A Dense Argument
Ezra does a nice job of demolishing Ezekiel Emanuel‘s arguments against single payer. (Well, I don’t entirely disagree with his arguments about how the veto-point laden American political system would make implementing such a program extremely difficult, but as Ezra notes this obviously applies to any major restructuring of the health-care system.) But I wanted to take on another of Emanuel’s arguments: his claim that the larger American population makes single-payer less viable.
You hear this argument a lot, which is strange because it’s glaringly, transparently wrong. The fact that Canada has a tenth of the population spread over a larger territory makes healthcare more expensive to administer. When the population is less dense you generally require more hospitals per capita, and these hospitals are less likely to be filled to capacity. (This is exacerbated by the fact that rural areas in Canada tend to be overrepesented in provincial legislatures, something that is no longer a problem in the U.S. thanks to Reynolds v. Sims. It is very politically difficult to close rural hospitals in Canada even when they’re not really necessary.) And nor, as far as I can tell, have people making this argument explained exactly what inefficiencies would result from having more people. Sure, the U.S. would have more people to cover, but it would also, er, have more money to do it. If it’s cheaper per capita for 30 million people–and it is–there’s no reason to believe it wouldn’t be cheaper for 300 million people. That people trot this out is a good example of the extent to which trying to defend the American health care system drives people to increasingly desperate shows of illogic.