…what “golden age” of laissez-faire capitalism and economic growth the people who say things like “Make America Great Again” or “back in the golden years” are referring to. Yes, the 50s and 60s were economically awesome for the United States, but even that story isn’t without its darker sides, and our prosperity seems to have had more to do with our postwar economic position of dominance coupled with the era of cheap and easily accessible energy supplies rather than some inherent “greatness” of our people or our system. There seems to be only one way to get back to that level of prosperity, and all the numbers on oil/nat gas/coal supplies indicate it just isn’t going to happen. The “Golden Age” came from the Black Gold, and that Black Gold is going, going…gone.
Regarding free-market solutions to every problem, if one looks at historical records, including the writings by (usually interviews of) members of the working classes, it is clear that whether laissez-faire capitalism “worked” greatly depended on who you were, what class you belonged in, what nation you found yourself a citizen of - oh, wait, most of the little people didn’t have a say in their societies until late in the industrial game - what family you were born into, etc. Yes, the Rockefellers, Morgans, Carnegies and Krupps of the world thought it was spec-freaking-tacular, but I’m not sure all of the millions of working class people felt the same. They definitely did not profit near as much. There are also enough historical, economic, and sociology studies that show that wealthy elite families tend to stay wealthy and elite (even despite less-than-capable offspring), to show the notion that a free market of individuals will always reward the capable and punish the inept is dubious at best. One doesn’t need to read too deeply in history to discover the abuse that the wealthy and powerful put down on the rest of society, if limits to that abuse aren’t encoded in communal law somehow. So, I’m doubtful that complete individual freedom and a completely unregulated market will actually solve our healthcare issues, because it hasn’t ever solved any issue without also creating inequities (often massive ones) at the same time.
By the same token, I’m not fond of complete and unfettered government regulation and interference in the marketplace either. Government tends to act with a heavy hand that is unresponsive to local community needs and conditions, however well-intentioned the actions of the government may be, and the larger and more complex the government the worse it gets. ACA is a fine example - do we really need laws that are hundreds of pages long? Where companies need to have full-time lawyers who can decipher all of the stipulations, restrictions, regulations, conditions, etc? Where people signing up aren’t often certain of what they are signing up for? Where someone’s premiums go up by 61% in a single year? Clearly government intervention in this case hasn’t worked. I suspect it may be either that the system is too overly complex, or too warped by political considerations and lobbying, to be expected to work at all. History is pretty clear that systems based on complete government control of the economy don’t work any better than ones based on unregulated free markets either, so having the government control every aspect of healthcare probably isn’t the answer either. So there has to be a middle ground between government utilizing its power to insure the markets aren’t abused and dominated by a few on one side, and governments allowing the market to operate freely on the other. The catch is where that sweet spot is.
As for single-payer systems - and I’m walking on less solid ground when I say this, since it isn’t my area of expertise - my sense of what I know about the nations that have them is that their budget deficits have less to do with the costs of healthcare in those nations than they do with the costs of other social welfare programs and systems; such as extended holiday allowances, low retirement ages with high retirement benefits, and immigrant/migrant benefits, among others. In our case, the reasons we are in a budget crunch certainly can not be simply chalked up to welfare/medicare/medicaid without also giving a bit of a nod to defense spending, which by any measure is just insane.
Overall, it seems to me that a core issue is not whether a government should tax its citizens - look, you’re paying for membership in the community - so much as it is whether the citizens should have a say in, and control over, where those taxes go and what they are spent on. We are a communal species that survives and thrives as a group. There have always been “taxes,” although these were not usually “economic” in nature so much as they were social obligations and community obligations one was expected to adhere to as part of being in that community. These have always been the cost of belonging to a tribe or a village, but such obligations were bilateral and designed to provide for the well-being of everyone in the community. This would explain why most Germans don’t seem to complain about being taxed around 60% of their income, since most Germans seem content with a system that so obviously provides so many services cheaply and in such a transparent manner (For reference, I lived in Germany as an exchange student for a year, have been back many times, and still have many contacts in Germany with whom I discuss these kinds of things).
In any case, I’d be fine paying for a national single-pay system if it was transparent, simple, and benefited the many rather than the few, which is what it seems to be doing right now. I’m tired of getting a cucumber while a small few other monkeys get a bag of grapes. I mean, the CEO of my healthcare provider makes more in a DAY than I do in a YEAR. That’s f’ked up.