The Romance of Single-Payer Health Care
June 24th, 2008 | by Brian Schwartz |Pushing single-payer politically-controlled health care, Princeton health care economist Uwe Reinhardt says:
“[Americans] act more and more like a people sharing a geography. You don’t have the ethos that goes with being a nation. In Canada, in Taiwan, they view health care as the cement that makes a nation out of a group of people, rich or poor, when they are sick.
The other thing we need to recover in this country is a sense of shame.
I can think of several explanations:
One is that Reinhardt thinks it is moral to force other people to do what is right by making taxpayers fund a government-run charity. I address that here. Whether these programs are effective is another story, as many people die waiting for medical care under single-payer. 
Or, he could be like the socialists the economist Frederic Bastiat mentions in The Law (1850):
Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all.
We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.
But given the first part of Reinhardt’s quote, I think another explanation is best. OK, it’s not completely independent from the above, but it’s a useful concept. In short, Reinhardt is in love.
Reinhardt has eloquently expressed what George Mason University economics professor Dan Klein has called The People’s Romance:
If government intervention creates an official and common frame of reference, a set of cultural focal points, a sense of togetherness and common experience, then almost any form of government intervention can help to “make us Americans.” If people see government activism as a singular way of binding society together, then they may favor any particular government intervention virtually for its own sake—whether it be government intervention in schooling, urban transit, postal services, Social Security, or anything else—because they love the way in which it makes them American. …
When we think of the action of the primitive band, the family, or the organization, we think of the whole acting as an integrated entity. We may fail to consider that the posited entity consists of constitutive elements or members. We may neglect to think about how each member experiences his membership in the entity and achieves with the other members the consonance in action that permits us to say that the entity acts in this or that way. …
“Don’t Worry About the Government”
(Yes, I know the video and audio are out of sync.)
When people think of society at large as the group to which they belong—when they think of having “citizenship,” whether it be in a town, a county, or a country—the logic of coordination leads directly to government as the focal point. Unparalleled in power, permanence, and pervasiveness, the government is prominent, conspicuous, unique, focal. Moreover, as people look to government as the focal point, it increasingly draws them into thinking of its dominion as setting the boundaries that define the group. The government provides and validates the focal points in the sentiment game, and, in the first instance, it arranges and validates the games that citizens can play.
Government creates common, effectively permanent institutions, such as the streets and roads, utility grids, the postal service, and the school system. In doing so, it determines and enforces the setting for an encompassing shared experience—or at least the myth of such experience. The business of politics creates an unfolding series of battles and dramas whose outcomes few can dismiss as unimportant. National and international news media invite citizens to envision themselves as part of an encompassing coordination of sentiments—whether the focal point is election-day results, the latest effort in the war on drugs, or emergency relief to hurricane victims—and encourage a corresponding regard for the state as a romantic force. I call the yearning for encompassing coordination of sentiment The People’s Romance (henceforth TPR). …
TPR helps us to understand how authoritarians and totalitarians think. If TPR is a principal value, with each person’s well-being thought to depend on everyone else’s proper participation, then it authorizes a kind of joint, though not necessarily absolute, ownership of everyone by everyone, which means, of course, by the government. One person’s conspicuous opting out of the romance really does damage the others’ interests. …
TPR lives off coercion—which not only serves as a means of clamping down on discoordination, but also gives context for the sentiment coordination to be achieved. The government inculcates the notion of “The People” chiefly by coercion.
I first read this article in April (mentioned in an EconTalk podcast), and it resonated with me while riding the bus back from Denver after a legislative shadowing day sponsored by the Leadership Program of the Rockies. I saw “the sausage being made,” so to speak. Because I was shadowing Senator Schultheiss, I sat in on the Senate Health and Human Services committee’s discussion of Senate Bill 217, where I also made an impromptu testimony.
So after a day of ceremonial gavel-banging and Robert’s rules of order, I took the bus back to Boulder. When it passed Coor’s Field, I saw people arriving in the stands for a Rockies Game. I found myself thinking: “I could be at that game. … but I’m not, I’m on the bus.” The game. If you want to see the Rockies play live, you go to the game, and share the experience with everyone else. If you want to get from Denver to Boulder for $4, you take the bus, just like everyone else.Common frame of reference, togetherness, a common experience. I really felt it. And it scared me. For a brief moment, The People’s Romance posessed by body. This is what people feel, without articulating it, and is in part why they support government-run schools, health care, you name it. For me, the flood of emotion culminated with the Talking Heads song “Don’t Worry About the Government” (lyrics) playing in my head.
