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The Conservative Case for Universal Healthcare

Don’t tell anyone, but American conservatives will soon be embracing single-payer healthcare, or some other form of socialized healthcare.

Yes, that’s a bold claim given that a GOP-controlled Congress and President are poised to un-socialize a great deal of healthcare, and may even pull it off. But within five years, plenty of Republicans will be loudly supporting or quietly assenting to universal Medicare.

And that’s a good thing, because socializing healthcare is the only demonstrably effective way to control costs and cover everyone. It results in a healthier country and it saves a ton of money.

That may seem offensively counterintuitive. It’s generally assumed that universal healthcare will by definition cost more.

In fact, in every first-world nation that has socialized medicine–whether it be  a heavily regulated multi-insurer system like Germany, single-payer like Canada, or a purely socialized system like the United Kingdom–-it costs less. A lot, lot less, in fact [1]: While healthcare eats up nearly 18 percent of U.S. GDP, for other nations, from Australia and Canada to Germany and Japan, the figure hovers around 11 percent. (It’s no wonder that smarter capitalists like Charlie Munger of Berkshire Hathaway are bemoaning the drag on U.S. firm competitiveness from high healthcare costs.) Nor are healthcare results in America anything to brag about: lower life expectancy, higher infant mortality [2] and poor scores on a wide range of important public health indicators.

Why does socialized healthcare cost less? Getting rid of private insurers, which suck up a lot money without adding any value, would result in a huge savings, as much as 15 percent by one academic estimate published [3]in the American Journal of Public Health. When the government flexing its monopsony muscle as the overwhelmingly largest buyer of medical services, drugs and technology, it would also lower prices-–that’s what happens in nearly every other country.

So while it’s a commonly progressive meme to contrast the national expenditure of one F-35 with our inability to “afford” single-payer healthcare–and I hesitate to say this lest word get out to our neocon friends–there is no need for a tradeoff.  If we switched to single payer or another form of socialized medicine, we would actually have more money to spend on even more useless military hardware.

The barrier to universal healthcare is not economic but political. Is profligate spending on health care really a conservative value? And what kind of market incentives are working anyway–it’s an odd kind of market transaction in which the buyer is stopped from negotiating the price, but that is exactly what Medicare Part D statutorily requires [4]: The government is not allowed to haggle the prices of prescription drugs with major pharmaceutical companies, unlike in nearly every other rich country. (Both Hillary Clinton and Donald Trump pledged to end this masochism, but the 45th president has so far done nothing, and U.S. prescription drug prices remain the highest in the world.) Does anyone seriously think “medical savings accounts” with their obnoxious complexity and added paperwork are the right answer, and not some neoliberal joke?


The objections to socialized healthcare crumble upon impact with the reality. One beloved piece of folklore is that once people are given free healthcare they’ll abuse it by going on weird medical joyrides, just because they can, or simply let themselves go because they’ll have free doctor visits. I hate to ruin this gloating fantasy of lumpenproletariat irresponsibility, but people need take an honest look at the various health crises in the United States compared to other OECD (Organisation for Economic Cooperation and Development) countries [5]. If readily available healthcare turns people hedonistic yahoos, why does Germany have less lethal drug overdoses than the U.S. Why does Canada have less obesity and type II diabetes? Why does the Netherlands have less teen pregnancy and less HIV? The evidence is appallingly clear: Among first-world countries, the U.S. is a public health disaster zone. We have reached the point where the rationalist santería of economistic incentives in our healthcare policies have nothing to do with people as they actually are.

If socialized medicine could be in conformity with conservative principles, what about Republican principles? This may seem a nonstarter given the pious market Calvinism of Paul Ryan and Congressmen like Reps. Scott Perry (R-Pa.) and Mo Brooks (R-Ala.), who seem opposed to the very idea of health insurance of any kind at all. But their fanaticism is surprisingly unpopular in the U.S. According to recent polling, less than 25 percent [6] of Americans approve of the recent GOP healthcare bills. Other polls show even lower numbers [7]. These Republicans are also profoundly out of step with conservative parties in the rest of the world.

Strange as it may seem to American Right, $600 EpiPens [8] are not the sought-after goal of conservatives in other countries. In Canada, the single-payer healthcare system is such a part of national identity that even hard-right insurgents like Stockwell Day have enthusiastically pledged to maintain it [9]. None of these systems are perfect, and all are subject to constant adjustment, but they do offer a better set of problems–the most any mature nation can ask for–than what we have in the U.S.

And virtually no one looks at our expensive American mess as a model.

I recently spoke with one German policy intellectual, Nico Lange, who runs the New York outpost of the German Christian Democrats’ main think tank, the Konrad Adenauer Stiftung, to get his thoughts on both American and German healthcare. Is socialized medicine the entering wedge of fascism and/or Stalinism? Are Germans less free than Americans because they all have healthcare (through a heavily regulated multi-payer system), and pay a hell of a lot less (11.3 percent of GDP) for it?

Mr. Lange paused, and took an audible breath; I felt like I had put him in the awkward spot of inviting him over and asking for his honest opinion of the drapes and upholstery. “Yes,” he said, “we are less free but security versus freedom is a classic balance! National healthcare makes for a more stable society, it’s a basic service that needs to be provided to secure an equal chance for living standards all over the country.” Even as Mr. Lange delineated the conservative pedigree of socialized medicine in Germany–“You can certainly argue that Bismarck was a conservative in founding this system”–I had a hard time imagining many Democrats, let alone any Republican, making such arguments.

Indeed, the official GOP stance is perhaps best described as Shkrelism than conservatism, after the weasel-faced pharma entrepreneur Martin Shkreli [10], who infamously jacked up the price of one lifesaving drug and is now being prosecuted for fraud. (Though in fairness, this type of bloodsucking awfulness is quite bipartisan: Heather Bresch, CEO of Mylan corporation, which jacked up the price of EpiPens from $100 to $600, is the daughter of Senator Joe Manchin (D-WV), who defended his daughter’s choice.)

But GOP healthcare politics are at the moment spectacularly incoherent. Many GOP voters have told opinion polls that they hate Obamacare, but like the Affordable Care Act. And as the GOP healthcare bill continues to be massively unpopular, Donald Trump has lavished praise on Australia’s healthcare system (socialized, and eating up only 9.4 percent of the GDP there). Even in the GOP, this is where the votes are: Trump’s move to the center on questions of social insurance–Medicare, Medicaid, Social Security–was a big part of his appeal in the primaries. The rising alt-Right, not to hold them up as any moral authority, don’t seem to have any problem with universal Medicare either.

It will fall on “reform conservatives” to convince themselves and others that single-payer or some kind of universal care is perfectly keeping with conservative principles, and, for the reasons outlined above, it’s really not much of a stretch. Lest this sound outlandish, consider how fully liberals have convinced themselves that the Affordable Care Act–a plan hatched at the Heritage Foundation [11] for heaven’s sake, and first implemented by a Republican governor–is the every essence of liberal progressivism.

Trump’s candidly favorable view of Australian-style socialized healthcare is less likely a blip than the future of the GOP. Republican governors who actually have to govern, like Brian Sandoval and John Kasich, and media personalities like Joe Scarborough, and the Rock, will be soon talking up single-payer out of both fiscal probity, communitarian decency, and the in-your-face evidence that, ideology aside, this is what works. Even the Harvard Business Review is now giving single-payer favorable coverage [12]. Sean Hannity and his angry brigade may be foaming at the mouth this week about the GOP failure to disembowel Obamacare, but Sean’s a sufficiently prehensile fellow to grasp at single-payer if it seems opportune–just look at his about-face on WikiLeaks. And though that opportunity has not arisen yet, check again in two years.

The real obstacle may be the Democrats. As Max Fine, last surviving member of John F. Kennedy’s Medicare task force, recently told [13] the Intercept,  “Single payer is the only real answer and some day I believe the Republicans will leap ahead of the Democrats and lead in its enactment,” he speculated, “just as did Bismarck in Germany and David Lloyd George and Churchill in the UK.” For now, an invigorating civil war is raging within the Democrats with the National Nurses Union, the savvy practitioner-wonks of the Physicians for a National Health Program, and thousands of everyday Americans shouting at their congressional reps at town hall meetings are clamoring for single-payer against the party’s donor base of horrified Big Pharma executives and affluent doctors. In a few years there might even be a left-right pincers movement against the neolib/neocon middle, whose unlovable professional-class technocrats are the main source of resistance to single payer.

I don’t want to oversell the friction-free smoothness of the GOP’s conversion to socialized healthcare. Our funny country will always have a cohort of InfoWars ooga-boogas, embittered anesthesiologists and Hayekian fundies for whom universal healthcare is a totalitarian jackboot. (But, and not to be a jerk, it’s worth remembering that Hayek himself supported the socialized healthcare of Western Europe in one of his most reasonable passages from the Road to Serfdom.)

So even if there is some banshee GOP resistance at first, universal Medicare will swiftly become about as controversial as our government-run fire departments. Such, after all, was the trajectory of Medicare half a century ago. You read it here first, people: Within five years, the American Right will happily embrace socialized medicine.

Chase Madar is an attorney in New York and the author of  The Passion of Bradley Manning: The Story Behind the Wikileaks Whistleblower.

173 Comments (Open | Close)

173 Comments To "The Conservative Case for Universal Healthcare"

#1 Comment By Jim Mooney On August 4, 2017 @ 11:13 am

The Dems are so corrupt, conservatives might be ahead of them on universal healthcare. Frankly, if conservatives come out with it and the corrupt dems still don’t, I will vote conservative the first time in my life, since this travesty is killing more Americans than All the terrorists.

If the GOP had any sense, this one issue could literally kill the Democratic Party. And also make the GOP look more honest than them since Everyone knows insurer money is behind the DNCs resistance to the idea.

#2 Comment By Chief Walksalot On August 8, 2017 @ 12:03 pm

Mr. Madar, you are one really stupid dude. Private care can always do a better job, and cheaper, than gov’t run health care. Medicare is broke and their ability to provide adequate health care is questionable at best and faces financial ruin in just a few short years. For god’s sake, do your homework; don’t just think stuff up as you sit at your desk.

#3 Comment By CTPatriot On August 8, 2017 @ 4:50 pm

Correcting the US health insurance industry lies regarding allegedly long waits for care in Canada:

I’m From Canada. Here’s What It’s Like to Live with Universal Health Care

US Congressional Testimony by Canadian Doctor Danielle Martin on Health Care: U.S. vs. Canada

#4 Comment By Reno On August 26, 2017 @ 9:59 pm

Work first on the 23M. No deductible-we want no deterrents that make early detection impossible. make it up with graduated copays only. After the first visit in each quarter, the copay goes up 15% and back down at the start of the second quarter of each year. Don’t make the coverage too inclusive. No cosmetic surgery, etc. Eliminate the insurance companies unless they’d like to do the paperwork for vastly less than they’re getting now. Phase them out slowly – that’s why we focus only on the 23M first. Dig up the DRG’s of the 80’s and adjust them up for inflation. You see where I’m going with this???

#5 Comment By Barbara Harrison On September 3, 2017 @ 12:31 am

I have no problem with socialized medicine. But you are misleading people reading your article that single payer is necessarily a socialized system like the Veteran’s Administration. Please use the term in the proper context not as a way to lump all single payer systems under socialism

Below you will find a description of single payer systems.

• In a single-payer national health insurance system, as demonstrated by Canada, Denmark, Norway, and Sweden, health insurance is publicly administered and most physicians are in private practice.
• Great Britain and Spain have na#onal health services, in which salaried physicians predominate and hospitals are publicly owned and operated.
• Highly regulated, universal, multi-payer health insurance systems are illustrated by countries like Germany and France, which have universal health insurance via sickness funds. The sickness funds pay physicians and hospitals uniform rates that are negotiated annually (also known as “all payer” system.

#6 Comment By David Ross On September 6, 2017 @ 5:00 pm

WTF!? I wish there was a registration process for Conservatives because you stupid m-fers who subscribe to this BS should have their membership revoked along with their man card. Government intrusion into healthcare in the early 60s is what started us upon this dreadful path of skyrocketing healthcare costs. Toss this “mans” street cred into the purse his wife stored his balls.

#7 Comment By RICHARD On September 16, 2017 @ 11:00 am

Big business should be 100% behind single payer. And small business even more so. Why leave it up to business to provide healthcare? It is one big mess that they don’t need, and the fact that business in this country is burdened by this anchor is a competitive disadvantage against their competitors in Europe, Canada, Japan, UK and other countries where companies are not expected to provide healthcare.

#8 Comment By Dan On September 17, 2017 @ 2:35 am

I can not see the US political reality changing quickly enough for this to be real debate in 5 years, however you may well be right that it will eventually happen and when it does it will be a Conservative who brings it to a conclusion.

The debate now that lots of people will “lose” healthcare if the ACA aid repealled has normalised the assumption that, that would be a bad thing and the government should do something about it. In the US there will be a debate about should that governments should be Federal or 50 states, but it is no longer assumed it is not a government issue.

How it will happen and when someone should look at how and when all the other OECD countries made the change, Germany it is as long ago as the 1880’s and Bismarck, and a way of holding together the new united Germany, and holding off the newly vocal working class. In U.K. It is a Labour Government in 1948 in a post war bankrupt U.K., Conservatives under Churchill were back in power in 1951 and it could have been strangled in the crib but it wasn’t.

Single payer in theory will be much cheaper than what happens now in the US because it is much cheaper everywhere else now, but will all the people who will lose accept that or be able find ways to protect themselves.

#9 Comment By David Harrell On September 23, 2017 @ 11:30 pm

This piece, and the many socialist commenters claiming “the free market” has failed, only show that people who read and write for conservative publications can be as economically illiterate as anybody else.

#10 Comment By Mark Davis On November 4, 2017 @ 11:26 am

MONEY is a social system. It has NO value without community. The cornerstones of free markets are this social system.

For an individual to extract ridiculous amounts of money from this social system and then say to himself, (“This is mine and mine alone. I’ve earned this, and no-one else.”) is to miss a huge point. You owe some of it back to the system that made it possible; that’s US. The better you get at leveraging $$ out of the economy, the more benefit you derive from this social system, and the more you should share back … until the NEEDS (not luxuries, or even comforts) of all citizens are paid for; that is the basis for pursuit of happiness … and those citizens, and the earth itself, is where all true VALUE lies.

Why is SOCIALISM a dirty word, except that some few greedy, driven individuals have been effectively lobbying all their lives to brainwash us into thinking free-market capitalism is the only good, and socialism is ALL bad. They want us to think that government is only good when it is invisible. But government, among other things, is our only protection from this bully pulpit of anti-social insanity.

Universal Health Care is a great investment for our country.

#11 Comment By William R On November 16, 2017 @ 11:21 pm

The American Conservative. Good Gravy. Embarrassing.

Venezuela Reaches the Final Stage of Socialism: No Toilet Paper


#12 Comment By Chris Harrison On May 20, 2018 @ 7:01 pm

When I posted on FB about this, went back and forth a few times and then my post were all deleted and I can no longer post there. Is that was so called conservatives are coming to? Refuse to have debate and shut someone out who disagrees with them? And that’s the sort of person you want leading the charge? Shades of the professor from MIT that was a key player in masterminding Obamacare. No, and NO

#13 Comment By Nicolas On May 30, 2018 @ 5:55 pm

Madar writes: “socializing healthcare is the only demonstrably effective way to control costs and cover everyone.”

That requires believing that medicine is influenced by entirely different economic principles than every other endeavor.

A free market in medicine was abolished starting in the late 1800s with the advent of medical licensure, and crushed entirely with government abolition of the right to drugs. The author does not offer demonstrations of the failure of free market medicine.

Conservatives embraced a central principal of progressivism over time: that government should prevent people from hurting themselves. With that it was just a matter of time before the Right fell in love with government, as it has. From there it is a tiny hop to socialism

#14 Comment By Pelham On June 24, 2018 @ 11:15 am

The writer appears to assume that our political system is somehow responsive to the wishes and best interests of the American people.

#15 Comment By Pelham On June 24, 2018 @ 11:23 am

The German Christian Democrat’s statement that Germans are less free than Americans due to universal healthcare is clearly wrong.

In the only terms that matter, Germans are a good deal freer in this regard. Americans must labor under the oppressive yoke of private healthcare insurers and providers and the mountains of paperwork and perpetual life-or-death uncertainty they impose on us.

How does the fact that our system is largely private make us less free than Germans who never have to worry about healthcare?

#16 Comment By anon On June 24, 2018 @ 5:21 pm

conservatism is about using facts to find real solutions. it just happens that history usually applies well to the present. hence, conservatism.

socialized medicine works. period.

faux-conservatives who deny facts are just marxists of the right; self-destructive, unproductive, and willing to kill fellow americans in the name of ideological purity.

these marxists of the right are a cancerous blight on the effective work of true conservatives. the new generation of true and pragmatic conservatives will hopefully extinguish these parasites soon.

#17 Comment By Jay Dee On June 25, 2018 @ 5:55 am

We are promised many things by Big Government; Healthcare, Safety, Education, Jobs, whatever. What we get is another massive bureaucracy whose employees contribute to the election of pliable politicians using our tax dollars. I’ve seen the term Kaus-Reynolds Paradox; some agency fails at their appointed task and the only answer is to give them more power and money. Clean out the “administrators and many of these things will become much more affordable.

#18 Comment By SocraticGadfly On June 25, 2018 @ 11:03 pm

>>Chief Walksalot says:
August 8, 2017 at 12:03 pm
Mr. Madar, you are one really stupid dude. Private care can always do a better job, and cheaper, than gov’t run health care. <<

Really, Chief? Then why does health care cost half as much in every developed nation with national health care than in the US. And, don't repeat the lies about long wait periods. They're no longer than here. Don't repeat the denial of service lies; that's what US insurance companies do all the time here.

#19 Comment By Robert On June 26, 2018 @ 1:22 pm

There is no such thing as a conservative case for mandatory healthcare: as was obvious to anyone with a pulse, Obamacare amounted to shooting fish in a barrel (you): premium hikes with no limit, barrels of money for drugmakers, hospitals and insurance companies- one disgusting story of rape, greed, amorality after another.
If you are going to declare a war where the plebes have to sign up for the Army, wartime conditions must apply to the armsmakers too (which is why Congress never actually gets around to declaring war since WWII, when there were strict price controls and a fighter plane went for $50,000 (true) and not $100,000,000 today.)
The situation is so sh**ty today that Americans would actually be better off in a truly free market: no FDA and no control over the supply of health care providers. The only requirement to bring a generic drug to market would be the simple proof that the active ingredient was the same as one already approved.
And bring back public stocks for the shameless miscreants found guilty of price-gouging.

#20 Comment By Tom Snyder On June 29, 2018 @ 1:27 pm

This is the dumbest, most ignorant column I have ever read!!! Get the government out of my healthcare, for the love of Christ and all that is truly Holy and Divine!!!! The welfare state is not biblical; it violates the Word of God. Jesus supported private charity and family to help the poor, needy, and sick, not big government handouts and big government schemes.

#21 Comment By Tom Snyder On June 29, 2018 @ 1:30 pm

The writer here talks about costs, but he never says a word about taxes and other costs on individuals and business, much less small business. What he says is deceitful, it seems clear to me.

#22 Comment By Richard McEvoy On June 29, 2018 @ 2:42 pm

You have a choice – privatized health care with suitable insurance and immediate high quality service where the consumer has a choice to consume the service or not, in full knowledge of the risks, and can ration their own health care to their means, or socialized health care at low or no cost at the point of delivery for which you pay in higher taxes, longer waiting times and low quality care where the decisions on rationing service are made by someone else with no skin in the game. But do not pretend that there are not costs on both sides. The one issue with privatized care is that there are those who cannot afford it and not through laziness but genuine lack of capability. But the question is then one of whether charity or some redistribution of wealth is the means to meet this – or some mix of the two. But nothing in that situation justifies a fully socialized system of care. Furthermore, there is no such thing as price gouging because if it existed, another person by simply offering a competitive price would take market share rapidly away from someone who was overcharging.

#23 Comment By Maria C. Mitchell On June 30, 2018 @ 12:45 am

What a load of malarkey.

“And that’s a good thing, because socializing healthcare is the only demonstrably effective way to control costs and cover everyone. It results in a healthier country and it saves a ton of money.”

No, it is not a demonstrably effective way. It does not result in a healthier country. And the only way it saves money is by rationing. This is just a bunch of non-conservative garbage.