What We (Don't) Talk About When We Talk About Healthcare

Anytime anyone talks about a single payer system in the United States, you'll usually find people on two opposing sides of the practicality of such a system. 

I say usually, because there's now apparently a third group- what I guess you could call a sort of "progressive realist."  These are the people who claim to completely believe in the idea of socialized medicine, but who've committed themselves to the all-important task of gently telling the people who want to bring it about that they're full of shit.

Paul Krugman, economist and recently outed snob, bashed the Sanders healthcare plan in an article in the New York Times called Lack of Power Corrupts (it should be noted that Krugman is renowned for being an major figure in economic opinion pieces, and I assume he's also renowned for naming said pieces in the snobbiest way possible.) You can read the whole thing here, but what I find to be the most infuriatin is this line in the fourth paragraph:

"You don’t have to be a corporate hireling or a Hillary shill to be taken aback when a Democratic campaign endorses economic projections that are even more outlandish than the Republican fantasies you were ridiculing just the other day."

Now, of course, Krugman is doing his due diligence. First of all, even acknowledging the plausibility of any Clinton opponent would put this man at odds with himself. Krugman has worshiped the male Clinton presidency's economics since its inception. Considering that this president was in office during the greatest economic expansion in 40 years, it's not hard to do- all you have to do is forget that his presidency overlapped the massive expansion of the internet, and be able to conveniently forget that when Clinton overturned Glass-Steagall he laid the groundwork for one of the most destructive economic collapses in the history of the planet.  

(It would also be convenient to forget the GOP plan for healthcare, the long and short of which is somewhere between jack and shit.)

The second part is that Krugman understands the fine line Sanders is walking with his policy, so much as that Sander's knows today's political audience doesn't do well with multi-part arguments. Sometimes it takes time to explain things, such as how a single-payer healthcare system could drive costs down. Sanders knows his opponents are smart enough to cut him off between “we would raise taxes on people” and the “but we would end up saving those people money.” 

Krugman sees that if Sanders wants to convince people his plan could work, he has to work with the time he's given.  He has to give the outlines, then point towards countries that save themselves tons of money and hope we're smart enough to put the pieces together. 

But never mind if it works. If it isn't stated explicitly, in one sentence or less, it's no better than any bat-shit crazy plan that Trump has put out, right?

Here's my question: why are we even talking about this?

I'm seriously asking, because I don't think we know anymore. You can hear progressive economists like Robert Reight (and 170 others) argue the minutia of policy and the economic effects they would have, and you can hear basically fucking anybody on Fox News talk about the economic disaster it could become. 

We can (and are about to) talk about how on a case-by-case basis it's incredibly difficult to determine whether or not a socialized medicine system like [insert literally any other first world country here]'s would have on people's real, actual, day to day lives when it comes to finances. 

“People would lose! People would win! Some people would lose, some more important people would win!”  Whatever.  You could spend a whole day reading about the politics of Sander's plan or the benefits of Obamacare, and I think that by the time you were done, you'd probably have less certainty about your position, regardless of where you started. 

What's the point?

Do we need socialized healthcare? Could we afford it? Who would pay for it? Who would stand to gain, or lose?

I'll spoil this for you- until we answer the following question, there's really no point in talking

about anything else.

Is healthcare a right?

Nobody wants to be put into the position of defending the answers of “yes” or “no” or “it depends,” but it's something we need to decide, otherwise, you're either a. never going to see a policy enacted that you think is economically or morally justified and/or b. never going to hear the end of this policy debate/partisan circle-jerk.

Let's make the question easier. Is healthcare a public good? We're now talking about the most affordable, most effective healthcare as being the same as the right to an education, or a right to being safe from intruders, or the right to have somebody show up to stop your house from burning down.

Plenty of people, and now apparently a self described “progressive policy serious-person", are more than willing to dodge the question- to them, the more appropriate question involves the cost thereof. I understand that before we decide how to make something work on a federal level, we need to figure out how to budget it.  "Fail to plan, plan to fail" kind of thing. 

Or is discussion out of the question entirely?   Reality may have a liberal bias, but in our political climate, facts don't matter, unless you're a billionaire who needs to skew public opinion with very specific facts for the sake of policies that benefit you and the .05% of Americans like you. Otherwise, who gives a shit about what's real-  Say anything with enough confidence in a presidential debate, and you'll get the backing, especially when you're running against a world class bunch of wimps and liars.  Ask Trump.

But here's what I don't understand. The reason we have fire departments and police officers, the reason we have a criminal justice system, or the reason we collectively pay money towards maintaining bridges and roads and buildings so that they don't collapse, isn't just because we can afford them. Fire-fighters are trained to protect people. Police officers are trained to shoot people who would kill others. There's a publicly funded criminal defense system in every single county in the United States who would prosecute anyone who was charged with murder, attempted murder, kidnapping, assault, whatever. Clearly, the idea is to prevent injury or loss of life. For some reason, in these cases, we prioritize the life of human beings over the discussion of how much protecting that life costs.

Despite the fact that we don't bother to measure the value of humanity, we control the costs of public goods just fine.  Instead of having any number of police stations that people could choose to pay to protect them, we have one per city, county, and state.

Since there's no competition, and there's no profit margin, the cost is as low as it can go. Same with firefighters, and prosecutors, and trash collectors. These are public goods we determine are the most conducive to our survival, therefore, they are excused from any sort of profit battle. They're things we need, not things we want, so we put them in another pile. There's a word for that, and it's kind of a bad word: Socialism.

And yet, in one particular aspect affecting the possibility of loss of life or injury, namely, medicine, we're completely OK forcing people to pay for it themselves.

It's like we've collectively said “We all know that it's possible that fires, murderers, the weather, or most accidents can kill any one of us. Let's pitch in and make sure that if a house or building catches on fire, or if a tornado hits, or of somebody kills somebody else, or a building is going to crumble, somebody will attempt to rectify the situation. A person shouldn't have to pay for that as an individual, because it's something we all need.

“However, should you add the word 'cancer' to any part of that paragraph, then that person is on their own. Fuck 'em.”

What we're really talking about is the difference between dying from cancer or dying from a fire. What's the difference? They're all socialist policies.

The only answer, really, is the price.

That's why we need to decide. Because if the price is enough to stall you, then you're really asking how much any human life, including yours, is actually worth. And if that discussion sounds like a shit sandwich, consider that it's only the first of many, because if we're going to go through this with health care, then we might as well talk about all of those other pesky services we've decided are public goods. If we're simply going to ignore the morality argument, but we still want to talk at all, then we need to talk about the practical aspects of public goods. Are all goods unnecessary?

Perhaps. If we truly want free-market solutions, then for the sake of consistency in our rhetoric we now need to abolish all government, because even having a government is a public good.

In one of the weirdest pieces I've ever read on the subject, it's said that socialism means force, and force is wrong.  Truly free markets don't need force- if a better service is available at a lower price, then people can get that service instead.  Through plenty of these decisions, the invisible hand of the market will provide the lowest costs for the highest standards of service.  The only way anyone could cheat the system is with the help of the government.  It's that simple, right?

Well, simply put, fuck that. 

Force is society's way of keeping us from destroying ourselves. The only reason we don't kill each other over the last tickets to a Deadpool premiere is that we've decided that we need people trained to prevent that sort of activity. Do you really think that's wrong? Sometimes you have to give up some liberty for security.

Look at it this way- you were able to publish that article on the internet. Now all Al Gore jokes aside, without massive investments from the United States, the internet as we know it wouldn't exist. You're using a tool created by socialist policy to say that nothing good comes from socialism.

What I never understood about the free-market, anti-socialist crowd was that many of seem completely fine with spending public money lots of other things. Tell them we need to spend money on the military, or policing the corrupt unions, or making it more difficult to spend money on abortions, and they'll chalk it up to a star-spangled necessity. 

But here's the thing we have to realize eventually- even these services are socialist as well. And at this point, considering how easy it is to figure out exactly what “socialism” means, you have to figure that some of them are completely OK with ignoring the definitions of words in the English Language for the sake of maintaining their positions.

The point is that we are completely OK with using certain allocated resources for the sake of price control- in a private system, the vast majority of people wouldn't be able to afford their own security, or their very own trash service, or their very own fire service. 

If you're one of the 100,000 or so people in the United States who could afford this, well, I'm sure that sounds great. That would certainly keep those evil socialists out of your lawn- but what it probably wouldn't keep out would be an army of screaming people who haven't eaten in days because there's no longer any government subsidized food- let alone somebody who could harvest and transport the food. Probably a good thing; any working transportation would have been torn to scraps of what could be bartered, meaning that some poor fuck would have to walk the food all the way to you. Or they would, if it wasn't practically a mathematical certainty that they'd get robbed and murdered within a day because we decided those pesky government paid police didn't need to take any of our tax dollars away.

Can we just ask the politicians directly?  I'd love to hear Ted Cruz or Trump explain why spending a trillion dollars belonging to the collective United States on a war in a foreign territory somehow evades the technical definitions of “socialism,” but giving somebody a public option for healthcare somehow doesn't. Five bucks says they don't make it 30 seconds without trying to change the subject to 9/11.

But I guess not talking about it is sort of the point. Some things we glamorize and value, such as capabilities for violence and making our gasoline powered-machines even louder, and some things we like to look down on and present as evidence that our culture has lost its self sustainability, even though it's all socialism, according to the language we're all using to talk about it. 

But I get it. It's a lot more psychologically satisfying to look at people who have lost everything they'll ever own to medical bills, and blame them for misplacing their priorities- they should have been working harder to get a better job so that when they got cancer it didn't send them and their families into a cyclical hell of debt and sadness. “I pay for health insurance, because I'm [Insert any adjective here, so long as it isn't “I happen to be in a position where I can afford it.]"

Before there was a police department, there was probably a large, angry collection of people who looked at the problem of people getting robbed and decided that the victims were to blame. Never mind that people can “choose” to get robbed in the same way they “choose” to get cancer. 

 I'm strong enough to defend my goods and my family, so why aren't you? Why should my tax dollars go to defending people who won't even have the decency to defend themselves? This is socialism! We're forcing people to pay for a police service, and force is wrong!

Here's one of my least favorite sentences ever- let's do some math. According to the CDC, these are the 10 highest causes of death for Americans in 2015.
Heart disease: 611,105

Cancer: 584,881

Chronic lower respiratory diseases: 149,205

Accidents (unintentional injuries): 130,557

Stroke (cerebrovascular diseases): 128,978

Alzheimer's disease: 84,767

Diabetes: 75,578

Influenza and Pneumonia: 56,979

Nephritis, nephrotic syndrome, and nephrosis: 47,112

Intentional self-harm (suicide): 41,149

You might notice that a common theme, and that theme has a lot of names. Some prefer “natural causes,” some prefer “diseases.” I personally prefer “shit that has nothing to do with terrorism.”  Call it what you want, but at least call it a problem.  And if the goal is to prevent loss of life, then we either have to start spending collective money on health services or invent some sort of hand-held weapon or ICBM we can use to kill diabetes.

But let's look at this another way. Maybe somebody who's reading this really doesn't care that people are dying from things we can prevent. Fine, then. Let's talk about the practical aspects of keeping people alive.

According to data from The World Bank, the United States spent 17.1% of its GDP on healthcare spending. That equates to roughly 2.867 trillion dollars. By comparison, Italy, which was ranked the 2^nd healthiest country by Bloomberg, spends about 9.1% of its total GDP on healthcare. (Simply put, Italy has a mixture of public/private healthcare, roughly the equivalent of a very popular public option.) It should be noted that the United States is ranked 33^rd healthiest, according to that same study.

So forgive me for extrapolating, but hear me out: If we were to spend the same percentage as Italy, we'd save ourselves something along the lines of 1,324,676,187,000 dollars. That's more than the entire cost of the war in Iraq, in one fucking year. That's more than 4000 dollars for every single person in the country.

In review, that means if we implemented the exact same system they have in Italy, and spend the same percentage of our money, it means we'd be healthier, and we'd all be, on average, 4000 dollars richer. Is there any better reason to do anything?

This is the infuriating part about listening to people drone on about the unreality of a Sander's health-care plan. Maybe the numbers don't add up (they do). But if the plan sucks, but the goal attainable (per the dozens of countries that currently pull it off) then we're all under at least some variety of obligation (morality, fiscal sense, whatever) to figure out how to make it work.

And so, Krugman, to quote John Hartigan: "Breathe steady, old man.  Prove you're not completely useless."


Sam Wellborn lives in Austin, TX, and is going to watch Deadpool again.  Follow him on Twitter, or email him what you'd do with $4,000 at swellbo@gmail.com