Why Conservatives Oppose "Universal Health Care"

Zach of Civics Geeks has a good post in which he addresses a question posed by Matt Talbot of The Hopeful Populist. In a post entitled "Calling All Conservatives", Matt asks:

What alternative do you propose to universal health care, on the European model? Whatever the problems there, everyone is guaranteed basic care, no one there is bankrupted by medical bills, and everyone seems (by and large) happy with it.

How, as a Catholic, can you oppose that?

Just...explain to me why it would be so horrifying to just have universal health care in the United States. Yes it would cost money, and yes, taxes would go up - but so what? Isn't working people not being bankrupted by hospital bills ever again worth a few more percent at tax time? Isn't a society where everyone can go to a doctor when he's sick better than a society where he delays going because then he won't eat or won't be able to buy gas, or can't pay his car payment or whatever?...

The reply, "we ought to care for each other in the community" sounds good - heck, I even agree with it. But the price of modern health care is too much for that kind of community-provided care. I have no idea what an MRI machine costs, but I can't imagine my local parish can fork over than kind of cash....

Not, perhaps, the most temperately phrased question, but one that deserves a good answer. Zach's answer is a good and honest one, he lists off nine reasons ranging from the legal to the economic to the moral why one would be hesitant about "universal health care". I encourage you to read his post. But always being one to gild the lily (or at least to run on at length) I thought I'd add my own thoughts as well.

I'd like to start off by taking the last claim first. Is modern health care so insanely expensive that it's simply unreasonable to expect that a community could pay for its health care bills? Well, our parish is made up of 3,000 families. A large parish, perhaps, but far, far smaller than your average insurance pool. From dealing with small business insurance a while back, I can tell you that $500/mo is a fairly normal-to-low all in cost for insuring a family. So let's say that our parish became a community medical collective and assessed every family to pay $500/mo to meet everyone's health care costs. Let's also say that the parish absolved 1/3 of the families from paying anything, because their incomes were too low. So 2000 families each paid $500/mo into the parish medical fund. How much does that work out to? One million dollars per month. It's amazing what a large number of people all chipping in together can add up to. (As per Matt's rhetorical question: My friend Google tells me that MRI machines cost about one million dollars. A parish could buy one every month.)

But I don't realistically expect to see parish-based health care cooperatives any time soon, so let's leave that aside and answer the more general question: Why are conservatives down on "universal health care" according to the European model? And can one be so as a Catholic?

I think there are a couple main reasons:

1) The need for personal responsibility in providing for others.
In his post, Matt throws around lots of worries that people will be bankrupted in paying for doctor's bills, that people who are sick will have to decide whether to see a doctor or make their car payments, etc. Let's look wider for a moment in order to understand the principle we're bumping up against here. Why do we pay rent or mortgage? Why do we pay for our cars? Why do we pay for clothes and food and books and computers and game systems and beer? Is it fair that someone should have to choose between paying his rent and his car payment? Should he have to decide between his mortgage and food? Why do we pay for things? Why don't we just get all that we need?

Well, there's a practical reason: Fully collective organizations of society have not, historically, worked well at all except in the case of small religious communities.

But there's also a reason rooted in human nature: The natural state of man is one in which he works in order to provide for himself, his family and his community. At a biological level, we are descended from primates that lived in small social groups, and survived on the basis of group members foraging for food and sharing food with their dependants. At a religious level, when Adam and Eve were expelled from the Garden, God told them that from that point on they would live from the sweat of their brows. In both senses, we are meant at a very deep level to provide for ourselves and our families through our own work -- and even though we now live in a far more complex economy our senses of health, self-respect and well-being are directly tied to toiling in order to provide for ourselves and our dependants.

Money is how, in a complex economy with extensive specialization and trade, we pay for each other's time and labor. And so, paying for things with money that we earn through our labor is how we are at a fundamental level meant to provide for ourselves and those who depend on us.

What are the necessities of life? Food, shelter, clothing, medical care, education.

If our purpose and happiness in life consists of providing the necessities for ourselves and our dependants, we should want to see the connection between our labor and the provision of these necessities be as direct as possible. Toiling to provide these for the ones we love if not something that keeps us from being human, it's what makes us human.

Now I am not a radical individualist or libertarian. Most certainly, this does not mean that those who cannot at some point afford shelter should be homeless, that those who cannot afford food should starve, etc. As I kept reiterating above, one of our main duties in life is to provide the necessities for ourselves and "our dependants" and "those we love". As Christ taught us in the story of the Good Samaritan, we are called to love all those around us who are in need. We are social animals and social creatures, and as such we have the natural and moral duty to care for those in our communities who are in need. We absolutely need to have provisions for providing food, housing, clothing and medical care to those who cannot at this time provide it to themselves.

However at the same time, all those who are in any sense able bodied (and able minded) have not only a duty to avoid being a burden to others unnecessarily, but a human need to provide for themselves through their own work. So while we have a human duty to help those currently unable to provide for themselves, we also have a need as a society to help as many people as possible provide for themselves rather than relying upon help. We have a duty to avoid incenting dependency.

Now some readers may be frothing to rejoin: "But what about our current system? People don't pay for health care now. Massive, impersonal insurance companies do." This is true, but only in a sense. After all, the fact that my money resides in a massive impersonal bank (in which it is directly deposited by my employer, and which cashes the checks which I write to pay my bills) does not mean that I do not in fact earn my money and use it to pay for things. Similarly, I know that by holding the job that I currently do, I earn as a form of compensation a certain level of heath coverage, which I provide to my family as the head of my household. Many people do indeed pick our specific jobs and stick with them because they know that the benefits they can thus provide to their families are more valuable than the higher salaries they might be able to get elsewhere.

However, I do agree that our current system is overly indirect. And indeed, I think that some of the inflation of the cost of basic care is the result of that indirectness. As such, I would strongly favor a change to a system in which we pay for basic care more directly (either our of pocket or through small community health care pools -- no larger than a parish) and where we carried insurance only for large medical expenses. However the fact that our current system is very much imperfect does not make me want to adopt a European-style system, which would be a move in the opposite direction from what I believe we need to go in.

2) The need for checks and balances to prevent abuse.
People often complain about insurance companies denying coverage for certain people or certain procedures. That is unquestionably a problem. However, all honest analysts agree that a completely government run system would also involve denying coverage for a number of high expense/high risk procedures. The difference is that under a government system the fox is in charge of guarding the hen house.

I recall hearing a while back about a woman who was approached by Michael Moore for his documentary Sicko. He wanted to interview her about how her insurance had refused to pay for a procedure for her husband. She called the insurance company and said: "Remember that procedure you turned us down on? Michael Moore wants to interview about my experience. Are you sure you don't want to reconsider?" The insurance company, whose profitability relies in part in maintaining a positive public image, caved and paid for the procedure. Similarly, the government routinely (indeed, sometimes unwisely) steps in and rules that certain procedures must be covered by insurance.

All this works because people can switch insurance companies, and because the government regulates insurance companies from an outside perspective. Those checks and balances would be lost in a government run program. The result would probably be (as is currently found in the differences between health in the US and in countries with socialized medicine) that people would get better routine and preventative care under a government system, but those with truly serious illnesses would have worse outcomes than under the current system.

3) Hesitance to make irrevocable change.
Once people start to get something "free" from the government, it's nearly impossible to ever scrap the system and move to a different model. No matter how bad the government system is, it's "free" (as in paid invisibly through paycheck withhold and probably mostly by people richer than you), it's there, and no one wants to deal with the inherent uncertainty of privatizing.

As such, any suggestion of going to a European system for US health care is a suggestion of heading down a one way street. We won't get to change our minds without a total fiscal melt-down or political collapse.

It is, thus, a change I am very, very hesitant to make lightly. I'd happily commit lots of my own personal money or government taxes to a program designed to provide basic healthcare only to those who can't pay for their own first. That would meet the immediate need, without committing us irrevocably to a path about which I have grave doubts.

By proposing instead a full switch to a European-style system, progressives do themselves no favors when it comes to building bridges. (Which is, incidentally, probably why none of the viable Democratic candidates proposed such a program -- no matter how much they might have personally preferred such a move.)