A Defense of National Healthcare

Surveys

1. A plurality of economists favor universal health insurance: “Economists have not reached a consensus on the merits of universal health insurance—45.8% favor the idea, but almost an equal  number (38.7%) oppose it” (page 4 of https://docs.google.com/viewer?a=v&q=cache:O7ozLHOnfz0J:ew-econ.typepad.fr/articleAEAsurvey.pdf+&hl=en&gl=us&pid=bl&srcid=ADGEESiz6VO1qKHPH2gBdqyZgRdcIMmCZ-Hgy-GfrqjL5oPh4rd01GF3brJao2LEq-akOHynVUOOCfX3q1dzg1iQqhtW1fbqVNFUkgPfHPwA3BOt1_nwPa2xOcAu1Fm2M-yww6AMMSFp&sig=AHIEtbRX4NF6yKkLvSkONY06TXpkDK4Jig). While not a majority, the responses show slight support for national health care, and shows that the economic evidence against the merits of national health care is likely far from overwhelming. 
2. Citizens with national health care are more satisfied with their health care systems: “Americans are more dissatisfied than citizens of other nations with their basic health care. One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16 percent of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed.” (http://www.foxnews.com/story/0,2933,136990,00.html) This is despite the fact that the U.S. is the 11^th happiest country in the world (http://247wallst.com/2012/05/22/the-happiest-countries-in-the-world-2/). The OECD consists of at least 30 countries that could be considered developed countries (http://en.wikipedia.org/wiki/Organisation_for_Economic_Co-operation_and_Development), and the U.S. is the only developed country without a national health care program (http://www.foxnews.com/story/0,2933,136990,00.html). So, Americans are not dissatisfied with their health care due to undue pessimism. 
3. Doctors support national health care: “Of more than 2,000 doctors surveyed, 59 percent said they support legislation to establish a national health insurance program, while 32 percent said they opposed it, researchers reported in the journal Annals of Internal Medicine…The Indiana survey found that 83 percent of psychiatrists, 69 percent of emergency medicine specialists, 65 percent of pediatricians, 64 percent of internists, 60 percent of family physicians and 55 percent of general surgeons favor a national health insurance plan. The researchers said they believe the survey was representative of the 800,000 U.S. medical doctors.” (http://www.commondreams.org/archive/2008/04/01/8018)

International Comparisons

1. WHO rankings: The World Health Organization ranked the health care systems of 190 nations, with France’s being ranked the best and America’s being the 37^th best (http://www.who.int/whr/2000/en/whr00_en.pdf, http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems#cite_note-whowhr2000-0). Note that many in the top 10 have national health care. Admittedly, the Who’s ranking system favors equality of health care access and quality, which is not directly related to overall quality of health care. However, WHO rankings are one set of evidence for national health care, and it seems unlikely that inequality alone can explain the U.S.’s low ranking considering that (1) only 62.5% of the rankings can be explained based on equality considerations, (2) America’s rankings are incredibly low, (3) American health care access is not completely unequal (http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems#Methodology). 
2.  The U.S. is the only advanced country without national healthcare: “The U.S. is the only industrialized country that does not offer government-sponsored health coverage for all citizens.” http://www.foxnews.com/story/0,2933,136990,00.html). 
3. U.S. has long wait times: Only Canada had longer wait times.  “Sixty percent of patients in New Zealand told researchers that they were able to get a same-day appointment with a doctor when sick, nearly double the 33 percent of Americans who got such speedy care. Only Canada scored lower, with 27 percent saying they could get same-day attention. Americans were also the most likely to have difficulty getting care on nights, weekends, or holidays without going to an emergency room.” (http://www.foxnews.com/story/0,2933,136990,00.html)

Research 

1. “Two US-based economists ran the numbers and found large, positive effects for near-universal health care on the self-assessed health of individuals in Massachusetts.” (http://larrywillmore.net/blog/2012/03/12/the-effects-of-romneycare-in-massachusetts/ ) 
2.  “After the passage of Romney’s reforms, the rate of per capita health-care spending growth slowed in Massachusetts both in absolute terms and relative to the national average.” (http://www.frumforum.com/romneycare-bent-the-cost-curve/ ) 
3. Extending health insurance to the uninsured reduces healthcare costs: “In the program this article describes, increasing individuals’ access to health care reduces the overall costs of care. ” (http://npalliance.org/blog/2012/02/26/expanding-health-insurance-coverage-should-reduce-costs/) (Original study here: http://content.healthaffairs.org/content/31/2/350.abstract)
4. Greater health care coverage results in greater public health: Taken together, our results strongly indicate that expansions in health system coverage lead, on average, to improved general population health." (http://eche2012.abstractsubmit.org/presentations/2993/)

Various

1. National health care also offers peace of mind: This is an often overlooked point. With guaranteed coverage, one does not need to worry about finances if medical disaster strikes but only about becoming well. 
2. Some argue that U.S. health care fares so poorly due to excessive government intervention. However, this argument is implausible since better health care systems use more such intervention.

The Great Libertarian Inconsistency

Libertarians pride themselves on their consistency, but how consistent are they?

They believe that the state should not "initiate force" (their terminology) except to prevent others from doing so in a way that directly violates the negative rights (rights to be left alone such as not being robbed or killed) of others. They do not support using coercion to benefit third parties (e.g., the welfare state) or in using force to stop actions that may indirectly harm third parties (e.g., libertarians support drug legalization regardless of what harms may result indirectly to third parties from licit cocaine use).

However, libertarians support the use of law enforcement to protect individuals from other individuals that may directly violate their right to be left alone. Such law enforcement requires taxes, which are coercive.

Libertarians argue that indirect third-party harm (e.g., resulting from a lack of safety regulations) or the poverty of others (e.g., resulting in part from a lack of welfare programs) are not the responsibility of individuals.

But then, why is it my responsibility to pay the necessary taxes to prevent your house being robbed, but not my responsibility to pay taxes so someone can have necessary medical care? I'm no more directly involved in the case of a third-party being robbed than I am in the case of someone suffering due to a lack of necessities.

The only consistent libertarians on this matter have been anarchist libertarians.

Libertarians must also choose between their support of private property rights with freedom of contract on one hand and their limited conception of the state on the other when it's the case that the state gradually grows in size and scope via private property and freedom of contract. If private property owners can control what others do on their property, then why can't the state of a national territory control what others do within it's boundaries if that state is the result of freedom of contract and private ownership?

For example, large landowners may voluntarily incorporate their land, and then later, via contractual agreements, allow tenants to live on their land provided they pay rent (taxes) and then vote on various policies affecting the land's management.

The Myth of Libertarian Economists

Many on the left discount economics as right-wing propaganda, while many libertarians present economics as supportive of libertarianism. However, the presentation of economists as libertarian is largely a myth, meaning not that no economist is libertarian, but that relatively few are.

In fact, surveys suggest the typical economist is a moderate Democrat, not particularly extreme one way or the other.

Consider the following:

1. 2.9:1---The ratio of Democrats to Republicans among economists (http://www.insidehighered.com/news/2005/12/21/politics). Among social scientists, economists are the least Democratic and sociologists are the most Democratic, with 21.1 Democrats for every Republican.
2. Many economists believe Obama's 2012 jobs plan, which cuts the payroll tax and increase spending, would likely prevent a 2012 recession (http://www.bloomberg.com/news/2011-09-28/obama-jobs-plan-prevents-2012-recession-in-survey-of-economists.html).
3. Economists also believed that Obama had "the superior economic plan, a firmer grasp of economics and [would] appoint better economic advisers" (http://www.economist.com/node/12342127?story_id=12342127) compared to McCain. Of 142 economists, 80% believed Obama better understood economics. Even among Republican economists, 46% versus 23% believed Obama possessed better understanding. 81% thought Obama would appoint better advisers than McCain. "On our one-to-five scale, economists on average give Mr Obama’s economic programme a 3.3 and Mr McCain’s a 2.2."
4. According to a survey of 264 economists, "most economists are supporters of safety regulations, gun control, redistribution, public schooling, and anti-discrimination laws. They are evenly mixed on personal choice issues, military action, and the minimum wage. Most economists oppose tighter immigration controls, government ownership of enterprise and tariffs. In voting, the Democratic:Republican ratio is 2.5:1."(http://econfaculty.gmu.edu/klein/PdfPapers/KS_PublCh06.pdf) Generally, economists are slightly liberal but mostly moderate .
5. Economists overwhelmingly favor free trade, with 66.7% of the 264 economists strongly oppose tariffs to protect American industries and 20.1% oppose it mildly, whereas 2.3% strongly support, 3% mildly support these tariffs, and 7.6% have mixed feelings (page 4 of http://econfaculty.gmu.edu/klein/PdfPapers/KS_PublCh06.pdf).
   
6. Economists are mixed on the minimum wage, with 20.5% strongly opposed, 17.8% opposed mildly, 14.4% having mixed feelings, 18.9% mildly supporting, and 28.4% strongly supporting. This means 38.3% oppose the minimum wage, while 47.3% support a minimum wage. Generally, economists have mixed feelings about the minimum wage, considering that 14.4% also have mixed feelings (Ibid.).
7. Economists overwhelmingly favor occupational safety regulations, with a total of 71.5% favoring safety regulations and only 16.9% having mixed feelings (Ibid).
8. Economists overwhelmingly favor pharmaceutical safety controls, with a total 70% favoring such controls and only 15.5% having mixed feelings (Ibid).
9. Economists overwhelmingly favor air and water regulation, with 79.9% supporting and only 8.3% having mixed feelings (Ibid.).
10. Among other issues, economists strongly favor anti-discrimination laws, gun control, controls on hard drugs, support prostitution controls, support gambling controls, strongly oppose government ownership of industry, strongly support redistribution (that's right, economists overwhelmingly support the welfare state), strongly support government production of education, oppose tighter controls on immigration, support foreign aid, and also strongly support strengthening the economy through monetary and fiscal policy. I didn't break all of these figures down since you can read the data yourself in the link I provided.

Though economists don't lean far to the left, it's fair to say they are slightly liberal moderates. These results demonstrate that libertarian economists are almost entirely pseudo-experts or just don't care what consequences policies have (e.g., economists favor foreign aid and government redistribution of wealth). We often think that economists are libertarian simply because libertarian economists are more vocal.

Of course, economic evidence and consequences are not everything to consider in designing policy. Positive economics studies only what empirical data tell us about consequences. Normative economics concerns what consequences are desirable or whether consequences matter in determining policy.