Kate's argument with her boss over universal health care touches on something important about universal health care and how liberals should approach it. The Boss's WSJ-inspired argument was that the uninsured can mostly afford insurance, they just choose not to buy it. They're lazy, shiftless, irresponsible -- they're getting what's coming to them. This is a land with Medicaid, with HSA's, with cheap ways to gain basic health coverage, and those not taking advantage of them don't deserve our pity.
There's a kernel of truth in the Boss's argument, a fairly large fraction, though we don't know how large, could purchase health insurance. They may have to forego every other luxury in life to do it, but it could be done. And we should make them do it. When the uninsured enter an emergency room, it costs me, you, and Kate's Boss money. But the question of the uninsured, for liberals, should be immaterial when talking about universal health care. If our end is simply full coverage for the currently uninsured, a CAP-style structure that doesn't radically alter the current health system but gives the poor subsidies, everyone more insurance options, and imposes a mandate to buy into coverage would do the trick with less disruption than most anything else.
But that's not the point.
America's health system is bad. It's no more complicated than that. We pay more for services, we pay more for drugs, we don't cover all our citizens, we have sky-high administrative costs, we have massive disparities in care, and we can't control costs. Restructuring health care isn't about -- at least not solely -- covering the uninsured, it's about creating a more sensible, logical, manageable, affordable, and usable health system. And when we argue this, we shouldn't be caught by the red herring of the uninsured because, at best, that only leads to a few subsidies and expansions. Good stuff, and we shouldn't refuse it if it's offered, but it's not why we want single-payer. Rebuilding the whole health structure isn't the answer to a few stragglers who remain outside its embrace, it's about fixing a system that doesn't work.