August 24, 2017

For all that Britain and America have in common, they are divided by their radically different systems of healthcare. Indeed, among the nations of the west, they represent polar opposites in this regard.

However, that doesn’t mean the various other healthcare systems are evenly distributed between the US and UK extremes. As Chase Madar argues in the American Conservative, the US system is out on its own because it is so expensive:

“In fact, in every first-world nation that has socialized medicine–whether it be  a heavily regulated multi-insurer system like Germany, single-payer like Canada, or a purely socialized system like the United Kingdom–-it costs less. A lot, lot less, in fact: While healthcare eats up nearly 18 percent of U.S. GDP, for other nations, from Australia and Canada to Germany and Japan, the figure hovers around 11 percent.”

In asking why socialised healthcare costs less, Madar uncovers three awkward truths that conservatives need to incorporate – or rather re-incorporate – into their worldview. The first is that government isn’t always the enemy of efficiency; the second is that the private sector isn’t always the enemy of bureaucracy; and the third I’ll come on to:

“The barrier to universal healthcare is not economic but political. Is profligate spending on health care really a conservative value? And what kind of market incentives are working anyway–it’s an odd kind of market transaction in which the buyer is stopped from negotiating the price, but that is exactly what Medicare Part D statutorily requires: The government is not allowed to haggle the prices of prescription drugs with major pharmaceutical companies, unlike in nearly every other rich country. (Both Hillary Clinton and Donald Trump pledged to end this masochism, but the 45th president has so far done nothing, and U.S. prescription drug prices remain the highest in the world.) Does anyone seriously think ‘medical savings accounts’ with their obnoxious complexity and added paperwork are the right answer, and not some neoliberal joke?”

One might also ask if there’s anything un-conservative about the state acting proactively to reduce demand for its services:

“If readily available healthcare turns people hedonistic yahoos, why does Germany have less lethal drug overdoses than the U.S. Why does Canada have less obesity and type II diabetes? Why does the Netherlands have less teen pregnancy and less HIV? The evidence is appallingly clear: Among first-world countries, the U.S. is a public health disaster zone.”

The third awkward truth is that there is no such thing as ‘the market’, but rather markets, which can work in radically different ways. For instance, a market for a product where supply is limited, but demand isn’t, will drive prices skywards – allowing even the most basic of needs to be peddled as a luxury. That is when the rationing power of the state comes in handy, not so much to limit consumption, but to constrain the market power of producers.

That brings us to a fourth awkward truth, but this time one that liberals may find unpalatable: the medical establishment, whether public or private, doesn’t always have our best interests at heart.

Like many of the ‘cuddly’ vested interest groups, such as the tech sector, academia or the mainstream media, the medical lobby is deeply entrenched within the Democratic Party. If the Republicans ever decide to prioritise the fight against inefficiency and bureaucracy over theoretical notions of ‘choice’, then Madar believes that they could become the party of universal healthcare:

“The real obstacle may be the Democrats… thousands of everyday Americans shouting at their congressional reps at town hall meetings are clamoring for single-payer against the party’s donor base of horrified Big Pharma executives and affluent doctors. In a few years there might even be a left-right pincers movement against the neolib/neocon middle, whose unlovable professional-class technocrats are the main source of resistance to single payer.”

Stranger things have happened.

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