The case for universal, single-payer health care

The Langrangian Republican Association is in favour of introducing a universal single-payer health care system in space settlements, for us such system is a matter of civilization. In this post we will defend this position.

Having a good health, is unlike many other things, not a matter of choice. It’s true that live-style choices do affect one’s health, and unhealthy live-styles could and should be discouraged. But having a healthy live-style is in no way a guarantee for a good health. Our health is for a large part determined by factors outside the control of an individual.

First of all, genetics are an important factor. Many people suffer from health problems caused by genetic disorders, and it’s obvious that having a genetic disorder is not a personal choice. Therefore it’s unethical that people who happen to be wealthy can have any cure for their genetic disorders, while the poor will die from it.

Secondly, one’s health is to some degree determined by the social-economic conditions of their youth. It’s common knowledge that poorer people have less nutritional diets than more affluent people. And nutrition is critical in the development of children, and this has life-long effects.

Thirdly, one’s health is effected by actions of third parties such as environmental pollution. Even people with a good physical health and healthy live-styles, will become sick as result of pollution by others. And often physicians are only able to establish that someone has became ill due to pollution, but are unable to tell whom is responsible for said pollution.

Fourthly, infectious diseases do not discriminate people on merit. The strength of one’s immune system determines whether an infected person will become ill or not. But the strength of one’s immune system is heavily depended on factors mentioned under 1, 2, and 3.

The arguments raised above, explain the need for a universal health care system. But why a single-payer system? The main alternative for single-payer health care is a system of compulsory (private) insurance. This approach has several issues.

Private insurance companies are for-profit organizations. In order to maximize their profits, these companies can do two things: demand the least expensive treatment or increase the insurance fees.

However, the least expensive treatments are not always the most effective ones, and might in the long run even more expensive.

The second alternative, increasing insurance fees, is only good for the insurance companies as it increases the overall cost of health care.

Even if having a health care insurance policy is mandatory, some people might be still uninsured. In order to maximize profits, insurance companies might attempt to refuse clients with known health risks, even if such practises would be illegal. Other people might be unwilling to buy an insurance policy, or unable to pay for it and are kicked out of their insurance.

A problem for every health care system are the costs of health care. There are several ways to reduce health care costs, but the most important is prevention. Promotion of healthy live-styles, vaccines, strict laws against pollutions, proper sanitary all help to increase general health, and therefore to reduce the demand for health care.

Unhealthy live-styles can be discouraged by implementing certain taxes, such as a tax on fat, soda and salt. An idea might be to levy such taxes on the producers of food, rather than on the consumers. This would encourage food producers to reduce the amount of fat and/or salt in their products. The revenues of these taxes should be earmarked, and they should be used in funding the health care system.

Another idea to reduce health care costs is suggested by philosopher James Park. He proposes to pay doctors a high but constant salary, instead of paying them on a per-treatment base. The rationale behind this, is that if doctors are paid per treatment they will prescribe all kind of unnecessary treatments rather than the most effective one. Another idea suggested by Park is to re-use surgical instruments, rather to throw them away after one use. Modern sterilization methods, will reduce the health risk associated with re-use of such instruments.


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