Oh, Ben Shapiro! The intellectual heavy-weight of the right. The destroyer of snowflakes. The sexiest man alive. The king of rational arguments. The man who puts facts over feelings. Despite his clearly superior intellect, this brilliant debate master has made some mistakes when it comes to healthcare policy. I have no doubt that Shapiro is an attractive, smart man with brilliant rhetorical skills. In fact, when I was in the 7th grade, I thought that some of his ideas were convincing despite my left-wing views. But his flawed views on healthcare need to be called out.
1. Nationalized Healthcare Destroys Innovation
“First, government should not be in the business of telling you – or anyone – how to deal with their health care….They destroy medical innovation, deny and delay care, and blow out budgets.”
One of the most common and persuasive anti-nationalized health care talking points is the idea that single payer will get rid of any incentive for innovation. The argument states that the US's healthcare system is so expensive because we are paying for innovation. He believes that involving the government will force down drug prices which will lead to less innovation. While it is certainly possible for innovation to be stifled under a nationalized healthcare system, it doesn't have to happen.
The United States has more healthcare innovation than any other country in the world. But it is unreasonable to assume that this would disappear under a nationalized system. Only recently has the private sector been the biggest force in American medical research. Before this development, however, America was still a leading figure in healthcare innovation, as the NIH funded most of the medical research in the US and around the world. There is no reason to believe it could not be this way under a nationalized system.
It is also fallacious to presume that private healthcare research would also have to stop. It is entirely possible for private drug developers to function and flourish under a nationalized system. This believe results from nothing more than a fundamental misunderstanding of how healthcare works. People who want to nationalize the distribution of healthcare may not necessarily support the nationalization of the medical research industry (although that is a valuable discussion to be had). Under a nationalized system, the government could theoretically buy drugs from private companies and then distribute them to those in need. In addition, critics of nationalized healthcare like Shapiro claim that the government will force private companies to sell the drugs for less and this lack of money will discourage researchers from innovating. This is simply not the case. Research has shown that drug makers charge more than the value of innovation, so there's room for prices to be lower while still maintaining some innovation and a national system will probably expand the consumer base. Since the government will be distributing drugs to more people who previously wouldn’t have been able to acquire medication, the sales of drugs will go up and private researchers could make more money, or at least avoid significant costs associated with lower drug prices.
If we look at healthcare systems around the world, we can see that it is perfectly possible to have innovation under a nationalized system. Cuba, for example, a country that is extremely poor (partially due to international sanctions), is still able to have a significant amount of healthcare innovation. Despite the American embargos making it impossible to trade with one of the biggest medical markets in the world, Cuba has still been able to develop numerous healthcare innovations, the most famous of which is the CimaVax vaccine, a highly effective cancer-killing drug with little side effects. They have also come up with treatments for diabetic foot ulcers that prevent people with diabetes from having to get amputations.
2. Comparing Healthcare to Furniture
(Tweeted in response to Bernie Sanders mentioning that some people can’t afford healthcare)
“I go to a fancy store to check out a piece of furniture, can’t afford it. That’s totally crazy!”
When he first tweeted this, Shapiro received a significant amount of backlash for seemingly comparing the value of healthcare with the value of furniture. He later explains in an article that he wasn’t comparing the value of healthcare to furniture but merely was stating that it is a commodity like furniture, and thus follows the same economic rules. He proposes to limit regulations so that healthcare is easier to buy. He explains this in the following quote.
“Let’s say your life depended on the following choice today: you must obtain either an affordable chair or an affordable X-ray. Which would you choose to obtain? Obviously, you’d choose the chair. That’s because there are many types of chair, produced by scores of different companies and widely distributed. You could buy a $15 folding chair or a $1,000 antique without the slightest difficulty. By contrast, to obtain an X-ray you’d have to work with your insurance company, wait for an appointment, and then haggle over price. Why? Because the medical market is far more regulated — thanks to the widespread perception that health care is a “right”— than the chair market.”
Assuming that he was right in viewing healthcare as a commodity, his claim in this quote does indeed make logical sense. It is much easier to buy a chair then it is to buy an X-ray, and if they both could save my life, I would choose the chair. However, as this is the real world and not Shapiro’s imagination, this is definitely not the case. Chairs and X rays are extremely different goods and thus need to be distributed and utilized differently. If one does not have guaranteed access to an X-ray when needed, it could result in deteriorating health or even death. On the other hand, if one does not have access to a chair, it only means that they may be more uncomfortable. As such, when one needs an X-ray, there is no room for the bargaining involved in purchasing a product like a chair, as their life may, quite literally, depend on it.
3. Treat Healthcare like a Commodity (Not a claim made by Shapiro himself but on his site the Daily Wire)
“By the same token, when health care is treated as a right, individuals can demand a doctor treat them at any given price, which not only violates the doctor's right to charge for their services, which is immoral, but also de-incentivizes jobs in health care due to the inevitably low pay that accommodates this, reducing the incentive for someone to spend many years and huge funds training to practice medicine.”
Shapiro’s site argues that because the government will end healthcare’s status as a commodity, a nationalized healthcare system would lead to an under-supply of doctors. There may be some truth, however, to his claim that a nationalized system will reduce salaries for doctors. Nonetheless, his claim that it will lead to a vast under-supply of doctors is simply not correct. If there is a decrease in doctors’ incomes, it is unlikely to occur through direct salary cuts. Instead, it would likely occur through slow, long-term deductions in pay growth which likely won’t have as much of a dramatic effect.
If we, once again, look at Cuba, we also know that it is possible to have nationalized healthcare without shortages in doctors. Cuba, regardless of how some may view it, has a nationalized healthcare system with twice the number of doctors per capita in the United States. And it’s not as if their pay is that great either, as they make almost the same amount as other citizens. Why? Cuba’s constitution guarantees all citizens access to healthcare yet because they are very poor they have had to do their best with very little, and that could mean finding ways to incentivize being a doctor. It could also have something to do with the fact that it is far cheaper to become a doctor in Cuba, compared to America where it can cost up to one million dollars. So perhaps making college more afford affordable could offset some of the salary reducing effects of a nationalized system.
4. Treat Healthcare like a Commodity
“Treating medical care as a commodity means temporary shortages, and it means that some people will not get everything we would wish them to have. But that’s also true of government-sponsored medical care, as the most honest advocates will admit. And whereas government-sponsored medical care requires a top-down approach that violates individual liberties, generates overdemand, and quashes supply, markets prize individual liberties, reduce demand (you generally demand less of what you must pay for), and heighten supply through profit incentive”
In a way he is right is you were to put healthcare in the market you would reduce demand (to some degree) and increase supply. However, demand for healthcare is extremely inelastic so demand for healthcare wouldn’t go down all that much, it would just cause many of the people who are looking for medication to suffer financial distress. And to the extent that it would decrease demand, I don’t see how this is a good thing. Reduced demand for healthcare because of the “market” means fewer people can buy healthcare. This isn’t a good thing. If your goal is to make sure that the greatest amount of people have access to healthcare how can you want this to happen?
And I guess if healthcare is more expensive there would be more supply because fewer people will be able to get access to it and that shouldn't be something we strive for. As stated above other countries have shown it is possible to increase supply within a nationalized healthcare system while still allowing healthcare to be accessible to all.