A conservative case for the welfare state
Americans believe that their health system is the best in the world, but in fact it is not. According to the Commonwealth Fund, many countries achieve superior health quality at much lower cost than paid by Americans. A detailed study of the United States and England in the American Journal of Epidemiology in 2011 found that over a lifetime the English have better health than Americans at a fraction of the cost.
The one area where the United States tops all other countries in terms of health is cost. According to the Organization for Economic Cooperation and Development, the United States spent more than any other country – 17.4 percent of gross domestic product on health in 2009, 8.3 percent through government programs such as Medicare and 9.1 percent privately. By contrast, Britain spent only 9.8 percent of G.D.P. on health, 8.2 percent publicly and 1.6 privately.
Thus, for no more than the United States already spends through government, we could have a national health-insurance system equal to that in Britain. The 7.6 percent of G.D.P. difference between American and British total health spending is about equal to the revenue raised by the Social Security tax. So, in effect, having a single-payer health system like Britain’s could theoretically give Americans 7.6 percent of G.D.P. to spend on something else – equivalent to abolishing the payroll tax.
This is a powerful conservative argument for national health insurance.
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I don’t care if it costs 2x as much, government run health care is unconstitutional and an unacceptable intrusion on my personal liberty and autonomy.
And our health care is expensive because of government, not in spite of it.
Charlemagne on December 25, 2012 at 12:39 PM
The ends justifying the means? That’s not conservative. That’s liberal.
Paul-Cincy on December 25, 2012 at 12:41 PM
Exactly! How is allowing big government into your healthcare decisions conservative?
melle1228 on December 25, 2012 at 12:42 PM
No.
ZachV on December 25, 2012 at 12:44 PM
Google British healthcare. Do it. If your stomach is feeling strong add “horror stories” to the search.
One particular article, talking about a man who’d starved to death at a hospital and other wonderful tales, added that apologies by the NHS-run institutions are rare, and settlements/restitution even more so. No f%^&ing thanks.
And that’s ignoring the argument over the philosophy of government.
Atlas on December 25, 2012 at 12:46 PM
Also, I demand that every tax dollar paid by every Brit be calculated into their healthcare costs. Tired of the two-timing, double standards, and fuzzy math.
Other than that, Merry Christmas to all at HA
Atlas on December 25, 2012 at 12:49 PM
^^This.
Plus, it’s only cheaper if you don’t count all the drug research and device development.
Fenris on December 25, 2012 at 12:53 PM
GUFFAW!
Sharke on December 25, 2012 at 1:00 PM
Based on what I’ve been hearing about the British system recently? No thanks.
A few comments–
– I’ve always been curious: Why is a monopoly considered the ultimate evil if it’s run by a CEO, but the perfect system if it’s run by a politician or political bureaucrat?
– Has anyone ever factored in how much all these glorious socialized health care systems depend on technology and medicines churned out by the “expensive” profit-based system in this country? In the days of the Cold War, you could go to any Marxist nation you could name, and see almost nothing there that wasn’t invented in the West.
– “Efficiency” isn’t everything. It would be a lot more efficient and less wasteful of resources if every store only carried one kind of every product. Anybody want that? Who gets to pick the product?
– The direction to go is to push our medical system toward more choices and competition, not less. In almost every other field this results in more efficiency, better products, and lower costs for consumers. But this solution does have one big disadvantage: There’s no political power in it.
tbrosz on December 25, 2012 at 1:01 PM
davidk on December 25, 2012 at 1:04 PM
Does that study account for (1) the huge number of less healthy immigrants and minorities in our country amd (2) the huge number of obese people and obesity-related health problems we have here?
Also, does this study account for all the free-riding that socialist countries do on the backs of American pharmaceutical companies? (Half the reason our drugs cost as much as they do is that Europe only pays drug manufacturers 10% above the unit cost of the drug, which means that pharma companies have to recoup their hundreds of millions of dollars in R&D and advertising and such on the backs of American consumers.
Outlander on December 25, 2012 at 1:09 PM
A = not A.
We live in The Age of Irrationality …
In a truly fiscally conservative/libertarian society (laissez-faire capitalism and separation of economy and state) there would be very little poverty and plenty of opportunity to escape it — with perhaps the exceptions of the physically and mentally disabled — and thus no need to fear social instability/revolution (the author’s justification for conservatives to support a welfare state).
ShainS on December 25, 2012 at 1:10 PM
Whats next? A Conservative case for beastiality?
tommy71 on December 25, 2012 at 1:10 PM
Ah, yes, the “Liverpool Care Pathway” to death is the way to go.
Bartlett ignores the fact that other countries are parasitical on US innovation, and can take advantage of drugs and procedures for which they did not have to lay out a decade or so of research funds.
Wethal on December 25, 2012 at 1:12 PM
@ShainS A very minor point. You’re equating fisc cons with libertarians. They’re not the same.
tommy71 on December 25, 2012 at 1:13 PM
I fully support this. As long as it’s paid for by the users’ taxes.
Us “no thnk you” people are then free to contract with doctors directly. By the way, there would be much less wasted doctor visits if the patient had to pay first and then get reimbursed by insurance. That risk of being denied would be a strong control mechanism.
platypus on December 25, 2012 at 1:15 PM
@Wethal Bingo. Thats a huge point that has no $ value.
tommy71 on December 25, 2012 at 1:16 PM
Nor is it conservative to discount, out of hand, the ends themselves.
If you wish to take a hard Constitutionalist line on this argument, then you would be right. But we know that is a hard path to walk. If one is willing to be less than pure, as most are, then it becomes an argument about morality, and the math.
And the math the author presents is compelling…
JohnGalt23 on December 25, 2012 at 1:19 PM
And the morality?
CW on December 25, 2012 at 1:23 PM
An astounding array of demonstrably false assertions regarding the efficiency and competency of government bureaucracy, but perhaps the most unreal is the assumptions that politicians will run it honestly. The biggest problem with Social Security is that we permitted the politicians to pilfer the trust fund.
novaculus on December 25, 2012 at 1:23 PM
Only if you find having 20% control over your health care compelling. What the author’s numbers say is that in Britain you have almost no say in your health care, in exchange for abdicating financial responsibility for same.
If you’re curious as to where this road leads, check out Thomas Hobbes. The end result is the sacrifice of all personal liberty in return for the supposed security of a sovereign with total authority over all of his subjects. Which incidentally is the thought process behind both the Patriot Act and Obamacare.
Atlas on December 25, 2012 at 1:30 PM
Government-run anything is immune from litigation.
Had tort reform been addressed, we would have a much better system
Valiant on December 25, 2012 at 1:30 PM
What we need to do is to find a way to eliminate “benefit cliffs” where a single dollar of increased earning over the cutoff amount can cost one thousands of dollars in a benefit. This acts to prevent people taking a better job or accepting a raise or promotion in their current job. Who wants to take a $4,000/year raise to lose a $8,000/year benefit?
Eliminating benefit cliffs is the key to giving people a way out of welfare through their own efforts. It should always pay to improve your own situation.
crosspatch on December 25, 2012 at 1:32 PM
We also need to get people used to the idea that they can’t sit and wait for jobs to come to them, they need to go where the jobs are. There are a lot of jobs out there. Many of them require hard work outdoors and many of them are not in the city where you work, but they are out there. Instead of sitting in a high-cost area waiting for a job to come to them, it might be cheaper for the govt. to provide relocation assistance for people to move to a place where the job is.
crosspatch on December 25, 2012 at 1:35 PM
We pay more for our health insurance in America in large part because we pay for the R+D that the rest of the world then drafts off of. Almost all new drugs, implements and procedures are made ONLY for the American health care market (since we pay for them). After they have been developed for our market and paid for by us the rest of the world just takes them without any of that expense.
This idiotic article could have been written about defense, instead, showing that the Europeans spend far less on defense than we do but have the same level of security from external attack – because we defend them and have done so ever since we saved their pathetic azzes in WWII.
I don’t know or care what the Commonwealth Fund is and I don’t know or care who this Bartlett character is but there’s nothing conservative about any of this. If he were anything approaching a conservative he would realize that individual programs reside in the purview of the states, not the federal government. Of course, I guess he wants us to adopt a stupid, Euro-style, unseparated, party-oriented, unlimited parliamentary system like Britain and the rest of the world have. He doesn’t seem to even understand the difference between a federal government and a national one, nor between a collectivist party-oriented parliamentary ad-hoc mish-mash and a well-constructed, permanent, separated government of the American Constitutional architecture.
Lastly, most of us pay for our own health insurance so it isn’t that “AMerica pays ….” as the leftists like to always say – as if my check to pay for my health insurance somehow came out of someone else’s pocket. It is the feral government interference in the health insurance market that does drive prices up for me, though. That is without any doubt, as government interference in any program tends to drive up price and drive down quality.
ThePrimordialOrderedPair on December 25, 2012 at 2:10 PM
It certainly is when the ends are totally and completely un-Constitutional. American conservativism is about, first and foremost, the sanctity of our Constitutional structure, regardless if you think that you’ll save a few bucks by ignoring it (which is untrue for this idiotic concept about nationalized health care, anyway).
ThePrimordialOrderedPair on December 25, 2012 at 2:12 PM
Who knew that the great Milton Friedman is the same with Alynski and Obama?
Bartlett, and yours, in philosophy, go to Hades, you fools.
It’s a matter of freedom versus modern day plantations.
May the socialist Utopias engulf you all.
Starve the Looters, always.
Schadenfreude on December 25, 2012 at 2:15 PM
A conservative case for nationalizing the means of production. A conservative case for the Gulag.
B.s. This guy’s a liberal, and it’s been apparent for years.
ddrintn on December 25, 2012 at 2:20 PM
Right. Give them freebies, and turn them into pliant sheeple.
ddrintn on December 25, 2012 at 2:21 PM
^ It might be added that Bismarck was “conservative” in the 19th century sense. The conservative of today would be the classical liberal of Bismarck’s time — which he despised.
ddrintn on December 25, 2012 at 2:23 PM
Always have to wonder… was there ever a time you actually had any John Galt in you or did you pick the name just so you could besmirch it with your pathetic posting.
astonerii on December 25, 2012 at 2:23 PM
astonerii nailed you. Ayn cried in her grave when she read your comment. I said it before…you don’t live up to your nom.
Schadenfreude on December 25, 2012 at 2:31 PM
And what math would that be? Artificially capping health care expenditures to x percentage of GDP and ration health care to the public based on this capped amount? I thought people who believed in free markets understood that price system and free markets are the most of effective means for distributing scarce goods and services. If a centrally planned health care delivery system without a pricing mechanism and no consumer choice is superior to the free market why stop at health care? Why not expand into other areas such as energy, manufacturing, computer software development? Think of all the administrative costs that can be saved by switching to a command and control economy.
By the way, there are two services that has costs that routinely exceed inflation; health care and college education. It should be noted that government heavily subsidizes both. This is not a coincidence.
antifederalist on December 25, 2012 at 2:52 PM
A few things jumped out at me. First, by claiming the English have better health is not the same as claiming their health care is better. There are other contributing factors like genetics, climate, and diet. The proper way to measure the quality of health care are things like waiting times of procedures, availability, and recovery rates of cancer and other treatable diseases. (Once they are contracted, not the percentage of people who contract them or who die from them as some populations are going to be more susceptible.) The US is far superior by these measures.
In comparing costs, you cannot look at what the government spends on health care because it does not factor in the beauracracy and waste. Apple and oranges. In the private sector spending all the levels of administration are included while in government spending much of that is not, collection is in the IRS, administration is elsewhere, etc.
The innovation costs of research others made is a good point. It is sad that when we socialize medicine enough to stifle that, there is no way to measure the quality of life lost due to loss of innovation and research that would have been done otherwise.
rose-of-sharon on December 25, 2012 at 2:56 PM
Fair point, Tommy. I’m thinking in theory and with what is claimed by the leaders of the present-day movements (of “fiscal conservatives” and small-L “libertarians”), but in practicality and reality — you are correct.
Thank you for pointing out the clarification …
ShainS on December 25, 2012 at 3:03 PM
Which is a more accurate definition of “better” when it comes to health care systems: cost or disease survival rates? I’d say the latter and we beat all other countries at that.
If you want to reduce cost, de-link health insurance from employers and government then spin off the FDA into its own corporation charged with getting the same job done only more cheaply.
Exactly.
Because all politicians and bureaucrats are honest and pure of heart. /
Odysseus on December 25, 2012 at 3:06 PM
Here is a response that I wrote to Bruce’s opinion piece in the NYT:
antifederalist on December 25, 2012 at 3:21 PM
Notice how it’s always the bitter Mark McKinnons, David Frums and the other No Labels squatters who claim to make the “conservative case” for failed socialist policies…
fitzfong on December 25, 2012 at 3:45 PM
I believe that the primary objective of these “conservatives” has been to destroy conservatism from within. Look at what they have done. They have co-opted conservatism and completely redefined it to the point that it is hardly distinguishable from modern liberalism.
antifederalist on December 25, 2012 at 3:55 PM
Once again, when you have read and studied a third of Rand’s material, please feel free to comment on my name. Until then, you might want to try listening to people who know better than you.
JohnGalt23 on December 26, 2012 at 2:26 AM