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Title : The argument AGAINST Medicare for all
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The argument AGAINST Medicare for all

Believe me, no household in America could benefit from a single-payer system more than my household could. I haven't visited the doctor since my heart attack because I can't afford to do so. My ladyfriend, who has insurance, tends to "tough it out" rather than visiting a doctor because the deductibles are so terrifying.

Part of me hopes that a single-payer plan succeeds -- but I also recognize that there are potential problems, from a let's-win-the-election standpoint. Bill Scher in Politico gives a pretty balanced assessment:

Note that I didn’t say single-payer is electoral suicide. I would have said so a year ago, but today I can’t say that with certainty. As any single-payer devotee will eagerly tell you, a July Quinnipiac poll found 51 percent of voters support such a system. When characterized as Medicare for All, a June Kaiser Health Tracking poll registered support at 57 percent. In the current era of polarized politics, where centrist voters are increasingly elusive, single-player would certainly energize progressive voters and could help Democrats woo back some economic populist Trump voters.

But single-payer hardly comes with an Election Day guarantee. More than 90 percent of voters support requiring background checks for gun buyers. More than 60 percent oppose a border wall. Fifty-six percent say America should “discourage the use of coal.” And yet, we have a president on the opposite side of all those issues.

Moreover, the top-line numbers don’t ensure that support can withstand attack. Kaiser’s poll analysts concluded: “The public’s attitudes on single-payer are quite malleable, and some people could be convinced to change their position after hearing typical pro and con arguments.”

For example, upon hearing the startling news that single-payer might “give the government too much control over health care,” support plummets to 40 percent. The revelation that the plan would “require many Americans to pay more in taxes” did the same. Maybe, just maybe, a Republican will give these talking points a try.

Precisely. The single-payer poll numbers are deceptive. It's polled over 50 percent in times past -- and then plummeted well below that point. Basically, Americans want health insurance without paying for it. And there are many white Americans who feel like vomiting when they think about their tax dollars potentially helping to pay for a non-white person's health insurance.

My preferred solution: Not Medicare-for-all, but something like Obamacare with a public option.

Which, as you may recall, was the original Obamacare idea.

What I like best about this notion is that it puts to the test -- a brutally fair test -- two competing economic visions. Think of it as Milton Friedman vs. FDR, matched in an honest battle. Are you a libertarian who really and truly believes in Friedman's vision? Then you should love to see this test play out in the real world. If you genuinely accept as an article of faith that Bug Gummint never operates efficiently and never does anything really right, then you should relax, secure in the expectation that private insurers would wallop the public option.

When O-care was a-borning, I said pretty much the same thing in a blog post. A libertarian reader sneered that the deck was stacked against the private insurer, and that on a truly even playing field, the non-gummint entrepreneur would always win against the evil ol' Gummint. I asked this reader: Just how was the deck stacked against the private insurers? At that time, everything was in flux; the details of the proposed law were not yet known.

The libertarian had simply assumed that the fight was unfair. He couldn't cite any facts to support that presumption.

My take: Let us have a truly even-steven battle between the two ideologies. If the apostles of Ayn are proven right -- if, in honest competition, the private plan always delivers better health care for less money, then so be it! I am much more committed to efficiency than I am to any ideology.

But when the public option was proposed before, all of the Randroids insisted that the very idea was terribly unfair. There was simply no way that private insurance could compete.

This reaction was telling. In essence, the libertarians admitted that they were wrong to insist that Big Gummint could never get it right. They admitted that Big Gummint would probably do health care better and cheaper. As I wrote back in 2011:

The health care debate had one virtue: It forced the Republicans to admit that libertarian theology is a sham. They came right out and admitted that private industry could not offer the citizenry a better deal than the (soon-discarded) public option. Why would they say such a thing? Why did they fear competition from the gummint, if the gummint always does everything wrong? Didn't Milton Friedman tell us that private industry is always more efficient?

Gosh -- could it be that the Friedmanites lied?

You think maybe that's why your credit card bills are sent to you via the post office, and not via Federal Express?

Libertarians want to have their ideology put to the test because they know in their hearts that their most cherished beliefs will be proven wrong.

Right now, I say no to Meidcare-for-all. A single-payer system will mean that the Apostles of Ayn will shriek "WE TOLD YOU SO!" every single time the system has a hiccup. No, let's have a public option doing honest battle with the various private options, and let the best weltanschauung win. If the public option succeeds, then the Randroids will have no basis for complaint; they will simply go to their corner and sulk.

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