Single Payer

I was stuck in a hotel last night watching Paul Ryan’s speech, and after he ripped on Obamacare, I had to comment on twitter:

Fellow BHT patron (and, so far as I can tell, staunch conservative / libertarian) Randy replied this morning.

So, stuck in another hotel room tonight (headed home tomorrow, thank God), as promised I want to write down some thoughts about single payer health care.

I’ll lay out my disclaimers out front: I haven’t done a lot of research on this. I’m shooting more or less from the hip. I’m not a doctor, nor do I have experience with the medical industry, save as an infrequent consumer.

So, about single payer…
Maybe I should be a good engineer and first define what I mean by “single payer” health care. I use the term to describe a system where the government provides the funding for the health care system in the country, paying for services directly. Examples of single payer systems include the British National Health Service, and, to an extent, the Canadian health care system.

Why might single payer be a good idea?

Lower costs
It’s a fair question: do we really think government is the most efficient way to run things? But let’s face it: the current system isn’t efficient. Administrative costs eat anywhere between 10 percent (if you believe the insurance agencies) and 30 percent (per a Harvard Medical School report) of the total health care dollars in the US. With $2.26 trillion dollars spent each year in the US on health care, percentage gains for administrative overhead will equal savings. Think about the number of insurance companies and billing middle-men that can be avoided in a single payer system.

Better understanding of actual costs

Any time I look at a bill received from the doctor I realize there are a bunch of shenanigans going on with the pricing of health care. The “list price” for a procedure (i.e. the price I would pay if I didn’t have insurance?) is really high. But then there’s this “negotiated” price listed. Which is a lot less. And I only have to pay a percentage of the “negotiated” price. It’s bizarre and hard to explain.

It works other places

Republicans will tell you anecdotal horror stories about the British or Canadian health care systems, but in the less-biased opinions of my British and Canadian friends, those systems actually work decently well. They’re not perfect, but they’re not atrocious, either. It’s doable.

It’s different than housing and transportation

Randy asked why, if we’re going to go the public funding route, don’t we also publicly fund other needs, like housing and transportation?

First off: we often do. It’s called public housing assistance, and public transportation.

Second off: health care is a different sort of beast. Lack of basic health care can be the reason that poor people are physically unable to work a job. A preventable dental condition or disease can be the difference between being able to show up to work and having to stay home.

The Social Contract

Whether you fully buy in to Thomas Hobbes’ idea of the Social Contract or not, I think he got at least one thing right: that there are certain ills which the government is the appropriate remedy, and that citizens should agree to give up some freedoms to that government in return for the benefits it provides.

Heck, even the Apostle Paul (Romans 13) notes that God designed government to “wield the sword”, so it seems that God isn’t completely opposed to governments.

Reading the Old Testament (and the New), it’s also clear that God places priority on caring for the poor, and in treating all classes and races of people with justice and mercy. The Marilynne Robinson essays I read a couple weeks back spoke strongly on that topic, noting that the OT law is designed in multiple aspects to protect the poor and the week, by outlawing usury, time-limiting slavery, and forgiving debts in the jubilee year.

As the people of God, I believe we should value justice and mercy more than personal freedom and rights. Perhaps our Christianity has been tied to our politics for so long in the USA that we’ve forgotten that the church has flourished over the years under many different political theories and types of government. America’s version of democracy may have attractive features, but it’s not God’s only righteous design for governments.

Shouldn’t the church do it?

I’ve been down this discussion path enough times before that I know the next objection that gets raised: “it’s the church’s responsibility to care for the poor, not the government’s.”

To which I say great, if the church can fund it, let’s go for it. But if you look at the money that each church would need to raise in order to start covering things like welfare and health care, you’d quickly exhaust the coffers of every congregation in the country. The church simply does not exist as a significant enough percentage of the population for this to be feasible.

Yes, the church should give funds to care for the poor when they can. (And probably more than most of them currently do.) But it’s not a logical jump to assert that the church is the only group that should do it.

OK, that’s a lot of words already… get to the point!

When I boil it down, I conclude that if a society values justice and mercy toward all, ensuring provision for basic health care is a necessity. If I have to choose between the current unjust mess that we’ve got, and a system that, while run by the government, provides care for all, I’ll support the government-run plan.

For an equally-lengthy, but much-better-put piece on this topic, I’d encourage you to read Michael Bird’s piece from back in June over on Patheos.

One thought on “Single Payer

  1. Other advantages: people don’t take or stay with jobs just to get the insurance.

    Employers don’t base overtime. VS new hires on the increased benefits cost of a new hire.

    It redistributes wealth without killing incentive to work.

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