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The Cruel Hopelessness Of “Single Payer”

By  |  June 30, 2017, 10:32pm  |  @darrickjohnson


In the current debate over the Affordable Care Act, we really are in the midst of a great proxy war over single payer health care.   Sure, its not on the table with this Congress, and Obamacare, while a bureaucratic monstrosity, isn’t single payer.   But the debate surrounding GOP efforts to repeal, or at least reform the law is really a precursor to a national debate over single payer.

Regardless of the fate of the GOP pseudo-repeal bill, we are at a crossroads.  Obamacare is collapsing.   It was never intended to be permanent.  It was always a compromise, a bridge to complete, government sponsored, single payer health care.  We will soon have to decide if we want a market oriented health care system, or a government dominated system.

Every left-wing opinion piece on health care starts with the premise that medicine shouldn’t cost anything, and anytime it does, it’s a evidence of a failed system.  They point to Canada, the UK, and European states where the socialist dreams of medicine are, we are told, coming true.  Obamacare’s failures, they say, should drive us closer to “single payer”, not farther away.

As Christians, we believe that ever since Adam and Eve trusted the serpent instead of their Creator, we live in a fallen, imperfect world, where we can never “make it perfect”, and our best efforts can only succeed in “making it better”.  Socialized medicine, and market oriented medicine each present us with hard cases, so why do we recoil at government health care?  I think the answer comes down to one word that Obamacare’s namesake might be familiar with…hope.

Let’s look at two hypothetical examples, one, representing a worst-case scenario for free market health care, and one, representing a worst-case scenario for socialized medicine.

Meet the Jones family.  They have one child, 2 years old, who was diagnosed with a severe illness.   Experimental treatments are available, but prohibitively expensive.   The Jones family, while not living in poverty, cannot possibly afford the treatment, and they no longer have insurance, because of a recent job change.    This is the left’s fear (and to be fair, any American who has had lapsed health insurance knows this fear).   But while the situation is bleak, it is not hopeless.   The family sets up a GoFundMe page.  They tell their story in the local paper.   Community fundraisers are held.   They work with the local hospital.  Doctors and nurses agree to help this family at a reduced rate.  Local businesses contribute to the cause.    Is this a Polly-Anna resolution to this crisis?  Sure.  But it is possible, and it happens regularly in America.   Sometimes, it doesn’t work.   They can’t raise enough money.  The help comes, but too late.    But quite often, it does work.   And all the while, there is hope.  There is an opportunity for this family to make life better for their child.

Now, consider another family.  The Smith family also has one child, diagnosed with an equally severe illness.   The Smith family lives in a country with socialized medicine.  So the treatment won’t cost them a dime.   But  the treatment doesn’t exist.   Because there was no profit to be made in addressing this illness, pharmaceutical companies never invested in research to cure it.    Or maybe the treatment exists, but the local hospital, the only one the Smith’s are permitted to use, doesn’t have any beds available for 6 months.  When health care is “free”, the only ways to limit its consumption are lines and rationing.   Not only must the Smith’s wait, they must be “approved” to receive the treatment.    But the health service can’t do everything for everyone, and the Smith child’s 25% chance of survival doesn’t look good on paper, not compared with another patient with a 65% chance of survival.   The board denies the Smith’s request.   The Smith’s never worry about the money, but through their entire saga, there is no hope.   There is no hope when the treatment doesn’t exist.  There is no hope when the government, the final arbiter of your health care, says no to your child.  There is no alternate path, besides emigration.  Oh, and if you want to raise the money, and pay for the procedure yourself, that’s also a no.  See, single payer isn’t really single payer, if you let some people can pay for their own care.  Then you have a two-tiered health care system, one for the rich, and one for the poor, and that would be unfair.  Nothing can be done.  There is no hope.

The Smith’s story isn’t really a hypothetical.  The Gard family in the UK is living this hopeless nightmare.   They had a terrible prognosis for their son, Charlie.   But they wanted to keep fighting.   The couldn’t get treatment in their country, with its socialized health system.   But a new treatment was available in America.  They launched a GoFundMe page, and raised enough for the treatment, over $1.4 million.   But the doctors at the national health service said no.   The family sued to save their child.  But the courts said no.  The child must stay in the UK, have life support removed, and die.   No hope.  No chance to fight for your child, even if the odds are slim.

No system will be perfect.  Health care is vitally important to each of us, therefore it will be expensive; it is the definition of inelastic demand.    We don’t all have the financial ability to pay for what we might need, be it through insurance, or our own money.    But if faced with the choice of two terrible scenarios, – the Smith family’s hopeless “free” health care, the Gard family’s real life nightmare, or the Jones family’s expensive, but attainable care, wouldn’t you rather be the Jones family?   At least they can fight.  At least they can try.  At least there is hope.

Conservatives don’t oppose single payer because we are heartless.   This fight isn’t mainly about tax rates, or deficits, though single payer is catastrophic for both.   It’s about having not the cheapest health care, but the best.    So that when you need a hospital bed, the market makes sure you don’t have to wait until it’s too late.  So that when you have a rare disease, there is hope that the market found it worthwhile to develop a treatment.   That might mean that when you have medical issues, money is a worry.   You get scary bills.   But you have hope.   If the treatment is available, but the money is not, that can be fixed.   If the health care is free, but the government doesn’t permit you to receive it…well, that’s a cruelty we don’t want to see replicated in the United States.