At the age of 30 I became very very ill. I had no energy and had lost 40 pounds. I was diagnosed with type 1 diabetes. I was fired from my job because I was too ill to keep pace. Type 1 diabetes is VERY VERY expensive. There is a constant supply of medical equipment to pay for: insulin, syringes, blood glucose test strips…the list goes on. I was sick and fired and had enormous medical bills. I had no idea what I was going to do. Thankfully, the company my partner works for extends health benefits to same sex partners. I feel very lucky. I feel the pain of those gay people who are not so lucky to have a partner who works for such an enlightened company. This is a REAL issue that affect REAL people with VERY REAL problems. (By the way my partner works for Williams Sonoma. That have a beautiful attitude about equality.)

Care is already rationed in the US. Not just because of fiscal constraints on Medicaid and Medicare, but private insurance companies are more concerned about their profit than your mangled leg or bum heart. Many millions of Americans have a lifetime cap of $1 million or less on their health insurance. Two cancer diagnoses, or two rounds of bone-marrow transplant, can wipe that out in well under two years. After that you’re S.O.L. If you die and your illness could’ve been treated, there’s a good chance (based on age) that a single-payer approach would’ve kept you alive to pay more taxes, which would offset cost of care.

(Sidebar: when you hear about Canadians waiting six months for a diagnostic scan, remember that there are administrative rules which may limit machine use, and Canada spends roughly 60% per person what the US spends.)

Drowning in bureaucracy? Ever dealt with an insurer? I have Blue Cross, and I called for a urologist referral. There’s a hospital two blocks from me, two others within three miles, another within 5, and two more within 7. They wanted me to see somebody with an office 15 miles away–and four of the hospitals I mentioned are part of the same preferred network. I’ve dealt with Medicaid, Medicare and Social Security when my girlfriend was still alive, and they were each models of efficiency. Moreover, since I’m not paying for their profit margin, please note that CMS (Medicaid/Medicare) has the lowest administrative costs of any large provider in the US (15% or below). Nobody said that single-payer meant that a government agency would take over all administrative functions, either.

Half of US healthcare is already tax-funded. (Ever notice that Medicare tax on your paycheck stub?) Your property or income taxes probably help pay for a public hospital or health district. Property taxes also help pay for mental health care here. Every day I see people who’ve gone without care. Rotting teeth, for example. Oral bacteria are a direct factor in heart disease–the money spent now for dental care is therefore money which may not be spent on a quintuple bypass. Mental health–I’ve seen people who were hospitalized and whose lives basically fell apart because they couldn’t afford medication. As a taxpayer, I would rather see someone with bipolar disorder have access to Abilify than be hospitalized; a 30-day supply of Abilify costs $650 when paying cash. How many of you have $650 for one prescription, every month? I don’t. And that’s why I’m more than ready to see my insurance change and become more of a public service, like Social Security. Our system could be an international model, at lower cost, if we didn’t have this naive idea that nothing can be done effectively without a fat profit margin (insurance companies and Big Pharma have been doing very well these last few years).

One point I neglected. The US spends roughly 16% of GDP on healthcare, the most of any country. Switzerland is next, and Switzerland is seeing the same problems we are. On average, German manufacturing jobs pay more than US jobs do, and part of that is specifically because healthcare financing is treated as a tax rather than an employee benefit. That’s why small and mid-sized German firms can compete against larger US firms–they’re not weighed down by healthcare costs.

We can do better, and there’s no reason we can’t cover everyone for no more than marginal increase in net cost. Individual cost would drop. Congress has the power to require all providers accepting Medicaid and Medicare to hold a summit and create a uniform standard for paperwork; this would eliminate tens of thousands of claim processing jobs, saving billions of dollars, without changing the status quo one bit. Something to consider.

Frankly, almost any law the government can enact will have some economic effect (whether it’s blocking stem cell research or banning discrimination in employment). What’s most good for the country is what’s objectively pragmatic and creates the best overall situation, not what any ideologues ‘feel’ is best.

Under the current approach favored by the US government, the poor and many seriously ill people are effectively unable to obtain treatment, or at least unable to obtain treatment at the same level as others.

But if we’re truly interested in helping the society, we’re interested in the greatest quality of life for the entire society, not just a particular segment of it.. If the price to be paid for providing health care to everyone is greater than the benefit that it provides them, then we cannot justify doing so. We cannot justify taking from the rich to give to the poor if the rich lose more than the poor get in the process.

The convenient situation for universal health care, which is the *only* sound reason to argue for it, is that the poor gain more than the taxpayers lose.

With most economic policies, there are winners and losers. People who will receive positive benefit and people who will receive negative benefits. A good policy is any where the winners win more than the losers lose.

Net societal benefit in economics is a pretty simply defined term in economics… And good public policy requires that the NSB of a law be positive.

Political pressure can result in the creation of laws of a negative NSB, but that is not good policy.

Different perspectives provide different options if and only if you are looking to pander to a particular group. The approach that creates the greatest net societal benefit for the entire population, however, is the only one that can be considered unambiguously positive.

Good economic policy is objective, not subjective.