A Conservative Justification for Single-Payer Health Insurance

People who know me are sometimes surprised when I describe myself as "conservative on some issues." And to be sure, I'm mostly a raging lefty. But I've always wondered why "conservatives" oppose single payer systems. I believe a single-payer system like Canada's would be a net benefit to the United States and could be justified by "Buckley-esque" conservative ideals.

In the United States the cost of treating acute conditions in the uninsured comes from the public purse. So let's say you don't have health insurance and you're rendered unconscious in a car crash. You're taken to the hospital emergency room and revived. The hospital has already spent money on you before they could determine you couldn't pay for the treatment. So you're stabilized, shown the door and usually, the local county picks up the bill.

That's a bit of a contrived example, but it clearly shows what happens: if someone doesn't have insurance to cover the cost of medical care, it's the state that picks up the tab. Something that's a little more likely is due to some unforeseen circumstance or a previously hidden chronic condition, you need acute care. Maybe it's an accident around the home. Maybe you didn't have cash to pay for an annual colonoscopy and you have abdominal pain from stage 3 colon cancer. Treating a patient for complications due to late term cancer is considerably more expensive than detection and prevention. Put another way, appeals to the public purse are minimized if indigent and low income workers who cannot otherwise afford effective health care are provided with preventative care.

But in this country, we tie health insurance to employment. This made a lot more sense fifty years ago when the cost of health care was lower and employee turnover was lower. Health insurance was originally offered by employees as an incentive, but as costs increased it became more of an expectation. This is bad because employer provided health insurance introduces an artificial attachment to under-productive employment. That is, instead of working the job that best uses your talents or allows you to maximally contribute to economic productivity, you go for the job that offers the best health care.

In my own case, I left a "good job" to pursue an entrepreneurial opportunity. I was lucky I had enough cash to pay for COBRA coverage while my new business venture became a going concern. Other people will not be in this situation. A worker who thinks of a new process or a new invention will be hampered in their pursuit by the cost of health insurance. Minimizing the out-of-pocket expense for entrepreneurs during the initial "start up" phase of their business, gives them more "runway" to go from concept to minimum viable product. Reducing the cost of entrepreneurship increases the incidence of start-ups; increasing the incidence of start-ups increases the likelihood productivity-enhancing intellectual property is delivered to the marketplace.

And from the perspective of a mature enterprise, health care costs are now the single fastest growing expense and the least easy to predict. When I was an entrepreneur, our health care costs doubled every year as benefits went down slightly. The current system benefits large employers with larger risk pools at the expense of small and medium sized enterprises who must deal with unpredictable increases in health care coverage.

Also, the United States has the third highest per-capita health expenditure while enjoying the lowest rate of positive health outcomes of the top 17 industrialized nations. If we could replicate the Canadian model, shifting to a single-payer model would facilitate better negotiation for end consumers and more consistent pricing for health care services and medicines.

This is a just an outline of a real argument, but I think it presents the basics. We're already in a situation where the public pays for some coverage: emergency rooms, medicare, medicaid. Tying insurance coverage to employment encourages under-productive employment and minimizes the United States' competitive stance with respect to productivity-enhancing intellectual property which is frequently developed by small organizations with no stake in existing solutions.

Single-payer health care:

• reduces the per capita cost of health care
• removes barriers to technological innovation
• eliminates disparities between large and small enterprises

How is this not conservative?

Meaningful Change?

so here's an idea for a political party... the "change the narrative to something not especially crazy" party. it goes something like this...

life's tough, but if we work together it's not nearly as difficult to ensure we all get by. in the post WWII era, most of us have been lucky enough to have inexpensive food, inexpensive transportation and meaningful labor. our parent's (or grand-parent's) families lived in a world where one person's salary was enough to have a very comfortable living.

we told ourselves we were really good people (hell, we had just kicked the snot out of the nazis) while ignoring slavery, misogyny, fixed markets, ostracism of non-conformists and meddling in the internal affairs of foreign nations for financial benefit.

as time went on there were more people to feed and more competition for our goods. margins started getting shaved and we had to do more work for less pay. but we had become accustomed to cheap oil and cheap food, and felt it was our birthright.

we didn't notice when companies and government started telling us convenient untruths. "centralized monoculture food is the best way to grow food," they said. "people of the third world are clamoring for freedom, which is why we overthrew the tyrants ruling them," they said.

but i think we all know the score. we just don't want to own up to it.

in the united states (and australia) we're coasting on the economic push our parents and grand-parents gave us after the world went crazy for several years and did a number on germany and japan. this was after the russians were doing numbers on themselves in an effort to escape the czars and develop infrastructure in europe's most backward sister.

we _have_ done a lot of really cool stuff. the transistor? ossm. space flight? double ossm. i'm not saying we're a big ball of fail.

but i think we may have lost sight on what makes this country great. and while we're losing sight of that, we're starting to listen to corporate (and governmental) interests who profit from our ignorance.

the reason we have high taxes has very little to do with welfare queens and a lot to do with a bloated defense department. no. i'm not talking about US service-persons who risk their lives every day. what i am saying is as a people we've put a government in place that disgraces their sacrifice. we maintain a large military so we can dictate terms to trading partners. we need these good terms because we chose to purchase energy from abroad rather than develop internal infrastructure or better yet, develop more efficient cities, cars and food production.

we've come to accept corruption and human rights abuses abroad and at home if it means we get cheap steak and iPhones.

but sure. it seemed like a good idea at the time.

we no longer have the moral authority to claim we honor words like "freedom" or even "democracy." our religious leaders are co-opted into a system that benefits them while vilifying "the other." our media corporations have long retired the notion they are a public service and operate solely for profit. and of course, that's what our legal system requires them to do, to rigorously pursue the minimum viable information product that still makes them profitable.

we have abandoned the idea that universal education and an enlightened populous is a pre-requisite for an open, democratic society and now view our children's educational experience as a profit opportunity.
we live in a market, not a society.

but it's not too late to change. we CAN choose a different narrative. we can invest in our communities and our children. we can invest in more efficient fuels and cars. we can grow more of our food closer to our homes. we can spend the money we were spending on the most recent iPhone on infrastructure to create a sustainable society in which each child is fed and educated.

but first we have to stop vilifying each other. we have to spend a little more time digging into issues rather than shouting slogans. we can stop jealously guarding our stash and help our neighbors raise their metaphorical barn.

Things I'm Working On...

Just sort of thinking about San Francisco housing prices. And every time I think of San Francisco, I also think of George Takei saying "San Francisco, I was born there," in one of the Trek movies. It's clear his character Hikaru Sulu, really digs on the city. Other characters from the movie have ties to SF; James Kirk has an apartment there (at the opening of the first movie, he's working a desk job at Star Fleet Command in SF) and others no doubt have good memories off off-duty time at Star Fleet Academy (also in SF.)

So I get to thinking of a darker trek world where our beloved protagonists are members of a ruling elite, able to travel between the stars only because of the toil and suffering of untold under-workers you never see on camera. This is clearly not what Gene Roddenberry was originally thinking the future would be like, of course, but modern times seem much less optimistic than the late 60's. So just for fun, I'm thinking of the "Occupy Star Fleet" world. It's not as bloodthirsty as the mirror universe, but perpetuates the "haves vs have nots" Roddenberry originally wanted to say we escaped.

Who are the characters in such a world? I'm not going to sully the image of the canonical bridge crew by having them go all mirror-universe on the poors. That would be vaguely insulting to the characters (and the actors who portray them.) Instead, I'm creating new characters who are members of an exploited class; a class that lives outside the mindset of Star Fleet personnel. It's not that the classic Trek folk are actively putting these people down, it's just they don't even know they exist.

The first character is Tamiko Tenno (or 天皇 民子 for my kanji reading friends.) She's sort of a modern-day Antigone, who kicks off the story when a sequence of events brings her loyalty to her family in conflict with the power of the state. Depending on whom you listen to, the name "Tamiko" implies a "popular" origin while "Tenno" is the appellation applied to emperors in Japan, so she's setup for class conflict already. The first story I'm working out introduces Tamiko-san and is more or less just a re-telling of the Antigone myth (hey. great artists just know what to steal.) Also, go read about Antigone on the WikiPedia if you're unfamiliar with it.

But what's a great leading character without a perfidious antagonist? I mean sure, the whole story is setup to have "man vs. society" and "man vs. his social nature" type conflict, but a good antagonist will be a great personification of the hidden social forces that serve to betray the ideals of individual agency in the Star Trek universe. Tamiko-san will battle "Shift Supervisor Creon" in the first story, but after his demise we'll find he was a servant of a higher, darker authority.

Our eternal antagonist is a sort of reversed Queen of Pentacles, she takes delight in the subdued personal wealth of the Trek universe, but her primary conceit is more akin to that of Omelas: the elevation of humanity's elite justifies the invention of a wretched class. Unlike the traditional interpretation of the Queen of Pentacles being a character of worldly finery, in our story her finery is ideological. She never waivers from the path of "furthering the cause of humanity," even if she is losing her own humanity in the process. Our antagonist is clearly a "true believer," and we all know how dangerous attachment to dogmatic ideals can be.

Anyway... this is just an update of some of the things I'm thinking about and working on this weekend. More updates as they become available.