When progressives such as Representative Ocasio-Cortez propose to create new benefits such as a single-payer health-care system or a universal college-tuition benefit, the most frequent conservative rejoinder is: “That’s a nice idea, but we can’t afford it.” The reality is something closer to the opposite: We can afford these things, but they are terrible ideas for other reasons. The United States has a GDP per capita substantially higher than that of Sweden or Denmark — we could easily afford a Nordic-style welfare state if the U.S. middle class were willing to accept Nordic levels of taxation. (It isn’t, and that, rather than the machinations of plutocrats, is what actually stands in the way of the Democrats’ daydreams.) We can afford these things in the sense that an irresponsible 19-year-old thinks “I can afford it” is a synonym for “I have enough money in my bank account to complete the purchase.” (Or, worse, “I have enough in my bank account and available credit to complete the purchase.”) Financial costs aren’t the only costs.
The case against a single-payer health-care system is not only, or principally, its cost. It is that government-enforced monopolies are undesirable for other reasons, from their propensity to abuse their monopoly positions to the fact that they cultivate an attitude of dependency — which also can be exploited for political purposes. Just as workers have more power in an economy with a large number of employers competing for their labor, would-be college students and health-care consumers are better off when they have a great range of choices offered in an environment of strong competition. (The best indictment of the U.S. health-care system, pre- and post-ACA, is that it does not actually produce or encourage such a consumer-empowering environment.) Monopolies in the public and semi-public sector are no more desirable than monopolies in the private sector.