I seem to have set off a firestorm on Twitter today because I said something that is undeniably true, but I added a word I should not have. I’ll explain that later on. For now, allow me to explain why being “single-payer or bust” is narrow-minded and unrealistic.
This is still the only country in the world in which someone can get sick or injured through no fault of their own and see the fruits of their entire working life be laid to waste. With the passage of the Affordable Care Act, the number of medical bill-related bankruptcies has dropped precipitously, but it’s still a problem because some people don’t get insurance for a variety of reasons. The problem comes with our tendency to treat healthcare the same way we treat every consumer product in this country. It’s possible to never buy a TV, a toaster or even a car in your life, but no one will avoid needing healthcare at some point, even at the very end. You also can’t choose when you will need it. I mean, if we could schedule the bus to hit us a week from Friday, we could shop around and get the best deal on a hospital. If we knew when we were going to get the flu, we could make an appointment ahead of time and avoid the ED.
That is our problem. Healthcare is not a consumer product or a commodity, and it is not something we can plan for, so we buy insurance. Unfortunately, because it’s unpredictable, because some people think they’re immortal and choose not to get insurance, and because equipment and treatment advances are so expensive, healthcare is very expensive. Healthcare is technically a right, although we don’t treat it as such. When you arrive at the ED with your arm falling off, medical personnel have an obligation to re-attach it. If you are in great pain, they have an obligation to relieve your pain. If you have a chronic condition that could kill you, doctors are required to treat it.
So, here’s the problem. We all have the right to emergency or urgent care, but there is no mechanism in our system to make sure we can pay for it, except insurance. Because a significant number of people either can’t get insurance or choose not to buy insurance, a lot of people can’t pay their bill. Meanwhile, insurance companies are trying to make a profit, doctors, clinics and hospitals are all trying to make a profit, and medical care is very expensive. The only way to solve this problem is by making sure everyone has ready access to healthcare of all types whenever they decide to go to a doctor AND ALSO have the ability to pay the bill.
Healthcare should be an absolute right in all cases and everyone should have health insurance as a matter of course. Every bill should be paid and no one should lose their house or their livelihood because they got sick at the “wrong time.” No family should ever have to hold a fundraiser to pay for medical expenses. In other words, universal health insurance should be the law of the land. If you are in the country, you shouldn’t have to think twice about going to the doctor because you don’t have any money.
Most other industrialized countries have this as a feature of their society. If you are a citizen of almost every other major country, if you get sick, you go to a doctor and the bill will be paid. However, what you should know is, most countries who do this do not do so with a single, government-funded or government-run insurance system. In other words, whereas almost all advanced countries in the world guarantee health insurance, very few of them are single-payer systems. Therefore, this whole “single-payer-or-bust” movement is very puzzling.
Don’t get me wrong. I’m not against single-payer, I am for whatever works to get us to where nearly every other advanced nation in the world is. The issue is universal health care. If we can get there through a single-payer system, great. If we can get there through a heavily regulated private insurance market, that’s fine, too. If we have to employ a hybrid system, great. The thing is, the issue is getting everyone access to affordable health care, not focusing on one version of that and failing repeatedly.
Look; we have a great start with the Affordable Care Act. We now have a mechanism through which most people can afford to buy insurance at a price they can afford. The increased regulation gets rid of most of the abuses private insurance used to be guilty of in the past, and the vast majority of bills get paid. Does the ACA need work? Hell yes, it does. When it was passed, no one thought we were finished. There should be a public insurance option, which will not only provide inexpensive insurance to the poor, but also spread the risk more thinly, which is good for the private insurers.
All in all, though, the ACA is a good start.
Of course, the same segment of unicorn progressives and professional lefties who agree now screaming “Medicare for All!” And “Single-Payer or Bust” are primarily responsible for the election losses in 2010 and 2014, thus handing Congress to Republicans and thereby killing any chances for improving the ACA, so one has to wonder why they are screaming so loud now about things we can’t possibly get with the GOP in charge.
As I noted at the beginning of this piece, I used a word I shouldn’t have used on Twitter. The word is “white.” The ability to focus your lame efforts on “single payer” as the be-all and end-all of healthcare financing and insurance is a function of privilege. On Twitter, I said “white privilege,” but I misstated things. It’s a function of privilege. It is a luxury to think that way.
You see, given the millions of people who have to deal with the healthcare system on a regular basis, the issue is making sure they don’t lose access to the care they need. They do not care HOW we create a universal health insurance system, just that we do. As long as their disabled child gets what they need to stay alive and as healthy as possible, how we set up the system to pay for it is a secondary concern. That means your screams of “single-payer” are falling on deaf ears, and a lot of blank stares. Of course, you might want to know what single payer is. It is not synonymous with “healthcare as a right.” It is system where the government sets up a single insurer, or “payer,” and that payer handles all the bills. It is but one possible way to set up a universal system. Is it the best? Maybe. However, since only a handful of countries insure people that way, it is a difficult case to make.
Last time: the issue is making sure anyone can see a doctor, whether or not they have money. How we pay for it is but one component of that.
Also published on Medium.