I was originally going to post this in this thread because reading it made me think about this issue, but I realized it wasn’t particularly on topic. Once my post was long and general enough, I decided to spin it off into its own OP. I’m not quite sure that I’ve laid out a clear cut issue to debate, but hit me with whatever thoughts you might have.
I find it interesting that so few people consider the health care debate from a utilitarian perspective, rather than an ideological one.
I’m a utilitarian at heart. My utilitarian conclusions have lead me to a set of views which, if you have to pigeonhole them, most closely resembles libertarianism. But I am not staunchly stuck to a particular set of ideological beliefs - I try to evaluate any view on its merits. In general, I think that government is bad at doing most things, and is often inherently a force of evil - so my conclusions often lead to advocating less government because I simply think that it’ll result in the best average utilitarian result for everyone.
But again, I do not start with an ideological premise that all government is bad. There are some things which clearly work pretty well when done by government - for example police forces, regulations to prevent fraud in the market, and our public road network. In the latter case, I have a hard time believing that a private alternative with a mish-mash of toll road systems with complex ownership rights agreements would have a better result than the very good road system we have. But some libertarians, more loyal to ideological extremes than utility or practicality, would advocate such a thing.
So when it comes to this debate, I try to ignore ideological arguments. I don’t think “people have the right to health care!” is a useful argument, nor do I think “fuck anything government run, simply because it’s government run” is either. I’m interested mostly in practical results, and what works on average best for society.
If we changed our health care system in a specific way, would we spend less of our GDP on health care (whether it came from the public or private sector)? Would our health outcomes improve or regress? Would there be secondary benefits or costs in other areas, like for instance a greater economic flexibility if people weren’t tied to their jobs for insurance reasons? Is preventative treatment was cheaper than letting everyone go to the emergency room when the problem becomes catastrophic? What are the economic benefits of a populace that doesn’t have to worry about delaying or passing on medical treatment due to the costs involved? These are the sorts of questions we should be debating, but rarely are. I’m willing to be won over on the merits of arguments and facts by either side. My mind can be swayed by real-world evidence and extrapolation of specific proposals. I don’t simply say “damn the facts, this is what fits my ideology!” - am I that rare?
I used to believe the propoganda/lies about how other industrialized nations had poor health care systems and how poor people died on waiting lists and all that, and I rejected arguments based on assumed rights to health care, so I was generally and fairly staunchly against government involvement in health care. But I learned that the reality is that countries that handle health care in the public sector seem to do about as well as us - worse at the high end, much better at the low end - for cheaper. The issue is more complicated than that- for example they have significant benefits as a free rider of the US paying for a significant fraction of medical innovation. But it certainly isn’t the catastrophe that opponents paint it as.
But it disturbs me that almost everyone attacks this issue from ideology without regard for the actual practical effects. On the conservative side, it often seems mean spirited to me - that some people would never be willing to accept their (perceived) lessers getting the same treatment as them, even if hypothetically they wouldn’t suffer at all. There’s some perverted fallacy of the just world going on in their thinking. They haven’t faced problems from medical issues, therefore they think that if anyone has, it must be their own fault. You’ll see threads where people acted completely responsibly - healthy lifestyles, had insurance, etc. - but their insurance found some way to deny them treatment and these people will come in and talk about how the person deserved it. How dare they be so irresponsible! And yet in these cases the person wasn’t even irresponsible - there’s just an assumption that bad outcomes must be from behavior and character attributes inferior to the person doing the criticizing. There’s a certain significant minority that actually becomes gleeful at what they perceive as the deserved suffering of others - and often their ideology tells them that if a person is suffering, then they must’ve done something to deserve it. What an evil worldview this sort of thinking results in.
Which isn’t to say that everyone who opposes any governmental involvement in health care is evil or purely driven by ideology, but arguing about the actual practical, utilitarian effects of policies seems to take up a disturbingly small amount of the conversation. To demonstrate this - we’ve had hundreds of pages of debate on this board about the subject - and how many of those posts have been about the merit of specific policies being proposed currently in the US? Rather than “is this particular policy (proposed as part of the reform bill in congress) a good idea?”, instead we delve off into general debates. “People have the right to health care!” “A government panel deciding if you were worthy of treatment would be horrible!” - the opponents of the reforms in particular almost entirely attack the straw idea that we’re going single payer a total government takeover and attack that on broad ideological terms rather than examining the specific policies under debate in congress.
This whole thing reminds me of a conversation I had with my (Glen Beck-watching) conservative friend. I pointed out some of the practical flaws of our current health system, like how being tied to a job for insurance complicated by pre-existing conditions reduces the mobility and flexibility in our economy. He just assumed that because I dared question the status quo, I must be one of those socialist types. I then pointed out that the nature of employer-provided health insurance wasn’t somehow the natural or obvious model for health care, but that it was a quirk of wage fixing in WW2 which gained momentum to eventually give us our current situation, and that government tax policy was actually responsible for the nature of our coverage. And then I advocated detaching the tax incentives for insurance to employment - an option that’s a step closer to the free market than our current system - and he worked himself into mental contortions to defend the status quo and actually talked about how it was good that the government set the ball rolling by coming in and creating the wage fixing in the first place. His ideological conservatism made him so afraid to deviate from the status quo that he reflexively attacked me even though I was advocating less government in health care than he was. This is a disturbing trend I see amongst conservatives - a reflexive, unthinking defense against anything that would cause any changes. I guess that’s part of the definition of “conservative” (although there are people who advocate generally conservative economic values without falling victim to this sort of thinking. This is part of the problem of thinking of political ideology as only a two-sided affair - there is not enough finesse to seperate different views).
Do we see as much of this ideology-over-utility in other debates? Certainly there’s some, but this debate seems to serve as a prime example where almost no weight is given to practical debate and almost all the debate comes in broad ideological terms that may or may not actually be relevant to the issues at hand.
And why do we engage in this sort of argument? My own guess is that it’s simply easier - to think critically about each issue, learn what you can, consider the evidence, and challenge your views is difficult. Utilitarianism that doesn’t match any particular ideology takes a lot of work. It’s much easier to view all issues as having two sides, broadly painted, and hitch your wagon to one. Blindly espouse the general ideology of your team and always attack that of your other team. Not much thinking involved in that case - but we all end up worse for the inelegant and conflicting solutions that stem from blind partisanship and overly broad adherence to ideology.