Health Care

For Conservatives:

Viewpoint: Liberals, consistent with their general advocacy of government involvement, tend to support a universal health care system in the United States that is controlled in full or in part by the federal government.

Reasoning: Many liberals see access to health care as a natural right of the people; that is, they believe that it should be guaranteed to every individual and protected by the government. As Thomas Bodenheimer notes in The Political Divide in Health Care: A Liberal Perspective, this belief is based on two aspects of liberal thinking: first, that health care as a right will promote equality of opportunity and advance the welfare of the least-advantaged members of society, and second, that guaranteeing health services to all is beneficial for the greatest number of people.

“A dividing line between those who support and those who oppose health care as a right is the question of whether health care is a human necessity.” ~ Thomas Bodenheimer, The Political Divide in Health Care: A Liberal Perspective

Those who equate health care with a commodity will likely support it being part of a free market, as they would clothing or furniture. However, many liberals believe that a market in which customers use money to purchase goods is not suitable for the absolute human necessity that is health care.

Every health care system, no matter what type, has three components: a patient, a payer, and a provider. The patient typically pays premiums, or taxes, to the payer. The payer then pays the provider, a doctor, for some or all of the patient’s treatment. The patient often has to supply a co-pay to cover the portion of the treatment not covered by the payer. In the current multi-payer system in the United States, patients have a choice between many different insurance companies to which they will pay their premiums. The company that a patient chooses will then pay for a portion of the patient’s treatment, and the patient will be responsible for a co-pay.

Many liberals would support the adoption of a single-payer system of health care in the United States. In this system, there would be only one insurance company: the government. For example, in Bernie Sander’s ideal program, government insurance would cover so many services and require such small co-pays that private insurance would no longer be necessary. Such a program intends to extend health insurance to those who otherwise could not have paid the premiums required to get health care in the multi-payer system. It would, however, cost 32 trillion dollars over ten years, according to an Urban Institute report in May of 2016, which is an increase in federal spending by over 50 percent.

Liberals point to health care statistics in countries such as England and Sweden to show the advantages of their systems as opposed to that in the United States. In 2013, over 37 percent of American adults chose not to receive recommended care, did not see a doctor when they were sick, or did not fill out prescriptions due to the costs. By comparison, a mere four to six percent of people in Sweden and the United Kingdom did the same. According to 2019 statistics, the United States spends about $10,966 per person annually on health care. Switzerland, second behind the U.S., spends over $3,000 dollars less.

The United States does not currently have any legislation that guarantees its citizens’ right to health insurance. However, most Americans would prefer otherwise. According to a 2020 Pew Research poll of American adults, 63 percent believe that the federal government should be responsible for providing all Americans with health care. Even in 2004, the Opinion Research Corporation survey of adults in the United States found that 76 percent of them believed that health care is a right. This sentiment is shared by the majority of liberals in the United States, and they feel that such a goal must be accomplished through increased government intervention in the health care system. 

Sources:

Single-payer would drastically change health care in America. Here’s how it works. – The Washington Post

The Political Divide In Health
Care: A Liberal Perspective – Health Affairs

How does health spending in the U.S. compare to other countries? – Health System Tracker

Increasing share of Americans favor a single government program to provide health care coverage – Pew Research Center

Access, Affordability, and Insurance Complexity Are Often Worse in the United States Compared to 10 Other Countries – The Commonwealth Fund

For Liberals:

Viewpoint: On most topics, conservatives are generally in favor of very little government involvement. The subject of health care is no different. Most conservatives believe in a competitive, free market health care system in which American citizens choose the health care company they prefer.

Reasoning: Many conservatives want health care to be incorporated into the free market. They feel that this would cause doctors to increase their knowledge, improve their practices, and lower their prices because they would be given an incentive to do so: money. In a free market, every doctor or medical practice is attempting to outdo one another in order to attract the most patients and earn the most money. Therefore, medical companies will try to appeal to the large population of middle-class and poor people in America by making health care better and more affordable. In this way, conservatives believe that everyone will benefit.

Conservatives and liberals agree that the current health care system in America is flawed. Officially, the United States has a multi-payer health care system (see the “For Conservatives” section for details about this system). Many liberals feel it evident that the private-sector approach in the United States has failed, and they often blame the private marketplace for the problems in the health care program. However, conservatives who support a competitive health care system argue that the one currently implemented in the United States is not truly competitive and never has been. They therefore maintain that because the full incorporation of the health care system into the free market has not been tried, it is impossible to assume that it will fail.

Perhaps the most famous argument that health care is unfit for the marketplace can be found in a paper by economist Ken Arrow. The paper was published in 1963 in the American Economic Review and titled “Uncertainty and the Welfare Economics of Medical Care.” In his work, Arrow identifies five reasons that health care should not be based on a free market system. These include unpredictability, barriers to entry, the importance of trust, and a difference in knowledge between doctor and patient. Arrow argues that these characteristics are unique to health care as opposed to a product that might be bought in a store, leading to his belief that health care does not belong in the same category as other commodities. A conservative argument by Avik Roy, a Senior Fellow at the Manhattan Institute for Policy Research, dissects these points and provides counter arguments for each:

First, Arrow states that the time at which a person needs health care is very unpredictable, whereas the need for food and clothing, which are part of the free market, is easily anticipated. And, although it is possible to skip a meal or a trip to buy more clothes, a patient’s need for health care is often extremely urgent. However, Roy argues that this unpredictability is not unique to health care. In fact, this issue is the very reason for warranties on televisions in case they stop working, overdraft protection for when people have very little money or make a mistake with their checking account, travelers insurance for people who fear flying, and a variety of other types of insurance including homeowner’s, auto, and life. All of these are intended to account for the unpredictability of products that are part of the free market. As a result, Roy argues that health care’s unpredictability is not a valid reason for it to be excluded from the free market. 

Arrow goes on to argue that there are many barriers to entry in the health sector. He says that because it is very challenging to obtain a medical license, there is a constraint on the supply of medical services, whereas it is easier for new suppliers to enter the market in other fields. Again, Roy points out that this is not unique to health care, and that “It’s a lot easier to get a medical degree than it is to start an airline or a bank from scratch.” Lawyers, cat groomers, tattoo artists, and tree trimmers also require licenses, but Roy points out that Arrow does not argue for the nationalization of these industries.

Arrow again differentiates health care from other free market commodities by arguing that trust is a far more integral aspect of the health industry than of any other industries: patients literally trust doctors with their lives. However, trust regarding the life of a customer is also deeply important in many other commercial transactions. In buying a car, an individual trusts that the manufacturer has thoroughly verified that the brakes function properly. If not, that person’s life could be at risk, and yet cars are part of the free market and health care is not. 

Finally, the fact that doctors know much more about medicine than do their patients is also not unique to health care, according to Roy. This disparity in knowledge between a buyer and seller is present in all business transactions. Furthermore, the Internet allows patients to learn everything they need to know about their specific medical concerns, so if they would like to become more knowledgeable, they can do so.

The similarities between these aspects of health care and those of other industries in the free market support Roy’s argument that free market health care is possible, as well as perhaps desired. This sentiment is generally shared by most conservatives in the United States. 

Sources:

Liberals Are Wrong: Free Market Health Care Is Possible – The Atlantic

Compelling Evidence Makes the Case for a Market-Driven Health Care System – The Heritage Foundation