This year, there have been serious discussions about healthcare policy in America. The Republicans’ attempt to repeal Obamacare generated much backlash. The images of disability activists protesting in Congress circulated the world. For many foreigners, it’s a surprise that the richest country in the world doesn’t have any form of universal healthcare. In fact, many of the activists’ goals were not to preserve Obamacare, but support Medicare for all––or single payer. In America, organizations like Physicians for a National Health Program support single payer–a tax-funded healthcare system administered by the state that covers health care for all residents.
It is logical that this policy is backed mostly by progressives, on the basis of their belief that healthcare is a human right. Not all Democratic politicians support single payer, but the support for it among the Democratic base is putting those who oppose it in a difficult position. Republicans in office are opposed to single payer, but that doesn’t mean that there aren’t conservatives arguing for it, too. About 40 percent of Trump supporters back single payer and is worth acknowledging that some Republicans attitudes on the issue are shifting.
American libertarians tend to support the conservative criticism of single payer that says this would more ineffectual, price-destroying big government. More radical libertarians have even argued that the government has no role in healthcare at all. Given the fact that Republicans in control of the House and the Senate––plus the executive branch––couldn’t manage a full Obamacare repeal it shows that they are not willing to pay the price for pushing the issue. Many would risk losing their seats and confront their angry constituents at town halls.
Libertarians can oppose to single payer, but they should realize that there are libertarian ground on which to support this program. Libertarians as famous as Friedrich Hayek have express support for universal healthcare in his classic The Road to Serfdom, the Nobel Prize-winning economist argued that developed societies could take care of some basic healthcare coverage since is difficult to foresee unpredictable events in life. Writer Charles Perabo over at Being Libertarian has a very interesting argument where he says libertarians should negotiate a radical deregulation of the healthcare system in exchange for their support for single payer. Perabo argues for the elimination of regulation of imported drugs, visas for foreign doctors, reform of medical schools and even FDA reform that loose the current strict regulations in order to have access to new drugs. Ed Dolan at the libertarian think-tank Niskanen Center makes a more pragmatic case, arguing that since single payer is inevitable, libertarians should focus on ways to make it efficient.
These three arguments all raise valid points but the most important focus of libertarians should be that other groups gaining popular support over the healthcare issue take a very anti-libertarian position. During the recent Democratic Socialists of America (DSA) convention, DSA members reached an agreement that single payer would be their priority in activism. It isn’t hard to imagine that many hard-working Americans would consider universal healthcare a fair solution to the problems of the current system, however supporting that shouldn’t s force them to support politicians that want big government on every issue of public life. Even worse, the alt-right supports single payer, and would like the GOP to support it –and embrace their vision of ethno-nationalism.
Libertarians have the choice to offer single payer as part of a true program of healthcare reform that includes a radical deregulation of several aspects of the healthcare system. Plus, a budget discussion could include cuts in other areas where libertarians think the government role is not important like corporate welfare. Maybe they could even have an honest discussion about the military budget, which at least would require an audit of the Pentagon.
Every plan from Obamacare to Trumpcare and even going back to Romneycare where far from perfect in a libertarian perspective. Now Senator Bernie Sanders is held with the task of writing a Medicare for all legislation which in practical terms would establish a single payer system in America. The bill is expected to be presented in the next weeks so it is still a mystery how it would look like but guiding us from campaign website of Sanders this plan would include massive regulations.
Democrats and left-wingers more broadly are accused of loving regulations however this year they mocked Sen. Corey Booker for his opposition to the import of cheaper Canadian drugs. It would not be impossible to find them defending more regulations, even in the search for affordable healthcare. Even the plank that some would think conservative Republicans would oppose like making the immigration of doctors easier could generate backlash, since rural counties that generally vote Republican also tend to be the ones in which there is a shortage of physicians. A libertarian plan drafted either by a libertarian think-tank or organization could be sold as bipartisan, promising full coverage to convince Democrats and deregulation to convince Republicans. Now with these changes, libertarians could comfortably support single payer, but still demand deregulation everywhere else.