A frequent comparison brought forth by those who favor single-payer health insurance is to make note of nice places around the world where single-payer works well. If it is good for them, then it must be good for us. I’ll drink to that!
No I won’t. This kind of comparison is like saying if a shirt fits perfectly on a dwarf, then it should be great for portly me. Suppose single-payer is great in Sweden. Does that really mean it is great for the USA? Why don’t we see a single-payer system for all of Europe? Or for the EU countries? Or for the G20? The answer is simple. They don’t want it. These places I mention are not only big but they are also dissimilar. People in northern Holland don’t have much in common with those silly Limburgers. Can you imagine the Hungarians and the Germans wanting the same single-payer system? I can’t.
But the US is one country, you retort. States are not the same thing as countries. But pshaw, I say. I know a few New Englanders who can’t even say Mississippi with a straight face. The south is where those “deplorables” live. Without getting so silly, I cannot see folks in South Dakota or Idaho wanting to have the same single-payer system as the groovy people of California. And then there is the idea of a frugal state like Indiana pairing up with scofflaws in Illinois. The USA might be one country but that does not mean that we all live or think alike.
The proof is in the pudding – or shall we say our governing documents. We purposely created a federalist country composed of strong states. Today we continue to honor the federalist state in many ways. We find comfort in the idea that some king living on the east coast can’t tell us how to run our lives. Sure, we have a big national government that does a lot of things. But think about all the areas that are left up to states or cities or counties. Police, fire, education, zoning, roads, parking, and so on. This is not trivial stuff. State and local area government budgets and regulations impact us in major ways every day.
Why don’t we turn over the police departments to the national government? Why doesn’t the US Congress run our fire departments? I am sure that it is possible to make strong statements about the great efficiency or perhaps some sense of fairness that derives from national control. But the answer is simple. It doesn’t make sense. Locals better understand the local problems. Locals know how to create local solutions. And what might be fair in W. Lafayette might not seem so fair in Bloomington.
Some of our politicians and ideologues want us to believe that single-payer is a slam dunk for the USA. Since it is a fait accompli, then it follows that anyone against it must have ulterior motives. But the truth is that the case has not been made. Bernie Sanders can rant all he wants but that doesn’t make people in southern Georgia have the same health issues and problems as those who live in Brooklyn. It does not mean that because a small European nation finds single-payer ducky that a huge economic space populated by 330 million Hoosiers, Tarheels, and Buckeyes is going to love it.
Republicans are trying to make the case for healthcare reform. It is an uphill fight for many reasons. But one of the reasons is the apparent superiority of single-payer. Why isn’t single-payer being held to the same kinds of debate and logical standards? Why do we noddingly approve of single-payer as the words are spoken?