So on one of those stupid social networking sites I got into an argument with a guy I know. I quipped something to the effect that let’s say we agree for the sake of argument that ‘the public option’ for health care is socialist, and that anything socialist is bound to fail. The same basic reasoning (or rather, “reasoning”) would mean that the fire department, police, and military are both socialist and bound to fail. A guy I know responded with a version of my titular question. I wrote a long reply, long enough that I figure I’ll toss it up here.

This type of argument could be made about anything that is funded with tax dollars. Why is it anyone else’s responsibility to pay for your security against crime or fire? Why should anyone else have to help pay for your representation in the state and national government? Why should anyone else help fund the roads which you use to get to work?

There’s another reason why things like insurance and fire protection should be public, which is that there are economies of scale when risk is pooled. The more people in an insurance plan the cheaper the over all cost, plus larger pools of insured people can negotiate to keep costs of medical care down. Right now the US government already spends more money on healthcare per citizen than Canada, and total healthcare spending as a percent of the US economy is much, much higher than in Canada, without significantly better health outcomes here. Compared to other countries the US way of health insurance wastes both public and private money.

One other point – other people’s health is already your responsibility in three ways, as a consumer of insurance, as a consumer of healthcare, and as a taxpayer. Insurance: your insurance premiums are set in response to the total cost that your insurance provider pays out. If you take out more than you pay in, then the other people on your plan are subsidizing your care. If you put in more than you get back in care, then you are subsidizing others’ care. That’s just how insurance works.

Here’s how you’re responsible for others’ care as a consumer of medical care and as a taxpayer – It’s illegal for hospitals to refuse medical care to someone in need based on ability to pay. Hospitals are required to stabilize patients before releasing them. When people can’t pay for care, healthcare providers find a way to make up those costs. They bill the government when possible (so, from all our taxes) and they raise the prices they charge to all healthcare consumers and to insurance companies. So you already subsidize others’ care in that way too, as a function of both the market and the government.

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