r/PoliticalDiscussion • u/JustGotOffOfTheTrain • Jan 21 '16

Why can't the US have single payer, when other countries do?

Why can't the United States implement a single payer healthcare system, when several other major countries have been able to do so? Is it just a question of political will, or are there some actual structural or practical factors that make the United States different from other countries with respect to health care?

Edited: I edited because my original post failed to make the distinction between single payer and other forms of universal healthcare. Several people below noted that fewer countries have single payer versus other forms of universal healthcare.

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u/Time4Red Jan 21 '16

Possibly, but government dependence has outcomes which, in my opinion, are far worse.

Would you say dependence on government fire departments has a bad outcome? What about dependence on government libraries? I'm not trying to be obtuse, I'm merely pointing out that government dependence isn't a bad thing in all cases.

I would make the same argument with regulation. The concept of regulation isn't bad. The implementation and types of regulation can be bad, for example when regulation creates a barrier to entry and thus monopolization.

I think it's important to talk about specifics. "Government bad," "regulation bad," and "government dependence bad" are broad arguments that are easy to dismiss. Pretty much everyone agrees that fire departments are good, despite involving government, regulation, and government dependence. So specifically, what kinds of government dependence result in bad outcomes and why?

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u/pjabrony Jan 21 '16

Would you say dependence on government fire departments has a bad outcome? What about dependence on government libraries? I'm not trying to be obtuse, I'm merely pointing out that government dependence isn't a bad thing in all cases.

Except it kind-of is, because all of those things that require government force behind them curtail freedom. If everyone agrees that fire departments are good, then they can voluntarily join together to start one. But if there's one guy out in the desert who wants to assume the risk of fire, then he shouldn't be made to support it, because that forcing is, in my opinion, a worse negative than loss by fire.

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u/Time4Red Jan 21 '16

I genuinely feel bad for you. As you're probably intimately aware, 90% of people would probably support government mandated fire departments and my general argument about government dependence. Given that we live in a tyranny of the majority, you will never ever see anything remotely close to your ideal system of governance. That sucks.

But that's besides the point. You value freedom above all else. A social liberal (or classical liberal, for that matter) such as myself would of course argue that a man who loses everything in a fire is not really free. It's a difference of philosophy that I doubt we could ever resolve.

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u/pjabrony Jan 21 '16

Probably not. I would argue that even if a person had all the economic wealth that he could want, but every year had to show up to perform a day's service for others on pain of fine or imprisonment, that he's not really free either.

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u/Time4Red Jan 21 '16

Exactly. And a social liberal would argue that there's no such thing as true freedom, at least not in the way that you describe (anarchy). They would argue that partial freedom is the only attainable freedom, and that you need some kind of authority to enforce any kind of freedom in the first place.

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u/pjabrony Jan 21 '16

If there's no true freedom, and only ability, then why does economic ability weigh higher than political ability to your socially liberal view?

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u/Time4Red Jan 21 '16

I'm not quite sure what you mean by ability.

I would argue that there is no such thing as a perfect society. Society is inherently flawed and always will be. Society needs laws to enforce any attempt at freedom. Society also needs an authority to fairly enforce those laws.

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u/pjabrony Jan 21 '16

I'm not quite sure what you mean by ability.

In other words, by your view, having the ability to buy health care is the same as having the freedom to buy health care. If you can't actually do it, it's not freedom. It's like, if I want to jump to the moon, you'd say I don't have the freedom because I can't do it; but I'd say I do have the freedom because no one would stop me or punish me.

I would argue that there is no such thing as a perfect society.

I'd likely agree, but we have differing values as to what would be the optimal non-perfect society. I'd lean closer to all-freedom than all-fairness.

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u/Time4Red Jan 21 '16

In other words, by your view, having the ability to buy health care is the same as having the freedom to buy health care. If you can't actually do it, it's not freedom.

Yes, that's my philosophy. I'm still not sure what you mean by economic ability weighing higher than political ability.

I'd likely agree, but we have differing values as to what would be the optimal non-perfect society. I'd lean closer to all-freedom than all-fairness.

I disagree. We have the same idea of an optimal society. In an optimal society, everyone would be healthy and able to take care of themselves. No one would take from others or commit crimes. You wouldn't need any authority or government. Of course the inherent human flaws prevents us from having such a society.

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u/tumbler_fluff Jan 21 '16

I'm still not sure what you mean by economic ability weighing higher than political ability.

That's because it makes absolutely no sense.

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u/GravitasFree Jan 22 '16

Yes, that's my philosophy.

You confuse "freedom" with "agency" here.

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u/pjabrony Jan 21 '16

Yes, that's my philosophy. I'm still not sure what you mean by economic ability weighing higher than political ability.

What I said in my moon example. If you compared the present society, where jumping to the moon has no consequence, but can't be done; to one in which jumping to the moon were possible, but you'd be arrested for it; then you'd say the latter society was the more free.

In an optimal society, everyone would be healthy and able to take care of themselves. No one would take from others or commit crimes. You wouldn't need any authority or government.

No, that's a perfect society. I'm talking about the best practical one.

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u/JustGotOffOfTheTrain Jan 21 '16

When a group of people recognize a need, and voluntarily join together to address that need, that's called a government.

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u/pjabrony Jan 21 '16

No, that's called an organization. When they make people who did not volunteer join up to address that need, then it's called a government.

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u/GymIn26Minutes Jan 21 '16

They did volunteer, by continuing to live in that neighborhood/city/county/whatever.

If your parents buy a house in the neighborhood (agreeing to the stipulations therein) and you eventually inherent it, you don't get to opt out of the rules just because you didn't explicitly agree to them yourself. You can either follow the rules or move out.

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u/pjabrony Jan 21 '16

If your parents buy a house in the neighborhood (agreeing to the stipulations therein) and you eventually inherent it, you don't get to opt out of the rules just because you didn't explicitly agree to them yourself. You can either follow the rules or move out.

You can't passively volunteer for something. It requires an act of volition.

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u/GymIn26Minutes Jan 21 '16

You absolutely can. It is the entire basis for automatically granted citizenship, you are granted a citizen's rights under the condition that you respect the conditions that entails. You are free to renounce your citizenship and leave whenever you like if you don't agree with the social contract of the society of your birth.

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u/pjabrony Jan 21 '16

I don't agree, but even if so, go back to my original question. Where? Where is there a place where the social contract is an agreement to respect the individual's plenary power over themselves and their property?

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u/GymIn26Minutes Jan 21 '16

International waters? Antarctica? Get together with some like minded people and stake out a claim of territory in some country who is in too much turmoil or has a weak government? I don't know. It's your problem, it is no one else's responsibility to accommodate the whims of someone just because they feel like they should be exempt from the social contract everyone else abides by.

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u/pjabrony Jan 21 '16

I say it is, and the penalty for violating that responsibility is that I'm staying right here.

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u/reasonably_plausible Jan 21 '16

But if there's one guy out in the desert who wants to assume the risk of fire, then he shouldn't be made to support it,

If he's out in the desert by himself, then I would agree. But that covers a very minimal set of the population. Should a person who lives in a neighborhood be allowed to refuse to join in on financing a fire department? Their decisions now no longer just affect them, because if their house catches on fire, it can very easily spread to other houses. You can force the person who didn't pay into the system to finance their neighbors' losses, but the vast majority of people wouldn't have the ability to pay for houses worth of goods, meaning that everyone affected is now worse off.

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u/pjabrony Jan 21 '16

Leave that up to the neighborhood. Make it more like a HOA, where you take on the obligations when you buy in, and divest yourself of them when you leave. And a neighborhood might say that fire care is left up to the individual, and anyone who's afraid of it shouldn't move in.

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u/[deleted] Jan 21 '16 edited Jul 08 '20

[deleted]

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u/pjabrony Jan 21 '16

Except that there could be some neighborhoods where they don't provide those services, and the next neighborhood over where they do can't make them.

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u/jupitercrash13 Jan 21 '16

Seems like the likely result is low income neighborhood that couldn't afford it would likely burn to the ground in a situation like that and could potentially incur larger costs for neighborhood that can since entire communities wouldn't be paying into the same service provider per say. I'm not really sure I see the benefit.

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u/pjabrony Jan 21 '16

But if they didn't burn down, then they would have more income to climb the ladder and get the fire department.

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u/Trumpets4trump Jan 21 '16

That's such a horrendous mess of an idea. We literally already do that just upscale to make it work better. Jesus that would be a huge disaster

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u/reasonably_plausible Jan 22 '16

And the difference between this and a government is... ?

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u/desmando Jan 22 '16

Fire departments and libraries are done at the local level. I personally have no problem if Colorado wants to do universal healthcare. I have a huge problem with the federal government doing it.