Ezra Klein surprises me at least with some nuance on his views of single-payer healthcare, noting that it increases the stakes on politically divisive medical care (his example being contraception), making it possible for a government to de facto remove some kinds of care.
This is true, and, really, it goes further than that. Do you have some unhealthy habits? I do. I suspect that if you don’t, you’re lying, whether to me or yourself. My view is that my unhealthy habits are my business. But my view has a lot less support if you’re paying for my healthcare. The more subsidized my healthcare is, the more it becomes everyone else’s business not just what I do in the bedroom, but what I do in my dining room, in my gym, on my hobbies, how I drive, etc. Everything has health consequences.
I use a standing desk. Do you? Most of my coworkers don’t want to use them — but they seem to be more healthful. Perhaps everyone should be required to use a standing desk, no matter how inane they consider them, because it will save me money on their healthcare. Why should I pay for your desire to sit down at work?
This is in addition to more straightforward battles about what the appropriate theory of care is. I think that mammograms and prostrate screening are counterproductive for people under the age of 50 with normal risk factors. Why should we pay for care that is counterproductive? Every damn thing is potentially hors de combat here.
It’s not that I think that literally every silly thing in our lives will become regulated and controlled under socialized medicine — but people who do want to control your life will have undeniably stronger arguments for doing so, and I would expect that to push the line of battle in that direction. And I can’t see what is theoretically out of bounds. We’ll probably keep our ability to sit down at work, but not without at least occasionally fighting a political fight for it.
These may be costs worth paying for the benefits of a more socialized healthcare system. I’m no particular fan of the US system. But I think that some of its biggest proponents are also people who strongly believe that at least half the government is genuinely out to get them — if they do, they’re giving a huge weapon to their potential enemies.