This would require limiting immigration (something I am not opposed to) but we currently have an issue in the weight of fertility rates in the United States. So, I would prefer we look largely to the supply issue.
If we look to the rise of healthcare costs in the United States, the most major increases in healthcare happened after 1965. Well, in 1965 the Johnson administration began the government-buyer monopoly, passing Medicare and Medicaid. The continuous regulation of healthcare and the nationalization these areas clearly made an impact of raising healthcare prices.
To illustrate the strength of this argument, we can look at specific areas of healthcare and legislation passed. One of the major ones was the Drug Price Competition and Patent Term Restoration Act in 1984 which allowed the length of patents above 20 years. Once this was put into legislation, the dramatic increase (it had already increased some, but this was a specific point where it increased at a faster rate) of the price of pharmaceutical drugs began.
Crazy how that works out, isn’t it? It’s almost as if regulations cause prices to go up and limit the market’s ability to operate efficiently. But wait- there’s more!
A “crazy” claim would be to say healthcare spending isn’t really out of the ordinary, right? One would think. But, this has been well documented, researched, and written about by the author of the website, Random Critical Analysis. Yes, dozens of extensive, well researched articles have come about that show US healthcare expenditures aren’t too crazy.
Yes, US healthcare is expensive, but as the author of Random Critical Analysis points out, GDP is not a good measure of determining how “out of the ordinary” it is. When you look at things such as differences in standards of living by country, general consumption, etc. you find the US healthcare system is not too expensive, all things considered. I’ve picked a couple interesting graphs to display this, but you can read through all the content on the website for a ton of more in-depth information on this.
So, sure healthcare prices are a bit high in America, but single payer healthcare offers literally no fix for them.
This claim is made over an entire section by Mouthy Infidel in his article as well as near the end of the last quote. I’ll bring the specific part back to your memory:
“The study finds, ‘In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes. Contrary to some explanations for high spending, social spending and health care utilization in the United States did not differ substantially from other high-income nations. Prices of labor and goods, including pharmaceuticals and devices, and administrative costs appeared to be the main drivers of the differences in spending.'”
There are a few ways we can look at this. One is through mortality rates. Mortality rates are lower for cancer related deaths in America but higher than average for circulatory related diseases, this being the main area dragging the US down. If you controlled for the amount of obesity in America this would likely go away.
The amount of obesity is not a healthcare related issue but a culture related issue. The same goes for suicide relates which also bring down the American mortality rate. Healthier diets are preferred in European countries while America has a large issue with this obviously. America also eats a lot of fast food. As William Titshaw at the blog The MegaThink illustrates, fast food is a moderate-strong predictor of obesity. This is not a healthcare issue; this is an American issue.
The Peterson-Kaiser Healthcare System Tracker provides us the best evidence of healthcare systems in comparison. Sure, there is a gap in amenable differences in deaths due to healthcare. This does not however mean that single payer healthcare is a solution, just that American healthcare is not great as it is.
Disease burden is also higher in the US and declining at a lower rate than in comparable countries. As KFF states, “In the United States, mental health and musculoskeletal disorders are the leading cause of years lost to disability”. America does worse in musculoskeletal disorders, as well as congestive heart failure, asthma, and diabetes. These areas, while heavily highlighted as our flaws, are not because of healthcare. If we controlled for the obesity rates in America, the differences would likely go away.
There’s no doubt America has a mental health issue as well, but this doesn’t mean we should prefer single-payer healthcare, just that we should find ways to fixing it. One for starters would obviously be removing stigma from getting help for these issues.
Overall, most of the issues where America is doing worse in compared to other countries are due to obesity. This is not a matter of American healthcare but a matter of shifting our culture. It also might require heavily regulating fast food as Titshaw suggests. But, overall, if we are to try and combat these big issues, we may end up closing the gap. One thing is for sure – single-payer healthcare wouldn’t close this gap.
Again, we come back to the supply-demand issue of single-payer. This system given its immense wait times and inefficiency might never even try and touch these issues. There simply wouldn’t be a supply of doctors big enough to do so.
As I stated, America does better in cancer deaths in comparison to other countries. The Foundation for Economic Education (yes, I know, a biased source) takes data from the CDC and finds when you extrapolate the cancer death rates among other countries to the US population, you find massive increases in the death rates. The article states,
“If we weight the CDC-quoted survival rates for different forms of cancer in accordance with their contribution to overall cancer mortality, we find that, with the UK’s survival rates, there would be about 72,000 additional deaths annually in the United States. There would similarly be about 21,000, 23,000, and 31,000 additional deaths per year with Canadian, French, and German survival rates.”
Mouthy Infidel spends a good deal of time comparing the United States healthcare quality to other nations healthcare quality.
Yes, there are some countries that have socialized healthcare that have higher satisfaction rates than the United States. There are countries that are still less satisfied than the United States. No one is claiming the current system is good. Just that it is better than if America had a single payer system.
He also points out that America is ranked 5th out of 11 countries in terms of healthcare quality. Okay? Once again this does not mean healthcare in America should become single-payer like the other countries, only that it should be changed. Tl;Dr: Not an argument for single payer, just against modern US healthcare.
Finally Making Arguments for Single Payer (but not really)
Mouthy Infidel, after all this useless length of time, begins an argument that is kind of for single payer healthcare. That might be an overstatement. He claims it would boost the economy and put more money into peoples pockets. Mouthy Infidel states,
“Firstly, it would spur an increase in entrepreneurship, and subsequently, increase competition, which as these same right wingers who argue against universal healthcare will tell you, is good for the economy. The reason for this is fairly simple: As of right now, hundreds of workers are too afraid to start a business out of fear of losing the healthcare coverage which their work provides them, which disincentivizes them from starting a business. Going by this logic, we can safely conclude that providing all of these workers healthcare unconditionally would inevitably lead to more people starting their own businesses, which would be good for the competition which drives the economy. The increase in entrepreneurship isn’t the only way in which providing universal healthcare would be good for competition and the business climate, however. For example, if the state is providing workers healthcare, that takes the burden off of businesses to provide healthcare for their workers. Furthermore, because workers are more likely to work (and work more productively, for that matter), for companies which provide them healthcare which bigger corporations can more easily afford, providing all workers with healthcare would ease some of the competitive edge which bigger corporations have over smaller business at the present moment, which would increase competition. Besides hurting competition between businesses inside the US, it’s worth noting that businesses having to pay their employees healthcare costs put them at a competitive disadvantage in the context of the international market; This affect would be alleviated if we had universal healthcare.”
This claim is also made by Donald Trump in his book, The America We Deserve. Not related, but just a fun fact.
Here’s the thing about this though: it’s not really an argument for single payer healthcare, just for employers to stop taking the healthcare bills for their employees. That worked out well.
But seriously, why is the idea just falling out of consideration we should take the bill off of the employer, allow the employer to pay a higher wage, and put the bill on the employee.
Yes, his plan technically saves employers money because they no longer have to pay for insurance for their employees. Although, the people at the top of the employer chain will be paying most of the bill for this single payer system so it’s not like much changed. And of course, he will be paying less in comparison to now, but not in comparison to if we had a free market system.
The plans provided by employers are usually pretty bad. Many companies, such as Wal-Mart find ways to pay for the cheapest healthcare possible (obviously) and so the workers are stuck with a healthcare package they don’t even like. If we just take that away and deregulate the healthcare market, the employee would be much more satisfied.
Furthermore, the idea this puts more money in the employees pocket, especially in comparison to a free market system is ludacris. Let’s assume we start a progressive, social democratic system where people have many programs provided to them. This would definitely increase taxes on everyone and therefore, the person would have insurance, but he would still have less money in his pocket.
If we remove the regulations on businesses to have to pay this bill and we deregulate the healthcare market and stop most spending into it, basically making it a free market system, then maybe assume the wages rise for the employees, let’s see what happens. The employee has more money, pays less in taxes, and pays less for a healthcare plan. This altogether means he/she saves more by having the free market system.
Mouthy Infidel then makes a claim relating to the workers being healthier and therefore being more productive and stimulating the economy, stating,
“It’s no secret that healthier workers work more, for obvious reasons. Therefore, if we follow this logic, providing every worker with health care would inevitably increase the productivity of the workforce, which would be good for the economy. Besides this, it would inevitably increase the buying power of many workers as well who have to pay for their own healthcare which causes them to have less money to spend on other things. So, if we provided every worker healthcare, this would increase demand and cause further spending, which would be good for the economy. Besides the cost to people while they’re still alive, what about the cost of death? As I alluded to earlier, thousands of people die a year from universal healthcare: This costs families thousands of dollars. Obviously, universal healthcare will not make people immortal, but giving people healthcare will inevitably result in people dying at a much slower rate, which again will save the working people money.”
But this assumes people will be much healthier under a single payer system. I’ve already illustrated the falsity of this point. People are unhealthy because they are fat. Obesity rates are very high in America and the deaths match it. Most health issues where America is leading in the death rate for can largely be attributed to obesity.
Overall, this “argument” for (but not really for) single payer healthcare is uncompelling.
Free Market Healthcare
Finally, Mouthy Infidel argues against free market healthcare as a way to justify the single payer system. After all, if the free market options to all of the issues he has presented above do not work, we must have one other option: single payer healthcare. This might be right, but his arguments against the free market system do not hold up – at all.
Mouthy Infidel first states,
“First of all, when it comes to healthcare, in order for there to be a free market, the people have to have some sort of negotiating power with the company providing them the product. However, in an emergency scenario, the consumer is in no position to negotiate or shop for the best price, therefore whatever transactions occur are not consensual, making exploitation effortless. The only way to avoid this emergency scenario is insurance which you purchase beforehand. As author Chris Ladd points out, “Absent a competent regulatory scheme, patients, at the moment in which they make their insurance purchase, have no way to be certain which provider will actually deliver on their promise. They will only discover the answer when their life, or the lives of their family members, depend on it. Under an insurance system without effective, powerful regulation, the market forces that would exist in a face to face transaction between consumer (patient) and supplier (doctor) disappear, replaced with a grim gamble in which the insurance company has every incentive to cheat.” The profit incentive is absolutely vital; as alluded to earlier, in large part the reason the US spends so much on healthcare is due to the profit motive of the insurance companies, which by no means would go away under a free market system.”
But, those who advocate for a free market system aren’t going to be compelled by this argument for a few reasons.
First of all, it’s your personal responsibility to purchase insurance and educate yourself enough to do so. This whole point that we shouldn’t have freedom in our healthcare provider or make decisions of this matter is not going to hold up. It’s a subjective view, not an objective case against the free market. The system works so let it work.
Second of all, when you’re in an emergency situation you will likely be billed afterwards. You can negotiate how much your insurance company covers you after the emergency. If you go to the emergency room in the hospital right now, they will treat you right away and you will be billed afterwards. This is kind of a misinterpretation of the current hospital system in America.
Third of all, libertarians and advocates of free market healthcare are not fans of insurance. Most of us are in favor of a pay-as-you-go system which, when the supply-demand issues are fixed within the market would work very well. It would also circumvent controversy around pre-existing conditions to some degree. Health insurance is only a necessity because we regulate it to be.
This argument doesn’t really make a case against free market healthcare.
Second he says,
“There’s one thing many people don’t understand about markets: In order for a market to function properly, cost has to align with value. The problem with a free market healthcare system, however, comes in that people who are already healthy tend to purchase healthcare less because they’re not worried about sickness. Sick people, who also tend to be poorer, however, need healthcare. So, because most people are generally healthy and won’t purchase healthcare, health insurers are forced to drive up the cost for the people who need it, which makes healthy people purchase even less, forcing health insurers to drive up costs on the sick even more, etc. This theoretical free market paradise libertarians fawn over is really nothing more than a cycle of exploitation and suffering.”
Healthcare is demand inelastic so if people have to pay for it, obviously they will. This contributes to the supply-demand issue with rising premium prices. The demand stays at 100% but the amount of people demanding grows while the amount of doctors stays the same.
Free market healthcare does not need include exploitation if we a) develop a culture where markets are responsible and the nation cares for itself and b) encourage personal responsibility to learn what you are actually paying for in the market.
This article did not argue for single payer healthcare. The arguments you could see as arguing for it were uncompelling and don’t take into account supply-demand issues and the modern culture of America.
Overall, if we want to decrease the prices of healthcare we need to get more people coming out of college as well as heavily deregulate the industry. This is seen historically and empirically. This relies of course, on the assumption healthcare is already too expensive which is only kind of the case.
I will press the supply-demand point as my most important to this debate. Seriously. Without a rebuttal to this, a case for single payer healthcare can not be made. Until this argument is addressed, it is nearly impossible to start having a real conversation about if America should adopt this system.