The (not really) conservative case for single-payer health care

  • Posted on: 25 July 2017
  • By: benfell

Chase Madar offers a pragmatic case for single-payer health care, that he argues is conservative by reference to—get this—examples such as Winston Churchill and Otto Bismarck and, a little less unreasonably, pointing1 to Friedrich Hayek's acceptance that government may have to intercede to provide services where the profit motive is insufficient.2

Count me among the skeptics. First, neither Churchill nor Bismarck are U.S. examples. The European and U.S. contexts for conservatism are strikingly different and one way in which this appears is in the substantially stronger social safety nets to be found in Europe. Something different happened in the U.S. from Europe and that needs to be accounted for prior to importing Churchillian or Bismarckian examples. If Madar can convince me that Margaret Thatcher, Theresa May, or even Labour's Tony Blair would have instituted Britain's National Health Service had it had not already existed (and remember that I am deeply skeptical of counterfactuals), then I might be inclined to accept these examples.

Second, while Hayek continues to be revered by capitalist libertarians, he lost the argument on social goods (and I think later recanted it). Based largely if not entirely on cherry-picked anecdotal evidence, capitalist libertarians, neoliberals, and politicians generally see corporations as inherently efficient and the government as inherently wasteful. And that last part is key: In my dissertation, I noticed that conservatives are ideological rather than pragmatic; they prefer some ideal (go ahead and capitalize that 'Ideal,' if you prefer, to give it a Platonic flavor) over empirical evidence.3 Which is a problem for a pragmatic argument like Madar's.

It's interesting that Madar publishes this in the American Conservative, a publication that touts itself as "reformist" conservative but which I categorize as traditionalist conservative. Traditionalists are among the small government conservatives likely to oppose any expansion of human rights, such as to include health care.4 Further, Madar's arguments about social stability notwithstanding, traditionalists understand stability to arise from vertical social hierarchy not despite social inequality. They stridently oppose social 'leveling' as interference in "God's" plan, construe 'equality' in a mathematical sense of sameness,5 and thus conflate 'diversity' with authoritarianism. If it turns out that self-styled "reformists" do indeed endorse single-payer, that might compel me to recognize a distinct reformist tendency of conservatism.