The Question Of Whether We Can Afford Universal Healthcare Is A Dangerous Category Error, As Is The Question Of Whether We Can "Pay For" Universal Healthcare

Monetarist myths blind even advocates of universal healthcare to the obviousness of the injustice of the absence of universal healthcare.

Imagine that you lived in the time shortly before women were Constitutionally enshrined the right to vote.  Imagine that you lived in the time in which whether women should be allowed to vote was the main topic of debate in society.  You would hear this topic debated in local pubs, many of which were closed to women, or at any social event.

Imagine that you heard someone – a man, of course – say that “we cannot afford women’s suffrage.”

What would he mean by that?

Obviously, it means that he feels threatened by the idea of women voting; he feels that allowing women to vote would erode his power.  It would mean that, if we allowed women to vote, public policy would change in a way that might at least erode patriarchal order.

But what if you heard a man say “we can afford women’s suffrage?”  Even though he would seem to be making an assertion of support for women’s suffrage, you’d still find this to be deeply bothersome, because he should support women’s suffrage because it’s the morally right thing to do regardless of the degree to which he feels threatened by women’s empowerment.

This is the same conclusion that you would reach if you heard an Antebellum Northern white person say “we can afford to abolish chattel slavery” or if you heard a rich white person in the Antebellum US South say that “we cannot afford the abolition of chattel slavery.”  The latter guys fought an entire war to protect the institution of chattel slavery because they felt threatened by the anticipated cost of its abolition (though Henry George later noted that, at least in his lifetime, it hadn’t actually cost them that much after all, since mostly the same white people who owned all of the land before the war still owned the mostly the same land after the war, and the newly freed formerly enslaved persons weren’t much freer than they had been before, still required to labor under the threat of starvation for the white landowners.)

This is how we should think of universal healthcare, because this is how opponents of universal healthcare think of universal healthcare, because most opponents of universal healthcare know what universal healthcare actually is, whereas many advocates of universal healthcare seem to not fully grasp what it actually is.

A theme to notice in this essay is that the confusion and the mythologies described herein help opponents of universal healthcare conceal their true, dark reasons for opposing it, and that identifying this confusion and these myths help us see that the absence of universal healthcare is nothing more than a political choice.

Falling For Opponents’ Diversion Tactics

The discussion of universal healthcare very often is enmeshed in questions of whether we can afford or “pay for” universal healthcare, and, unfortunately, most advocates of universal healthcare don’t challenge the premises of these questions; instead, they try to answer questions for which there are no answers, which means that they’re always playing on opponents’ turf, and the movement never advances.

You must always question questions.

That is to say that you must always question the premises of questions.

The problem is that most advocates of universal healthcare don’t do that, and it’s part of why we don’t get anywhere good.  They treat the question of whether we can “pay for” universal healthcare as a legitimate question and try to answer it, very often confident in their answers.  They treat the question of whether we can afford universal healthcare as a legitimate question and try to answer it, very often confident in their answers.

The problem is that, if the “we” in question is assumed to be “the country” or “the United States” or “the United States Government,” the question of whether we can afford universal healthcare is a category error, as is the question of whether we can “pay for” universal healthcare.  This matters tremendously.  Not only are they category errors, but they are very dangerous category errors.

It’s like asking if we can afford or “pay for” women’s suffrage, racial desegregation, or same-sex marriage.

Why does this confusion persist?

Because we are brainwashed by a mythology about social relations and social obligations that is so pervasive that, like how a deep-sea fish doesn’t know what water is, most people don’t even know exists, even as – or, perhaps, because – they, like a fish, live their lives swimming in it.

Monetarism Is Murder

The problem starts by conflating money and currency – and by not really knowing what either actually are.  The problem then continues by thinking that currency is an external commodity even for an entire society, precisely the way in which most opponents of universal healthcare and other similar social-welfare measures want us to think!  The confusion is further compounded by the fact that, while public funding probably is a prerequisite of universal healthcare, it is – and this is so, so critical to understand – not its defining feature.

Yes, read that again.  Publicly-funded healthcare is not always universal healthcare, and what makes universal healthcare universal healthcare is something other than public funding, even if the resources in a universal healthcare system must be publicly funded.

This should be obvious, considering the critical nature of universal healthcare and considering the fact that many people have conditional publicly-funded healthcare by virtue of being government employees, and it’s obvious to opponents of universal healthcare, but it’s not obvious to many people who present themselves as advocates of universal healthcare, which is why we get treated to weird assertions like this.

Yes, that’s a former Democratic candidate for a House Of Representative seat and big-name social-media commentator saying that politicians “have” “universal healthcare.”

That makes no sense at all, not so much because it is not true but because it is a category error.  By its very nature, universal healthcare is not something that a privileged group of people in society can “have” at the exclusion of others.

What Would A Fully Publicly-Funded Non­-universal Healthcare System Look Like?

To understand the distinction and why the distinction matters, we must imagine a polity in which all healthcare services are publicly funded but there is no universal healthcare.

Imagine that you lived in a country in which health-care access functioned as follows: there is no right to healthcare, there may or may not be health insurance, there may or may not be employer-paid care, each patient would pay fees proportional to but not necessarily equal to the cost of the care provided for any service, and – most crucially here – all services are fully publicly funded, with the entirety of the salaries of nurses and physicians paid fully by the government and healthcare services not limited by revenues either from the fees for the services or any taxes, meaning that the aforementioned private insurance plans and employer-sponsored plans pay premiums straight to the government.

If you can’t afford the fee, which, depending upon the procedure, can be very expensive, then you go without the service, and possibly die or become permanently disabled, or you get put into onerous debt in order to get the needed service, even though the system is fully publicly funded. Some people resort to fundraisers to raise money to get the care that they need, even though the healthcare system is completely publicly funded.

Why would such an arrangement exist? Perhaps you might already have a clue! Still, as far as I know, no such system exists anywhere on Earth, but the possibility of such a system and why no such system actually exists are hugely instructive about a critical point that I wish to make here, a point that I have not seen made by anyone else anywhere.

I am writing today about how the questions of whether “we can afford” and how we ‘pay for’ universal healthcare are dangerous category errors stemming from Monetarist mythology, and I am using this pair of stupid tweets from Robert Reich to illustrate the point that even ostensible advocates of universal healthcare muddy the waters to the benefit of opponents of universal healthcare.

One of the points that I will make here is that the people who say that “we CAN afford universal healthcare” and “we CAN pay for universal healthcare” are harming the cause of universal healthcare, because they have already accepted a harmful and erroneous framing and don’t seem to actually know what universal healthcare actually is!

It's bad that Rashid, Reich, and various other Democratic leaders don’t seem to even know what universal healthcare is, and, no, do not dismiss this as “semantics”; words matter, words have material outcomes, and, if these Democratic leaders don’t even know what universal healthcare is, then they do not even know what universal healthcare is, and that is a big, big problem.

What Is Universal Healthcare?

Over the last year or so, I have, a couple of times, posed the following question with multiple-choice answers here on my Facebook page:

Can the United States Of America afford universal healthcare?
A.) Yes
B.) No
C.) If it cuts some government spending and-or raises enough money via taxation
D.) The question is a category error.

The answer is D and only D, and anyone saying that the answer is A or C, no matter how much they might think of themselves as proponents of universal healthcare, are only aiding opponents of universal healthcare.

Here, I will explain why.

How do we know that the answer is D?

The first thing that we must ask ourselves is … what is universal healthcare?

The answer might seem obvious, but the discussion about universal healthcare usually doesn’t bother to ponder what universal healthcare actually is.

Complicating this question is that, in many countries that have universal healthcare, people still have to pay small – very affordable – fees to get care. This complicates the “free” aspect of universal healthcare.

But let’s consider a few assumptions:

a.) Those fees are so low that they don’t actually prevent anyone from getting needed care, meaning that healthcare in those places is truly universal. This is especially true if payment is not required up front; being put in debt for $30 for a procedure that costs $15,000 worth of resources is essentially nothing.

b.) Those fees are actually unnecessary to fund the workers providing the services; they exist solely as a way of discouraging people from wasting everyone’s time with visits or procedures that they do not need.

So, as a practical and functional matter, universal healthcare can mean totally free service for essential procedures.

So, my own definition of universal healthcare, then, is that it is a legal-political arrangement in which every person (we could say every citizen or every legal resident, though this starts to play with the definition of “universal”) has free, fair, unconditional, and impartial access to the services of any healthcare resources employed by the state for this purpose.

Do you agree with this definition?

If not, tell me why.

If yes, then you may already know why the question of whether we can afford universal healthcare is a dangerous category error and why the question of “how we pay for” universal healthcare is a dangerous category error.  I will explain, though.

The confusion seems to stem from – and also reinforce – the conflation that Reich is making in these counterproductive tweets.

Playing On Your Opponents’ Turf

The so-called “socialized medicine” that Reich is describing is publicly-funded healthcare for government employees, which is not much different than the privately-funded healthcare that employees of private employers get.

One thing that most liberal people are really terrible at doing is recognizing when they’ve been baited into playing on their opponents’ turf.  (Since the contemporary Democratic Party is full of high-status people whose status might lose status if measures like universal healthcare, we can accuse them of complicity and see their ignorance as feigned.)

As is typical of a certain kind of smarmy liberal person who has no understanding of power, Reich seems to think that he is making some effective dig at Republicans – who oppose healthcare for all – by pointing out that the person at the top of the social hierarchy is getting free publicly-funded care by virtue of meeting the condition of the official job that he holds.

But Reich is saying “socialized medicine,” a term that is used mostly by opponents of universal healthcare, and he is using it to describe something that is not remotely like universal healthcare.  He is using their terms, while advancing no alternative terms of his preference.

The only thing that this accomplishes is to further muddy the waters, just as opponents of universal healthcare want.  Anyone against universal healthcare is going to read Reich’s tweets and say “wow, that’s right. We who want to ration healthcare for ‘our people’ are rationing healthcare for our people! Thanks for noticing, Bob!”

As is usual with dumb liberal ‘hypocrisy’ dunks, Reich is advancing no principles or morals of his own.

Being in favor of government employees getting publicly-funded healthcare while opposing universal healthcare is in no way hypocrisy, and that Reich seems to think that it is – that it is somehow meaningful, worthy of being pointed out – demonstrates the intellectual bankruptcy, specifically, the misunderstanding of power, of the cohort of modern liberalism that thinks of Reich as some sort of effective leader.

It's perfectly rational and perfectly consistent for someone who opposes universal – unconditional  – healthcare to think that healthcare access should be an inducement to or a perk of compliance. That’s totally consistent!

Reich is pointing to the fact that the healthcare that Trump got was government funded, when the relevant factor here when it comes to what opponents of universal healthcare mean by “socialized medicine” is that the care is offered only conditionally, to those who meet the conditions, the complete opposite of the spirit of universal healthcare, the point of which is that there should not be conditions on receiving care!

And, most unfortunately, that conflation between public funding and universality and unconditionality of access is prevalent among advocates of universal healthcare.

Back To Our Fully-Publicly-Funded Non-universal Healthcare System

To really see how this works, to really understand the importance of the distinction, we have to imagine a scenario in which a healthcare system would have total public funding but not have universality and unconditionality of access. To that end, let’s revisit the three earlier paragraphs describing our hypothetical system.

Imagine that you lived in a country in which health-care access functioned as follows: there is no right to healthcare, there may or may not be health insurance, there may or may not be employer-paid care, each patient would pay fees proportional to but not necessarily equal to the cost of the care provided for any service, and – most crucially here – all services are fully publicly funded, with the entirety of the salaries of nurses and physicians paid fully by the government and with healthcare services not limited by revenues either from the fees for the services or any taxes, meaning that the aforementioned private insurance plans and employer-sponsored plans pay premiums straight to the government.

If you can’t afford the fee, which, depending upon the procedure, can be very expensive, then you go without the service, and possibly die or become permanently disabled, or you get put into onerous debt in order to get the needed service, even though the system is fully publicly funded. Some people resort to fundraisers to raise money to get the care that they need, even though the healthcare system is completely publicly funded.

Why would such an arrangement exist? Perhaps you might already have a clue! Still, as far as I know, no such system exists anywhere on Earth, but the possibility of such a system and why no such system actually exists are hugely instructive about a critical point that I wish to make here, a point that I have not seen made by anyone else anywhere.

So, in our hypothetical example, the government, the public authority, fully funds all healthcare directly but then charges people to get that care, meaning that not everyone can access the care, which is essentially rationed by family wealth, meaning that the impoverished and the otherwise-marginalized get excluded from care or suffer a lifetime of onerous indebtedness for receiving care.

Sound familiar?

In this hypothetical example, even though the government is fully funding all healthcare and there is no privately funded healthcare anywhere (except to pay the fees charged by the government), is this really “socialized medicine”? By Robert Reich’s characterization of “socialized medicine” meaning “publicly funded healthcare”, it is, but this is also stupidly meaningless.

The more important question is, in this hypothetical example, even though the government is fully funding all healthcare and there is no privately funded healthcare, is this UNIVERSAL HEALTHCARE? Clearly, the answer to that question is an unequivocal “no.” The government is fully funding and fully providing all healthcare, but many people within the polity – generally, non-wealthy people and chronically disabled people – are excluded from receiving care, to their great detriment. Healthcare is rationed for the richer and healthier people, and everyone else except for chronically-disabled people who can’t even get or keep a job due to their disabilities is compelled into employment relationships in order to acquire money to maybe be able to purchase healthcare.

Sound familiar? The important takeaway from our hypothetical example of a fully publicly-funded NON-universal healthcare system is that the fact that all healthcare is fully publicly funded is COMPLETELY IRRELEVANT to the question of whether the arrangement in our example constitutes universal healthcare.

Got it?

So, the point here of this hypothetical example is to get people to understand what universal healthcare actually is and actually means, to stop conflating publicly-funded with universal, because it matters.

Drawing this distinction helps demonstrate the complete hollowness of Reich’s assertion.

Reject The Conflation

As my hypothetical example hopefully helps you to see, opponents of universal healthcare find it useful to conflate government funding of healthcare with universality, unconditionality (i.e., free), and impartiality of access to care, because they are trying to take attention off of the latter by getting people to focus on the former. By characterizing “socialized medicine” as being about who funds it rather than being about the fact that no one is excluded from it, Robert Reich, too, just like opponents of universal healthcare, is encouraging people to focus on the funding aspect, thereby only helping opponents.

Reich seems to think that he is making some effective dig at Republicans by pointing out that the President Of The United States gets publicly funded healthcare, perhaps that this is some evidence of hypocrisy among Republicans, but his criticism is completely hollow, nonsensical, and ineffective, no matter whether he images “socialized medicine” to mean universal healthcare or to mean publicly-funded healthcare.

Let’s examine both possibilities.

If, by “socialized medicine,” he means universal healthcare, then his whole claim is a silly, stupid category error, because the very nature of universal healthcare is that people are not excluded from it. So, the thing that Donald Trump wants and has for himself at the exclusion of others not only is not universal healthcare but cannot be universal healthcare – or socialized medicine. If he wants it only for himself and persons in his in-group, then it is not and cannot be “socialized medicine” – or universal healthcare. Reich’s assertion is, therefore, a category error, and he has accepted the Republican “free stuff” characterization of a public good as if it is a mere personal benefit. As I have said many times, the man is not so much a liberal or progressive person as much as he is a conservative caricature of a liberal or progressive person.

But, if, by “socialized medicine,” he means publicly funded healthcare regardless of whether one has to meet conditions to receive that care, which is the only other possible meaning that I can imagine here, then it’s still just as silly, because that is not what opponents of universal healthcare oppose in the first place.  We who advocate for universal healthcare are trying to eliminate that kind of conditionality for receiving care!  That’s the whole point!  The term “socialized medicine” is used almost exclusively as a pejorative by opponents of universal healthcare; I don’t recall ever hearing or reading a proponent of universal healthcare use the term. One of its purposes – at least in the modern pejorative context – is to conflate “publicly funded” with “universal.”

Thanks, Captain Obvious

So, if Reich is trying to say that Republicans are okay with publicly funded healthcare for people who meet certain conditions but not okay with it for all people unconditionally, then I must ask, what in the hell is new about that? and what is the point of pointing it out at all?  and why do you seem to think that Trump getting treatment at a hospital provides some new insight?

Yes, Republicans are against universal healthcare!  We knew that already!  Neither Trump getting publicly funded conditional healthcare nor Republicans being okay with it tells us anything new.

But public funding is not really what “socialized medicine” means anyway, except that the term seems to now be used to conflate universality with public funding, a destructive conflation that Reich is aiding.

The Possible Source Of This Conflation

The only explanation for Reich calling something publicly funded “socialized” is that he thinks that the funds somehow originate with people who then provide the currency via tax payments to the government that then funds the care, which is to say that he subscribes to the collection-plate view of taxation (because he does.)

But that, too, would be silly, because the adjective “socialized” modifies the noun “medicine,” suggesting that “socialized medicine” is about whether conditions are required for anyone to access care – to access medicine – and not about how it is funded.  Furthermore, again, “socialized medicine” has traditionally meant universal healthcare.

Many times in internet comments sections, I have seen proponents of universal healthcare point out to opponents of universal healthcare that they (the opponents) seem to be okay with government employees getting publicly funded care, as if this is in any way some kind of gotcha or ‘own’. Employer-provided care, even if the employer is the government, is conditional care, which has nothing to do with and is not universal healthcare.

Why are these universal healthcare advocates focusing on the public funding aspect, as if that is what matters here? Maybe because this is the reason that opponents of universal healthcare cited when stating their objection to universal healthcare, but have you noticed that people who promote deadly policies aren’t always honest about why they promote such policies?

The proper response to someone who cites public funding as a reason to oppose universal healthcare is to point out that that is silly and probably disingenuous and to redirect the conversation back to UNIVERSALITY AND UNCONDITIONALITY of coverage, which is the actual subject being debated – the subject that opponents don’t really want to debate, because it rightly makes them look like ghouls.

It should be obvious that, while public funding might be necessary for universal healthcare, it is not what makes universal healthcare universal healthcare. Publicly-funded healthcare can be and often is conditional.

Free, fair, impartial, and unconditional access to the care is what makes universal healthcare universal healthcare, and people who oppose universal healthcare but are fine with various NONuniversal, CONDITIONAL forms of publicly funded healthcare are not in any way hypocrites.  Their position is bad if not evil, but hypocrites they are not.  Chasing them down this path is a dead end and a waste of time; it will exhaust the advocate of universal healthcare before it exhausts the opponent of universal healthcare, and the latter is the person who is trying to maintain the status quo and, as such, doesn’t need to work as hard as the advocate of universal healthcare needs to work.  Chasing them down this dead-end path puts the focus on the funding, which is where the opponents want the focus, where they have led the proponents. That’s why I think that Reich is a sap who accepts conservative premises.

Who Would Even Be Persuaded By This Approach?

I grew up conservative, I spent early adulthood in the libertarian movement, and, so, I've changed my mind about plenty of policy positions! I just cannot, however, imagine the kind of person who is against universal healthcare whose mind would be changed by other people pointing out that he's okay with publicly funded non-universal health care, like for soldiers, air-traffic controllers, and members of Congress. It would make no sense to change your mind about universal healthcare by thinking about the fact that government employees get publicly funded health care AS A CONDITION OF EMPLOYMENT! It would make plenty of sense to change your mind about universal healthcare by coming to see that letting people die because they can't afford health care is both cruel and unjust, that healthcare access is a labor-disciplining device for employers and powerful people in general. My goodness, argue for your principles!

What I definitely can imagine is a person who is against universal healthcare becoming even more entrenched in that position by being reminded that government employees get publicly funded health care, because you're just reminding him of why he's against universal healthcare in the first place, which is that he understands employer-sponsored healthcare – in a society that does not have universal healthcare – as a labor disciplining device. You're just reminding him of why he's against universal healthcare while simultaneously offering no reason that he should not be against universal healthcare.

Monetarism Poisons Everything, Making Us Think That Political Questions Ain’t Political

Perhaps the reason that so many proponents of universal healthcare get stuck here is that, brainwashed by Monetarism, by the Commodity Theory Of Money, which leads us to the disgusting mythology taxpayerism in which we are swimming, they very myopically focus on the funding.

Now, there are many people who, upon learning the truth about money, think that “oh, this means that we can afford (or ‘pay for’) universal healthcare,” and, no, this is not correct. What the education about those money myths should lead you to see is that, as with women’s suffrage, universal healthcare is not something that we can either afford or not afford, that it is not a thing to be “paid for.”

Either we allow everyone to have unconditional (pay is a condition) access to the healthcare system, or we don't.

That’s it.

That is totally a socio-legal-political choice, not any question of affordability. The same is true for the enactment of women’s suffrage, the legalization of same-sex marriage, or racial desegregation. They are legal-political arrangements and choices.

So, if someone said to you, “can we afford women’s suffrage?” You’d probably find the question itself to be super offensive, and for good reason. You should find the question of “can we afford universal healthcare?” equally as offensive and for the same reason.

The Real Reason That Opponents Of Universal Healthcare Oppose It

Now, let’s stop and think about this for a few seconds. Why might someone express concern about whether we “can afford” women’s suffrage? Perhaps it’s because he thinks that it might mean that his power would be eroded!

Now, project that onto people who ask if we “can afford” universal healthcare!

When powerful people whine that “we can’t afford” and “we would have to pay for” universal healthcare, you should think about both who the “we” here is and exactly how they imagine “paying for” it. It is not about taxes, but they want you to think that it is about taxes! They will have to “pay for it” in so many ways other than taxes, but they direct your focus on taxes so that you don’t focus on all of the other ways that they actually will have to pay for universal healthcare.

So, universal healthcare is not something that we can either afford or not afford, meaning that the question of whether we can afford universal healthcare – or even the assertion, even by well-meaning proponents, that we can afford universal healthcare – is a dangerous and offensive category error.

Healthcare Is A Service, Universal Healthcare Is A Legal-Political Arrangement

Likewise, the question of whether we can – and the question of how we will – “pay for” universal healthcare are category errors. We cannot and will not “pay for” or even fund universal healthcare, because, as I hope that my example of a non-universal fully-publicly-funded healthcare system demonstrates, universal healthcare is a legal-political arrangement, not a product or service itself.

Almost every time I say this, someone replies to say that the work that nurses and physicians do is a service, and the government will pay for it.  Nurses and surgeons have to be paid.  So, government will, they say, “pay for” universal healthcare.

Yes, the claim that the government will pay nurses and surgeons is, of course, correct, but that doesn’t mean that universal healthcare is what we are buying.

Canada, Iceland, and Japan have universal healthcare, but, when the Government Of Canada, the Government Of Iceland, and the Government Of Japan pay currency to nurses and surgeons, they are not buying or paying for “universal healthcare.” They are buying health care work. Healthcare is the work that those nurses and surgeons do; universal healthcare is the legal-political arrangement that allows everyone free, fair, impartial, and unconditional access to the services provided by those surgeons and nurses.

See the difference? It is not possible to “pay for” universal healthcare. To talk about “paying for” universal healthcare is to diminish what universal healthcare is, to dimmish it from a legal-political decision to make healthcare a human right to a mere financial transaction.  In my hypothetical example of a non-universal healthcare system that is fully publicly funded, the government was buying or paying for healthcare services from nurses and physicians, but there was no universal healthcare, because everyone has to meet conditions in order to receive car.

A nurse can do healthcare work, but a nurse cannot do universal healthcare work, because universal healthcare is, like Freedom Of Speech, a legal-political arrangement. Right now, both the US Government and private insurers pay for healthcare work from nurses, and, right now, there is no universal healthcare in the United States. If the United States enacted universal healthcare, the work of those nurses would not necessarily change.  They would still be nurses.  They would be performing all of the same nursing tasks that they were performing before – that they already are performing now.  The government would not be paying them or anyone else to do “universal healthcare.”  Universal healthcare would be the legal-political decision to allow everyone free, fair, impartial, and unconditional access to their services.

In other words “universal healthcare” is totally about the patients, not about the staff, let alone the funding of the staff.

This is true even if we experience shortages in a universal healthcare system and have to do the thing about which opponents of universal healthcare are always fearmongering: the rationing of care. We already do ration care, and deliberately so, simply by not having a universal healthcare system.

It's A Human Right, Not A Product Or a Service

So, universal healthcare is not even about whether there are enough healthcare resources to serve the entirety of the human population.  Universal healthcare is about whether the entirety of the human population has free, fair, impartial, and unconditional access to the services of all healthcare resources employed by the system, regardless of the quantity of those resources.

My hypothetical example of a fully-publicly-funded NONuniversal healthcare system helps to demonstrate that we already do deliberately ration care. Why is my example of a fully-publicly-funded NONuniversal healthcare system only hypothetical? Why does no country do that? Why doesn’t the United States do that?

I think that the answer is simple: it would be too obvious that the point of such a system would be to deliberately ration care and use the charging of money to access care as a labor-disciplining device.  So, the ruling classes have to veil this desire some kind of way.

It’s much less obvious when much of healthcare is privately funded, and all publicly funded healthcare is conditional.  Our current non-universal healthcare system is designed in such a way as to obscure its true purpose!

Yes, “we live in a society,” and that means that everyone should have free, impartial, and unconditional access to health care, but that doesn’t mean that a person who isn’t a medical professional is “contributing” to it via taxes; it means that that person is relinquishing control not of his “hard-earned tax dollars” but of his exclusionary access to the time and services of medical professionals, and that is what opponents of universal healthcare fear most: no longer being able to exert power and hoard healthcare resources by requiring you to constantly jump through hoops to get the care that you need.

That is what they are afraid of “paying for.”  That is what they think that they cannot afford.

The True Cost Of Universal Healthcare

So, it's not that universal healthcare and, say, some amount of military spending come at the cost of each other.  It's not a question of either universal healthcare or some amount of military spending.  It's a stark question of universal healthcare or no universal healthcare.  The cost of universal healthcare is what those who somehow benefit from its absence will give up.

The "cost of universal healthcare" is the decrease in exclusivity that the privileged have over both the services of healthcare workers and the bodies of the unprivileged participants in the labor market.

That's it.

That's the whole thing. 

It's not "another way to look at it."

It's the whole thing.

There is no other (correct) way to look at it.

What's the cost of women's suffrage?

What's the cost of racial integration?

What's the cost of the abolition of chattel slavery?

That's how to look at it. 

The cost of all of those things was the erosion of power and status of those who benefited from the prior status quo.

That's it.

The same is true for universal healthcare. 

We're not talking about creating a healthcare system.

The total quantity of currency spent in a universal healthcare system is not its cost, because those resources would be - and already are - used in a non-universal healthcare system.  The aggregate money (unit of account) value of all resources used in a universal healthcare system is not its cost, because those resources would be - and already are - used in a non-universal healthcare system. 

The question of universal healthcare is not one of whether we are going to have a healthcare system at all.  The question of universal healthcare is about whether everyone has free, fair, unconditional, and impartial access to all of the services employed in a healthcare system.

That's it.

It's a question of universality versus exclusivity, not about a quantity of resources.  It's not like we are building an aircraft carrier, in which the alternative is to not build an aircraft carrier.

When we talk about the Navy getting an aircraft carrier, we are not talking about it taking over an existing aircraft carrier that the private sector is using. We're talking about building a new aircraft carrier, in which numerous resources that wouldn’t otherwise be employed in the service of building an aircraft carrier would be employed in the service of building an aircraft carrier; this has no analogue in the question of universal healthcare, because universal healthcare is about using the existing stock of nurses, physicians, and hospitals to treat everyone unconditionally and impartially.

The total cost of the aircraft carrier is the cost of building it, because, otherwise, there would be no aircraft carrier.

By contrast, we already have nurses. 

So, the "cost of universal healthcare" has no meaning beyond the threats to the status and the power of people who have safe access to care now, and all of the costs that stem from that threat to their status, and, if you talk about the "cost" of universal healthcare beyond that reality, you're speaking their language, and you're helping them.

Say What You Mean

Healthcare is a human right.  We should speak as though we actually believe it, and saying that “we can afford it” and “we can pay for” it undermines that belief.

“We live in a society” should mean that we don’t exclude certain people from access to existing health-care resources.

But we’re never going to get there for as long as we continue conflating public funding with universality, unconditionality, and impartiality of access and as long as we talk about “paying for it” and that we “can afford” it.

In other words, we’ll never enact universal healthcare for as long as we don’t even know what it is!