Friday, August 21, 2009

Single-payer System, Classic Socialism

Regardless of what you may think of a single-payer universal health care system, one thing aught to be clear: it's straight up socialism. Socialism is the concept of centralizing the administration of our means of production to achieve a more efficient and egalitarian outcome. If we make the government the sole provider of basic health insurance, we have centralized the control of who gets compensated for what medical services. However, presuming we allow additional private insurance for services not compensated by the government, the system will not be strictly socialist. Nonetheless, having centralized the process of getting compensatory authorization for the majority of all medical procedures, I don't know what else to call it but... socialist.

The unfortunate thing is that in many circles the term socialism has acquired such a derogatory connotation that once the term is used it shuts down all meaningful conversation. Now, I happen to believe that the best economic systems are neither socialist nor completely "free". As a federalist I believe in subsidiarity and the Rule of Law. It's appropriate for the government to impose rules about what CANNOT be done in specific markets. Without clear rules, organizations will inevitably use whatever means that afford them an upper hand, regardless of whether such means demonstrate prowess, ingenuity and service excellence in their specific field.

Though I believe it's necessary for the government to impose basic (sometimes strict) rules, it's hardly ever good for the government to actually administrate the means of production. The temptation is to think that centralization inevitably leads to optimization by the removal of unnecessary redundancies. But redundancies are not necessarily wasteful since they stabilize the overall system by making the system more resilient to failure. The best systems in my view are those that balance centralization and localization as well as conciseness and redundancy. I have no doubt that we need universal health care. But I'm wary of single-payer systems because I don't think they strike the aforementioned balance. A so-called "public option" seems far more attractive though I have yet to reflect on whether, as claimed, it would ultimately destroy the private industry, and thereby in the end institute a de-facto single-payer system.

One thing is for sure: it's unfortunate that the term socialist has acquired such an accusatory tone. Though I strongly disagree with some of the core tenets of the socialist movement, socialism is a useful term for describing the concept of centralization in our economy. And, let's face it, Americans have been employing and benefiting from clearly socialist structures since 1930's. It's neither knew nor un-American. But the fact that socialism isn't "un-American" doesn't mean that socialism is good either. Only the most banal use the words good and American interchangeably. We need to move beyond superficial phrases like "a single-payer system is bad because it's socialist". Yes it is socialist. But so what? Why is socialism bad? Ah, now, where getting there. Socialism is bad because...


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