The argument AGAINST Medicare-for-all

Added note: Apparently, this is one of those posts designed to test reading comprehension skills. Some people glance at the headline, skim the first few paragraphs, and presume that my argument is something other than it actually is. It is written in the Book of Proverbs: "The wise man readeth a blog post before he replieth, lest he be accused of jumping the gun like a silly-billy."

Believe me, no household in America could benefit more than mine from a single-payer system. I haven't visited the doctor since my heart attack because I can't afford to do so. My ladyfriend, who has insurance, tends to "tough it out" rather than visiting a doctor because the deductibles are so terrifying.

Part of me hopes that a single-payer plan succeeds -- but I also recognize that there are potential problems, from a let's-win-the-election standpoint. Bill Scher in Politico gives a pretty balanced assessment:

Note that I didn’t say single-payer is electoral suicide. I would have said so a year ago, but today I can’t say that with certainty. As any single-payer devotee will eagerly tell you, a July Quinnipiac poll found 51 percent of voters support such a system. When characterized as Medicare for All, a June Kaiser Health Tracking poll registered support at 57 percent. In the current era of polarized politics, where centrist voters are increasingly elusive, single-player would certainly energize progressive voters and could help Democrats woo back some economic populist Trump voters.

But single-payer hardly comes with an Election Day guarantee. More than 90 percent of voters support requiring background checks for gun buyers. More than 60 percent oppose a border wall. Fifty-six percent say America should “discourage the use of coal.” And yet, we have a president on the opposite side of all those issues.

Moreover, the top-line numbers don’t ensure that support can withstand attack. Kaiser’s poll analysts concluded: “The public’s attitudes on single-payer are quite malleable, and some people could be convinced to change their position after hearing typical pro and con arguments.”

For example, upon hearing the startling news that single-payer might “give the government too much control over health care,” support plummets to 40 percent. The revelation that the plan would “require many Americans to pay more in taxes” did the same. Maybe, just maybe, a Republican will give these talking points a try.

Precisely. The single-payer poll numbers are deceptive. The idea has polled over 50 percent in times past -- and then plummeted well below that point. Basically, Americans want health insurance without paying for it. Like it or not, there are many white Americans who feel like vomiting when they think about their tax dollars potentially helping to pay for a non-white person's health insurance. (People won't admit to feeling that way, but that's how they feel.)

My preferred solution: Not Medicare-for-all, but something like Obamacare with a public option.

Which, as you may recall, was the original Obamacare idea.

What I like best about this notion is that it puts to the test -- a brutally fair test -- two competing economic visions. Think of it as Milton Friedman vs. FDR. Are you a libertarian who really and truly believes in Friedman's vision? Then you should love to see this vision confirmed by experiment.

If you genuinely accept as an article of faith that Big Gummint never operates efficiently, then you should welcome the "battle" that I propose. You should feel secure in the expectation that private insurance would wallop the public option.

When O-care was a-borning, I said pretty much the same thing in various blog posts. A libertarian reader sneered that that the deck was stacked against the private insurer. I asked this reader: How? Just how was the deck stacked? At that time, everything was in flux; the details of the proposed law were not yet known. The libertarian simply assumed that the fight was unfair, that the rules were rigged against him. He couldn't cite any facts to support his presumption.

Let us have a truly even battlefield between the two counterpoised ideologies. If the apostles of Ayn are proven right -- if, in honest competition, the private plan always delivers better health care for less money -- then so be it! I will accept those results happily. I am much more committed to efficiency than I am to any ideology.

But when the public option was proposed before, Republicans insisted that the idea was unthinkable. They knew that was no way that private insurance could compete with a public option.

In essence, conservatives admitted that their most dearly-held beliefs were wrong. As I wrote back in 2011:

The health care debate had one virtue: It forced the Republicans to admit that libertarian theology is a sham. They came right out and admitted that private industry could not offer the citizenry a better deal than the (soon-discarded) public option. Why would they say such a thing? Why did they fear competition from the gummint, if the gummint always does everything wrong? Didn't Milton Friedman tell us that private industry is always more efficient?

Gosh -- could it be that the Friedmanites lied?

You think maybe that's why your credit card bills are sent to you via the post office, and not via Federal Express?

Libertarians do not want to have their ideology put to a fair test because they know in their hearts that all private insurance plans will be more expensive.

Thus, right now, I say no to Medicare-for-all.

If we are given a single-payer system, the Apostles of Ayn will shriek "WE TOLD YOU SO!" every single time the system has a hiccup. No, it is better to have a public option competing with the various private options. Let the best weltanschauung win! If the public option succeeds, then the Randroids will have no basis for complaint; they will simply go to their corner and sulk, unable to pretend that theirs was a noble, untried ideal.