I hope it won't be perceived as a fancy/sneaky/insincere rhetorical gesture if I start with a concession: universal healthcare is the most moral thing to do. That's an important point to make, because I gather from my friend-of-a-friend that he wishes to see morality brought to the forefront in this public debate. So, with one minor hesitation--[having to do with our granting moral agency to the state]--I concede as explicitly as possible that it would be a morally superior state that could supply all of its citizens with healthcare.
One more prefatory point: I don't really expect this short blog post to be convincing, in part because of the moral issue... people on either side are deeply entrenched, and are unlikely to be persuaded by reading a lowly blog post.
Interlude: if this were a semester-long course, I'd start with 8 weeks of this kind of thing.
However. My argument rests on positioning what I will call "economic reality" against morality -- if you go away from this post feeling that tension (even if you go away still disagreeing with me) -- I'll be very satisfied. I define economic reality as a situation in which resources are limited, or scarce. So, I mean to show that healthcare is a scarce resource (like air conditioning or hot dogs or almost anything else) and that the scarcity limits the state's moral agency.
Tonight I went to see District 9 at the movie theater. A large popcorn was $7.00. I declined to purchase.
Now, it's true that buttery popcorn is a scarce resource, but it feels like it's not that scarce. But I'm guessing that most people supporting a public option in healthcare would not support a public option at movie theaters... (right?)... because: those who support the public option deem healthcare far more important than popcorn. Same principle, but moral valuation creates a different policy outlook.
Is there a downside to legislating these kinds of moral valuations? For example, I think it's very important for people to feed their children healthy foods in moderate amounts: to what extent should the government be involved in what we feed our children?--more or less than what the FDA does? To me, these are murky decisions. I have plenty of friends who are 27-years old and single and who would certainly prefer to have healthcare to having no healthcare, but they might prefer to have a Lexus to healthcare.
This is a summary of a pretty typical conservative objection. But I think I have a better one:
Imagine two healthcare providers: one public (A) and one private (B). Both providers have certain costs (drugs, employees, electricity bills, etc.). To meet those costs, Company B, the private company, must charge certain amounts of money to turn a profit--if they don't, they go out of business. This means there's a sort of "natural" price for many of the services provided by the private company. On the other hand, the public provider need not turn a real profit: it can always draw from the tax collector's pocket (or "raise revenues" as the Obama administration's best rhetoricians like to say). But this leads to an important point: the public company need not really compete with the private company: it can simply set prices at whatever level it wants. Indeed, some "health czar" will eventually have to decide just how competitive they want this public provider to be: if they it to provide the same services as the private provider for half the costs to the consumer, they can do that. If they want the public provider to offer the same services as the private provider at one tenth of the costs to the consumer, they can do that. There is no limit (other than tax-payer resentment, which I expect will become very real if the public option becomes law) to the ability of the public provider to meet consumer needs. In other words: it's not really competing, it's undercutting.
One more point: there's a very very deep-set "liberal" myth -- a myth set so deep that most progressives genuinely don't believe they're speaking myth when they describe it. The myth is that the Bush administration produced policies that would've pleased the most dog-eat-dog amoral capitalist of the late 19th century. So you hear things like this: "The economy collapsed because the Bush administration undid some important government protections... we need Obama to put those protections back in to fix the economy."
In reality, Bush's government was all-kinds-of interventionist. To say that healthcare was a field existing in a laissez-faire market at any time in the past forty years is fundamentally either uninformed or disingenuous. In economic reality, "big healthcare" companies have been lobbying congress and have been rewarded in kind for decades. As a result, there is very little competition -- the barriers to entering the market are such that no private company that is not already a "big dog" could ever make a dent in the sector.
Picture the Leaning Tower of Pisa. That was healthcare in 1950. Now picture a long wooden beam supporting Pisa on one side. Now picture a rope tied to the other side. Now picture an "add-on" giving it extra height... height that throws the balance out of whack again, requiring further wooden support beams and more ropes... picture the Leaning Tower of Pisa turning into a tower of Babylon by this repeated process: each adjustment the government makes is, in its way, "necessary" -- and each makes the whole structure more unstable.
So these are some basic parables that try to describe some basic laws of economic reality: a prose essay on supply and demand might be more or less convincing. My favorite books on the topic include Ludwig Von Mises' Human Action, Joseph Schumpeter's Principles of Economics, and F.A. Hayek's Individualism and Economic order.
But back to my starting point--morality. Two thoughts to conclude: 1) it would certainly be more moral for the government to provide all of its citizens with Toyota Priuses and solar panels for rooftops and 5-bedroom houses, but (obviously) the cost is prohibitive. It's possible that we're not in that situation with healthcare... maybe we can afford it. But I'm waiting to be convinced.
And 2) -- a point I've saved for last because its doomed to be least convincing: liberals love to talk about their government being moral on their behalf. Should you get moral points for paying tax-dollars which go on to fund public healthcare and aid programs in Africa? It is my view that a moral perspective must precede a political order, rather than being embedded in it. The difference between the collapse of the soviet union and the hypothetical collapse of the United States will not be a matter of economic policy, but rather, will be a reflection of a lack of genuine interpersonal sympathies that had previously formed the basis for the social contract. To put it romantically: if the union does not exist in our hearts, it cannot be made to exist by political methods.
Sorry about the length -- I'll be very happy to read counterpoints, though I imagine this is (as I suggested at the outset) one of those issues where people are relatively entrenched in their ideologies.