Quote-of-the-day mailing list
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Subject: qotd: Bruce Bartlett's Christmas gift to all of us
Date: Tue, 25 Dec 2012 09:35:06 -0800
From: Don McCanne <email@example.com>
To: Quote-of-the-Day <firstname.lastname@example.org>
Though it is not our policy to distribute a Quote of the Day message on
Christmas Day, we have to make an exception this year and thank Bruce
Bartlett for his Christmas present to PNHP and to all of us who dream of
a future with health care justice throughout the nation.
The New York Times
December 25, 2012
A Conservative Case for the Welfare State
By Bruce Bartlett
(Bruce Bartlett held senior policy roles in the Reagan and George H.W.
Bush administrations and served on the staffs of Representatives Jack
Kemp and Ron Paul.)
At the root of much of the dispute between Democrats and Republicans
over the so-called fiscal cliff is a deep disagreement over the welfare
state. Republicans continue to fight a long-running war against Social
Security, Medicare, Medicaid and many other social-welfare programs that
most Americans support overwhelmingly and oppose cutting.
Republicans in Congress opposed the New Deal and the Great Society, but
Republican presidents from Dwight D. Eisenhower through George H.W. Bush
accepted the legitimacy of the welfare state and sought to manage it
properly and fund it adequately. When Republicans regained control of
Congress in 1994 they nevertheless sought to repeal the New Deal and
Great Society programs they had always opposed.
Republicans are now using the fiscal impasse to try to raise the age for
Medicare and reduce Social Security benefits by changing the index used
to adjust them for inflation. They know that such programs will be
easier to abolish in the future if the number of people who qualify can
be reduced and benefits are cut so that privatization becomes more
This is foolish and reactionary. Moreover, there are sound reasons why a
conservative would support a welfare state.
One problem with this conservative view is its lack of an empirical
foundation. Research by Peter H. Lindert of the University of
California, Davis, shows clearly that the welfare state is not
incompatible with growth while providing a superior quality of life to
many of those left to sink or swim in America.
In a new paper for the New America Foundation, Professor Lindert
summarizes his findings. He points out that there are huge efficiencies
in providing pensions and health care publicly rather than privately. A
main reason is that in a properly run welfare state, benefits are nearly
universal, which eliminates vast amounts of administrative overhead
necessary to decide who is entitled to benefits and who isn't, as is the
case in America, and eliminates the disincentives to work resulting from
A 2003 study in the New England Journal of Medicine found that Canada's
single-payer health system had less than a third of the per-capita
administrative cost of the United States system, with its many private
insurance companies and overlapping government programs.
Americans believe that their health system is the best in the world, but
in fact it is not.
The one area where the United States tops all other countries in terms
of health is cost. According to the Organization for Economic
Cooperation and Development, the United States spent more than any other
country – 17.4 percent of gross domestic product on health in 2009. By
contrast, Britain spent only 9.8 percent of G.D.P. on health.
Thus, for no more than the United States already spends through
government, we could have a national health-insurance system equal to
that in Britain. The 7.6 percent of G.D.P. difference between American
and British total health spending is about equal to the revenue raised
by the Social Security tax. So, in effect, having a single-payer health
system like Britain's could theoretically give Americans 7.6 percent of
G.D.P. to spend on something else – equivalent to abolishing the payroll
This is a powerful conservative argument for national health insurance.
Comment: Thank you, Bruce Bartlett, for perhaps the greatest Christmas
gift of all - a rationale for why we all have to join together to
provide health care for everyone.
(The 2003 NEJM article cited is that of PNHP co-founders Steffie
Woolhandler and David Himmelstein, plus Terry Campbell of the Canadian
Institute for Health Information.)