Edit at the bottom with multiple news stories about how some of the things I talk about here are already happening.
I’m in the middle of Mistakes Were Made (But Not By Me), a great book about how and why it’s so difficult to deeply admit mistakes and really change our minds.
Writing this is an exercise in trying to integrate some of the lessons on the importance of doing so. So, here goes.
I have supported some version of universal healthcare my entire life.
Single payer made the most sense to me, particularly after the time I went to the ER with severe abdominal pain. In a post-puberty female, severe abdominal pain can be so many things that 12-18 hours in an ER bed is not uncommon, as the doctors rule out one thing after another. They start by ruling out the life-threatening possibility of an ectopic pregnancy and go from there. If you’re lucky, they figure it out quickly. If you’re not, the tests go on and on. By the time they figured out that I had an ovarian cyst which had ruptured, I had been in the ER for nearly a day and the bill was over $20,000.
Why did this make me support single payer? Because of what happened during my check-out. The hospital had a policy about uninsured people and their ER bills. If I could pay $150 within 24 hours, they would write off the rest of the bill.
I asked, in astonishment, how in the world this could be so. “The hospital saves a lot in not having to deal with insurance companies, so it’s always cheaper for people who self-pay. And people without insurance usually don’t have piles of cash lying around, so we did the math on what the hospital usually gets in the end when all is said and done.” I rushed home and put about half my then-meager belongings on Craigslist to raise the needed $150 in 24 hours and drove away the next day in awe at the savings.
I spent years pondering this, imagining a world where a single payer system might’ve paid the hospital something reasonable — say, $3,000. Without all the bureaucratic bullshit of insurance companies, wouldn’t the cost of everything drop? Didn’t doctors have to charge a fortune in part because they’re all in debt the size of a good mortgage the first day they start residency? Wouldn’t universal healthcare and free tuition enable lower prices across the board?
As I got older, I met some folks from Canada and heard another side of single payer. Long delays, rationing of care. That made me question the wisdom of single payer and re-visit the value of competition. Still, I thought that some sort of public option would work, and to some degree, I think it does, in some limited circumstances, like for the desperately poor.
I was on Medicaid for several years, before I got my current job with its private coverage. The Medicaid income limits in my state are reasonable, though. In other states, they are absurdly low. In the state I grew up in, an income of well under $1,000 a month made me ineligible. Medicaid coverage worked as it was intended — I got the care, particularly therapy and hearing aids, that I needed. I would not be earning a middle-class income and paying taxes now if both had not been available to me.
If you had asked me at any point until about two weeks ago, I would have argued for expanding Medicaid in a particular way — make it available to everyone who wants it, not just the desperately poor. Let anyone who wants to sign up for Medicaid pay a fixed, reasonable percentage of their income and get the coverage. My favorite argument revolved around four friends of mine — M, T, A, and R. Each has a particular reason why they or their family needs really good coverage (a diabetic child, a Down Syndrome child, the need for long-term therapy, etc). Each also has a passion and talent in an area that would make them a fabulous entrepreneur, but they are handcuffed to their current position by the insurance. The risk of starting a business is high enough without also taking the risk of walking away from the fabulous coverage they now enjoy. Each has expressed to me many times that if they could only keep their insurance they’d hand in their notice today and be running their own business two weeks from today, but the risk of giving up the coverage is just too much.
I understand this a bit better now. My therapist charges $120 per session, of which I am presently responsible for 10%. When I hit my out-of-pocket maximum, I will no longer have to pay anything, but for now I write him a check every Friday for $36 to cover my portion of my three weekly sessions. I have my own passions and talents — my dream of dreams would be to start a charter school for traumatized kids and teach mathematics there — but if I were to pursue it in actuality, any calculus on this decision must now include $360 a week in therapy costs, in addition to my other healthcare needs (hearing aids are expensive AF). Someday I might consider it, but I’d only be taking the risk for myself. If I were taking it for a child? Almost no chance.
I made that argument so many times, over and over. “The lack of some kind of public health insurance option is crippling the economy! Stifling innovation! Keeping entrepreneurs out of the marketplace! We could revitalize the economy from top to bottom in one year if we fixed this!” was my favorite hobby horse, to the point that even friends who agreed with me asked me to STFU about it, more than once.
I was so, so, so, wrong.
The current situation is damaging, and it does keep people like my four friends from becoming entrepreneurs. But single payer or a vastly expanded public option would be worse.
I was wrong because I failed to consider something very important, something that only occurred to me in the last couple of weeks as I’ve watched public discourse on the issue of vaccine mandates develop.
I failed to consider that the public paying for healthcare would make the public feel entitled to weigh in on who deserves care, who should be allowed to access what medical procedures, and in what circumstances.
Seeing people advocate, under their own full names and without the slightest hesitation or caveat, that unvaccinated people should be required by law to forego care if they get sick from COVID (or, in some cases, sick from anything, period; as their dirty presence in a hospital, for any reason, would theoretically put the clean, vaccinated people at risk) — this has been mind-blowing. I was surely naive not to expect it, but I didn’t. They are neither venting nor joking. Every news item about an unvaccinated person being hospitalized or dying results in thinly or not at all veiled cheering for the dirty dissenter getting what they had coming.
A section of the population who has made one choice about their medical care is so certain that they know what another section of the population should do, would do if they weren’t so dumb/stupid/brainwashed/immoral/selfish/insert any of the dozens of other pejoratives I’ve read, that they are totally willing to require, by law, that those people be denied access to medical care as punishment for their bad choices.
This dynamic should terrify everyone who has ever:
1) needed birth control
2) needed treatment for an STD
3) had a child they weren’t totally financially prepared for
4) had any surgery that could conceivably be called “elective”
5) had any kind of accident while engaging in anything recreational (how reckless, to go skateboarding for fun) or potentially related to unpopular activities (like protesting for an unpopular cause)
6) used any kind of drug
7) had a problem with self-harm
8) eaten junk food
9) been one pound overweight
I could go on, but you get the idea.
Do you care about anyone whose lifestyle is not popular with the elite? Do you think your uncle—the one who stepped up when your dad died and did his best by you, taught you to drive and gave you away at your wedding, but is also fifty pounds overweight and whose most likely route to an accident is falling off the ladder cleaning the chandeliers at the fundamentalist church he attends — will qualify for care in the eyes of these people?
It was sixteen months from “these right wing conspiracy theorists are actually worried about vaccine passports, ha ha” to “anyone who doesn’t want vaccine passports is a potential murderer and should be treated as such.”
How long do you think it will be from “people are who are unvaccinated should not be allowed hospital care, as it takes away resources from the vaccinated” to “families are on their own from the third child forward, as it takes resources away from people who believe in science and care about climate change” or — far more likely than any of this — some version of “equity” ?
If we get universal healthcare in the US, do you think the same people who are perfectly happy to deny care to you for refusing to get vaccinated will think your “cis het” white son should get an equal priority to his trans classmate? Are you ready for listing your “privileges” or handing over your demographic information to the state in order to determine your priority for medical care?
Holly, Holly, Holly. You’re being alarmist.
Friends, it’s already happened, starting with the vaccines.
Are you ready to expand this to appendectomies, psychotherapy, cancer treatment?
I’m not. I’ll take my chances in the system we already have, flawed as it is.
I used to believe that America was a nation that would benefit from a system of universal healthcare.
I was wrong.
I was so, so wrong.
Edited to add the below:
And here we see that not getting a COVID vaccine is being used to deny transplants. Because someone who needs a new heart and is in very fragile health should clearly have to take an experimental drug that people have adverse reactions to—that even healthy, young people get sick for days after taking—in order to deserve medical care, and death is an appropriate punishment for non-compliance.
Here a doctor in Alabama has announced a refusal to treat patients who are unvaccinated. The comments, in both cases, are enlightening. People are cheering this development, with seemingly no ability to think ahead or imagine unintended consequences.
A pregnant woman with a young child — so three people’s health and potentially two lives are affected — who is having heart problems was refused access to a cardiologist for not being vaccinated.
Is there any better way to save lives than to turn people with heart problems away from doctors for being hesitant about taking drugs authorized only under emergency use conditions and for which no long-term data exists?
The door has now been opened for medical care to be denied on the basis of personal choices that are politically unpalatable. It may be impossible to overstate the importance of this, and it’s going to come back to bite the Left. It may be illegal to discriminate against people for being gay or trans, but will it be illegal to discriminate against people for engaging in same-sex sexual activity, or for living as the opposite sex? There is a difference between being female (a protected class) and having an abortion, or being sexually active outside of marriage.
Contrariwise, can we expect Leftist doctors to start demanding patients “do the work” and demonstrate their “anti-racism” in order to remain patients? Is there about to be a market in digestible summaries and soundbites of Robin DiAngelo and Ibram X. Kendi in order to pass muster to keep one’s medical care? Likewise, there’s no protected status for having more kids than the climate change alarmists want you to have, having too large of a carbon footprint, etc.
Are you ready for doctors to refuse to treat people based on their criminal records, voting, party membership, or church attendance/lack thereof?
Are you ready for doctors to demand to see your social media history and check out your podcast subscriptions? No?
It’ll never get that far, you say? What is the limiting principle, then? Clearly it’s not bodily autonomy — “my body, my choice” is over.
Now that doctors can announce—with applause from the Left!—a refusal to treat people with whose choices they disagree, there is no limit.
Social credit scores are coming fast, but the Left overestimates how palatable their views are to the average American. This is going to come back to bite them so hard.
Trump was always a symptom, a reaction to certain types of Leftist overreach. The door is open for someone who will make Donald J. Trump look like George W. Bush, and the Left has earned it.
Maybe there will be a smaller backlash to this creepy, authoritarian trend, and maybe it’ll be soon enough to salvage things, and maybe it won’t. I hope it is soon, as the direction right now is profoundly terrifying.
Bodily autonomy and the right of the individual to her own conscience are now secondary to the will of the mob, who demand that others get vaccinated regardless of their personal circumstances, risk level, or choices. They are perfectly happy to see dissenters dead, and the irony of doing this “to save lives” is stunning.
I used to think that fear of death panels was hyperbolic. I don’t, anymore.