Florence Nightingale, engraving c. 1855

Florence Nightingale, engraving c. 1855

I write fairly frequently about health care policy. And almost every time I do, someone crawls out of the woodwork and says something similar to this:

I worked hard for my health insurance. I don’t see why someone who didn’t work hard, save, and prioritize paying for health insurance, should get as good a health care as I do.

Let’s look at this. We’ll leave aside the assumption that people who don’t have health insurance aren’t hard workers, it’s bullshit, but let’s grant it. Let’s say it’s true. Then lets parse the morality of this statement. Let’s re-state it more clearly:

Lazy people don’t deserve good and timely health care. That means that some of them will die or suffer pain, nausea or debilitation that could otherwise be stopped, but since they’re lazy they deserve to die or suffer for their laziness.

Let’s take this one step further. It is a fact that the US pays about 50% more per capita for health care than Canada. On all major metrics except for one the Canadian system performs as well or better than the US one. What is that metric?

Non-essential surgery waiting times.

Now sometimes this doesn’t mean surgery that you sure as hell wouldn’t like to have fast, but it does mean surgery that isn’t actually needed to save your life. Since the other side loves to deal in anecdotes, I’ll deal one right here. In ‘93 when doctors decided I needed surgery to save my life and needed it right now, they mobilized a surgical team on Sunday at 10pm and performed surgery on the spot – saving my life. The Canadian system came through for me.

But let’s step back. Non-essential surgery waiting times. That’s what you pay 50% more for.


Not so that the 40 million odd people who aren’t insured are insured and get health care when they need it. Not for a national drug plan (which if you reduced health costs by 1/3 and then plowed the savings into a drug plan along with smacking the drug companies around a bit, would probably mean prescription drugs for everyone who needed them), but waiting times for non-essential surgery. That’s what your money has produced.

And I've compared to a system that isn't the best. The US could choose a system like Germany's and France's that don't even do worse than the US on optional surgery, still cost way less and still beat or match the US on every metric.

So here’s the choice.

You can have the current system. Benefit: reduced waiting times for non-essential surgery, only if you choose a suboptimal plan.

Or you can have a single payer system where care is still provided by private doctors and hospitals and where patients have more choice than under the HMO’s that are taking over the US medical scene. Everyone will be insured and every health metric will be as good or better except waiting times for non-essential surgery. Cost: 1/3 less than you’re currently paying.

Bonus: you could take that 1/3, and since drug costs currently come in at less than 10% of total health care costs, you could give everyone in the entire country a prescription drug plan and still have money left over.

Bonus #2: 50% reduction in the bankruptcy rate, since that's how many bankruptcies are caused by health care costs, mostly of people who had insurance and thought they were covered.

The losers – some people with non life threatening ailments that would benefit from surgery. I don’t want to underestimate this, some people will suffer from this and it will be real suffering – the question is whether it’s less suffering than the 40 odd million people who are currently uninsured are now experiencing. And whether it’d be more than offset by, say, a prescription drug plan?

In addition private insurers would go out of business along with their huge administrative margins, sometimes approaching 30 or 40% compared with the consistent under 5% for Medicare. That’s a lot of administrative overhead and a lot of jobs – but the people who are pumping up private insurance sure aren’t the people who cry when so-called “creative destruction” “frees” up resources from other industries.

Health care is a moral issue and a pragmatic one. Those who support the current system support a profoundly immoral system which is causing people to die and suffer needlessly and costs more than the completely obvious alternative. They almost certainly do it out of some misguided belief that a bad result from the private sector is morally preferable to a good result from the public sector – or perhaps they do it because they’re at the trough and benefiting.

But it is a moral issue and being against single payer healthcare says something about the person with that belief. And it isn’t anything good (and certainly isn’t anything Christian, but I’ll leave that to those Christians who remember that Jesus cared for the poor to remind people of.)

So choose whether you support single payer health care. But remember that in making that choice you are making a profound statement about what you consider important – free market ideology or saving lives and pain – and that single payor healthcare has been proven to actually be cheaper than the current system. Immoral and impractical - all in one.