4 ms·

I think the main opposition to single payer in the USA is that it's counter to some of the bedrock principles the country was founded on, such as freedom, indep

by pbreit 11y ago

I think the main opposition to single payer in the USA is that it's counter to some of the bedrock principles the country was founded on, such as freedom, independence, limited government and personal responsibility.

toomuchtodo 11y ago
America (disclaimer: I'm a US citizen, born and raised) has this delusion of rugged individualism, that everyone should pull them up by their bootstraps. In reality, everyone who is successful is simply taking advantage of those who came before them, and shared infrastructure (both the physical an economic types). I don't see Americans adverse to Medicare, which is essentially single-payer for anyone over 65. Why does being under 65 mean you should die in the street without healthcare? Single payer is cheaper/more efficient than our current system. We just need to find the political will to implement it, and cut the legs out from anyone attempting to stymie that change who is currently profiting from the status quo.
- pbreit 11y ago
  Because your earnings ability declines. And dying in the street is a 100% myth.
  - HarryHirsch 11y ago
    On the other hand, medical bankruptcy is reality.
    - pbreit 11y ago
      That's what real insurance is for, currently known as "catastrophic insurance", and unfortunately being outlawed.
  - kgilpin 11y ago
    Medical bills are the leading cause of bankruptcy in the U.S. http://www.nerdwallet.com/blog/health/medical-bills/nerdwallet-health-study-estimates-56-million-americans-65-struggle-medical-bills-2013/ http://www.nerdwallet.com/blog/health/medical-bills/nerdwall...
  - deleted 11y ago
    [deleted]
vox_mollis 11y ago
There's also some degree of moral judgment involved. It would be much easier to sell single-payer to Americans if coverage was denied to lifestyle illnesses. It's easier for the American ethos to swallow charity for the poor sap who got brain cancer from an errant cosmic ray than for the obese chain-smoker with type II diabetes and lung cancer. There is a long history of Puritanical thought running in American culture, in which personal virtue is reflected in outcomes.
- ams6110 11y ago
  On that basis you'd also have to exclude coverage for injuries from almost any sport or exercise activities done "by choice"
  - rogerbinns 11y ago
    It goes way further than that. How about people who have children (again a choice) as that also increases health expenses. Living in areas with more sun (let's call that a choice too) means more likelihood of skin cancer. Those people using private cars rather than public transport are also more likely to be more severely hurt in more accidents. Someone engaging in "bad behaviour" like smoking may have higher health costs at the end of their life, but their lifetime total costs may be lower because their life ends quicker than healthy people having a longer end of life period. (And the smokers paid more tax, collected less social security etc.) Realistically all legal choices and activities have to be covered, or you would be arbitrarily victimising certain groups.
- HarryHirsch 11y ago
  The personal responsibility riff gets really problematic when you are faced with things like alcoholism or venereal diseases. People certainly have a choice to keep alcohol consumption down practice safe sex &c. But it's a reality that some people catch STDs or drink too much even though they should not, and these things have a way of affecting more than the afflicted individual. And food deserts are a very real thing. If you live in one of those you haven't even much of a choice regarding obesity.
rayiner 11y ago
"Personal responsibility" is not a founding American principle. There's no Federalist Paper dedicated to "personal responsibility." Indeed, "independence" and "personal responsibility" along with "individualism" were retconned into American history during the settlement of the West. Moreover, "limited government" in the context of American founding principles refers to the allocation of responsibilities between states and the federal government, not the overall scope of government. There is, in fact, a principled originalist argument for universal healthcare. First, it has always been assumed that the states have the power to provide for the welfare of their citizens, as well as to police their behavior and morals. The states are, in that regard, decidedly not "limited governments" of "enumerated powers." State-level universal healthcare is contrary to no founding principle. Second, the Commerce Clause was incorporated into the Constitution to allow the federal government to solve what we today would recognize as economic collective action or free-rider problems. At the time it was aimed to address the collective action problem of free trade. It's good for the United States as a whole, but individual states have a short-term incentive to erect trade barriers. The purpose of the Commerce Clause was to allow the federal government to counter-act those short term incentives. Precisely the same problem exists with state-level universal healthcare. Even if most people in a state want it, they can't enact it because it's too easy for people from neighboring states to free-ride on those services. The Commerce Clause is thus properly invoked for resolving that problem at the federal level.
- evanpw 11y ago
  Vermont looked into single-payer insurance within the state borders, but AFAIK they abandoned the idea after seeing the estimated price tag. I think it would be great if some state tried implementing this, some state tried implementing a Singapore-style free-market solution, etc., and we got to see what worked.
- vonmoltke 11y ago
  > Precisely the same problem exists with state-level universal healthcare. Even if most people in a state want it, they can't enact it because it's too easy for people from neighboring states to free-ride on those services. How so? If you are a resident, you get "free" care. If not, you get a bill. Is this not how Canada works WRT Americans who need to use the Canadian health system?
serge2k 11y ago
> freedom Why is it counter to freedom? The USA might be the only country on the planet with a definition of freedom that idiotic. Personally I think it's the combination of anti-socialism brainwashing and the "I got mine so screw you" attitude too many people have.
- pbreit 11y ago
  At least 1/3 of the US population, probably closer to half, is pretty serious about not wanting much government involvement in personal affairs. I'm left of center but that sentiment doesn't seem crazy or crazy to associate with freedom.
  - grecy 11y ago
    It's amusing they don't want government involvement with personal affairs, but they have to deal with endless private companies meddling in their lives, taking tons of money, denying their claims, denying them coverage, etc. etc.
    - toomuchtodo 11y ago
      It's okay when a private company declines their healthcare claims. But if the government does it? SOCIALISM!
  - serge2k 11y ago
    That sentiment is not crazy. Associating a working health care system with the government interfering with your life and impinging on freedom is completely insane.
jameshart 11y ago
Why does that argument get applied to healthcare, and not to education? Those bright yellow government provided schoolbuses painted National School Bus Glossy Yellow aren't paid for out of educational transport insurance copays, you know...
- vonmoltke 11y ago
  I live in Texas, and I am increasingly seeing that argument applied to education was well.
- pbreit 11y ago
  It does (vouchers).
  - jameshart 11y ago
    Vouchers are a mechanism for diverting government funds to individually chosen (government accredited) education providers. They aren't comparable to employer funded private 'insurance' programs. In healthcare terms they more resemble Medicaid. They're hardly an example of rugged individualism.

by pbreit 11y ago

toomuchtodo 11y ago

America (disclaimer: I'm a US citizen, born and raised) has this delusion of rugged individualism, that everyone should pull them up by their bootstraps. In reality, everyone who is successful is simply taking advantage of those who came before them, and shared infrastructure (both the physical an economic types). I don't see Americans adverse to Medicare, which is essentially single-payer for anyone over 65. Why does being under 65 mean you should die in the street without healthcare? Single payer is cheaper/more efficient than our current system. We just need to find the political will to implement it, and cut the legs out from anyone attempting to stymie that change who is currently profiting from the status quo.

pbreit 11y ago
Because your earnings ability declines. And dying in the street is a 100% myth.
- HarryHirsch 11y ago
  On the other hand, medical bankruptcy is reality.
  - pbreit 11y ago
    That's what real insurance is for, currently known as "catastrophic insurance", and unfortunately being outlawed.
- kgilpin 11y ago
  Medical bills are the leading cause of bankruptcy in the U.S. http://www.nerdwallet.com/blog/health/medical-bills/nerdwallet-health-study-estimates-56-million-americans-65-struggle-medical-bills-2013/ http://www.nerdwallet.com/blog/health/medical-bills/nerdwall...
- deleted 11y ago
  [deleted]

vox_mollis 11y ago

There's also some degree of moral judgment involved. It would be much easier to sell single-payer to Americans if coverage was denied to lifestyle illnesses. It's easier for the American ethos to swallow charity for the poor sap who got brain cancer from an errant cosmic ray than for the obese chain-smoker with type II diabetes and lung cancer. There is a long history of Puritanical thought running in American culture, in which personal virtue is reflected in outcomes.

ams6110 11y ago
On that basis you'd also have to exclude coverage for injuries from almost any sport or exercise activities done "by choice"
- rogerbinns 11y ago
  It goes way further than that. How about people who have children (again a choice) as that also increases health expenses. Living in areas with more sun (let's call that a choice too) means more likelihood of skin cancer. Those people using private cars rather than public transport are also more likely to be more severely hurt in more accidents. Someone engaging in "bad behaviour" like smoking may have higher health costs at the end of their life, but their lifetime total costs may be lower because their life ends quicker than healthy people having a longer end of life period. (And the smokers paid more tax, collected less social security etc.) Realistically all legal choices and activities have to be covered, or you would be arbitrarily victimising certain groups.
HarryHirsch 11y ago
The personal responsibility riff gets really problematic when you are faced with things like alcoholism or venereal diseases. People certainly have a choice to keep alcohol consumption down practice safe sex &c. But it's a reality that some people catch STDs or drink too much even though they should not, and these things have a way of affecting more than the afflicted individual. And food deserts are a very real thing. If you live in one of those you haven't even much of a choice regarding obesity.

rayiner 11y ago

"Personal responsibility" is not a founding American principle. There's no Federalist Paper dedicated to "personal responsibility." Indeed, "independence" and "personal responsibility" along with "individualism" were retconned into American history during the settlement of the West. Moreover, "limited government" in the context of American founding principles refers to the allocation of responsibilities between states and the federal government, not the overall scope of government. There is, in fact, a principled originalist argument for universal healthcare. First, it has always been assumed that the states have the power to provide for the welfare of their citizens, as well as to police their behavior and morals. The states are, in that regard, decidedly not "limited governments" of "enumerated powers." State-level universal healthcare is contrary to no founding principle. Second, the Commerce Clause was incorporated into the Constitution to allow the federal government to solve what we today would recognize as economic collective action or free-rider problems. At the time it was aimed to address the collective action problem of free trade. It's good for the United States as a whole, but individual states have a short-term incentive to erect trade barriers. The purpose of the Commerce Clause was to allow the federal government to counter-act those short term incentives. Precisely the same problem exists with state-level universal healthcare. Even if most people in a state want it, they can't enact it because it's too easy for people from neighboring states to free-ride on those services. The Commerce Clause is thus properly invoked for resolving that problem at the federal level.

evanpw 11y ago
Vermont looked into single-payer insurance within the state borders, but AFAIK they abandoned the idea after seeing the estimated price tag. I think it would be great if some state tried implementing this, some state tried implementing a Singapore-style free-market solution, etc., and we got to see what worked.
vonmoltke 11y ago
> Precisely the same problem exists with state-level universal healthcare. Even if most people in a state want it, they can't enact it because it's too easy for people from neighboring states to free-ride on those services. How so? If you are a resident, you get "free" care. If not, you get a bill. Is this not how Canada works WRT Americans who need to use the Canadian health system?

serge2k 11y ago

> freedom Why is it counter to freedom? The USA might be the only country on the planet with a definition of freedom that idiotic. Personally I think it's the combination of anti-socialism brainwashing and the "I got mine so screw you" attitude too many people have.

pbreit 11y ago
At least 1/3 of the US population, probably closer to half, is pretty serious about not wanting much government involvement in personal affairs. I'm left of center but that sentiment doesn't seem crazy or crazy to associate with freedom.
- grecy 11y ago
  It's amusing they don't want government involvement with personal affairs, but they have to deal with endless private companies meddling in their lives, taking tons of money, denying their claims, denying them coverage, etc. etc.
  - toomuchtodo 11y ago
    It's okay when a private company declines their healthcare claims. But if the government does it? SOCIALISM!
- serge2k 11y ago
  That sentiment is not crazy. Associating a working health care system with the government interfering with your life and impinging on freedom is completely insane.

jameshart 11y ago

Why does that argument get applied to healthcare, and not to education? Those bright yellow government provided schoolbuses painted National School Bus Glossy Yellow aren't paid for out of educational transport insurance copays, you know...

vonmoltke 11y ago
I live in Texas, and I am increasingly seeing that argument applied to education was well.
pbreit 11y ago
It does (vouchers).
- jameshart 11y ago
  Vouchers are a mechanism for diverting government funds to individually chosen (government accredited) education providers. They aren't comparable to employer funded private 'insurance' programs. In healthcare terms they more resemble Medicaid. They're hardly an example of rugged individualism.