For those on the left side of the political spectrum, single-payer health care — a system in which the government, rather than private insurers, pays for all health care costs — is one of the most popular policy proposals in America. But the recent Hobby Lobby decision is reminding some liberal technocrats that giving the government full control over health care funding also gives the government control over what medical services will be funded.
As liberal pundit Ezra Klein explains:
The assumption behind some of the Hobby Lobby-based arguments for single payer is that a single-payer system would cover contraception and that would mean everyone’s insurance covers contraception. But a Republican-led government could decide that taxpayer dollars shouldn’t be going to cover contraception at all, and then a single-payer system means no one’s insurance covers contraception.
An example comes from one America’s current single-payer systems: Medicaid. While Medicaid does cover contraception, Congress decreed years ago that it can’t, under any circumstances, pay for abortions. So while people buying private insurance can choose a plan that covers abortion if they want (and, in fact, about two-thirds of private health-insurance plans cover abortions), people in the Medicaid system have no option to choose a plan that covers abortion.
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So the question with single payer isn’t just whether you like the model. It’s whether you trust the US government to implement the model. This was driven home to me during a conversation with Uwe Reinhardt, a Princeton health-care economist who supports single payer. “I have not advocated the single payer model here,” he said, “because our government is too corrupt.”
The point here isn’t that single payer is a bad way to structure your health-care system. As other countries show, single-payer systems can work beautifully. But a single-payer system can only be as good as the government that runs it. So how good do you think the US government is?
One of the problems with putting our entire health care system in the hands of politicians is that they are, well, political. If your side of the political spectrum is in control of the political process, you might like the results. But when the other side is in power and curtailing your choices, then it’s more difficult to support government control.
When it comes to topics like health care, liberal technocrats tend to focus more on issues such as efficiency than liberty, which is why they (inexplicably) tend to prefer centralized control. But hopefully the Hobby Lobby case will cause more of them to wake up to the realization that giving the government more power isn’t always the best solution for getting what they want.