As more progressive candidates enter the 2020 presidential race, it is doubtful that any other issue will be more heavily debated than healthcare. In fact, during the 2018 midterm election season, healthcare was brandished as the most urgent issue by Democratic candidates. It should not be surprising that Democrats are embracing this issue. Healthcare is increasingly becoming unaffordable and although Obamacare has lessened the acceleration in healthcare costs, it is by no means a long-term solution.

The most frustrating element of this debate is the callous disregard by Republican politicians of struggling families, who, without adequate health insurance, have been leveled financially by serious health crises. It is so frustrating, insofar as Republican policymakers would actually move backwards by repealing Obamacare, which has increased the number  of Americans insured. Even worse, they continually try to reinstall the grossly inefficient system that preceded the ACA. Nevertheless, the fundamental argument is whether healthcare is a human right or a product to be sold.

Many other industrialized countries have succeeded in employing a market-based delivery system with private providers, while paying for costs through social insurance. These countries administer a single-payer system wherein government acts as the sole insurer. The United States administers a similar program that is quite popular and efficient, called Medicare, whereby elderly Americans over the age of 65 are insured by the federal government. Healthcare of this type is guided by the philosophy of healthcare being a right.

However, in the United States, where Medicare is the exception, healthcare is predominantly privatized, with profit-maximizing companies providing insurance. Some examples of private insurers are Aetna, Humana and UnitedHealthcare. Because of under-competition, excessive administrative costs and bloated overhead, these private insurers provide costly products that price many individuals and families out of the market, leaving them either underinsured or with no insurance at all. Under this system, health insurance is plainly unaffordable, with huge deductibles and inadequate coverage.

The result is disheartening: families are destroyed by unforeseen medical emergencies, forcing them to file for bankruptcy and leaving them with nothing. A healthcare system of this type is guided by the philosophy of laissez-faire, which Republicans champion although it heartlessly advocates for so many to be deprived of an essential right. President Abraham Lincoln once magnanimously remarked “with malice toward none and charity for all.” Sadly, Republicans have regressed considerably from their founding father’s wisdom as they reserve nothing but unbridled malice for hardworking Americans who cannot find affordable health insurance. Perhaps if Republicans were to once again acknowledge facts and evidence, they would realize the merits of a single-payer system.

As already mentioned, many developed countries have successfully installed single-payer systems while preserving the private practices of physicians and hospitals. For instance, in Taiwan, a social insurance scheme was implemented in 1995 which, in real terms, reduced the rate of change in healthcare spending per capita from two percent to 0.5 percent annually from 1996 to 2000. Such a reduction was achieved because a single-payer system allows for a uniform reporting procedure and claims-filing system that greatly reduces administrative costs and permits economies of scale.

According to healthaffairs.org, administrative costs constitute only two percent of total direct operating costs in Taiwan’s national health insurance plan, whereas in the United States, administrative costs of private insurers add up to 20 percent of total premium revenues earned. Such an alarming discrepancy partly explains why healthcare costs are so much higher in the U.S. compared to Taiwan. In dollar terms, as of 1999, an American paid an average of $4,373 annually for healthcare while a person in Taiwan paid an average of only $686. Alex Preker, a leading health economist at the World Bank, upon completing research of OECD countries concluded that “universal healthcare led to cost containment, not cost explosion.”

Most importantly, a single-payer system ameliorates the issue of the uninsured because there is no avoidance of risk through client selection by private insurers. Essentially, private insurance companies would no longer be allowed to solely insure the healthiest and youngest individuals to protect their profit margins. Before the ACA, private insurers refused to sell coverage to sick individuals or those with pre-existing conditions, because both need costly treatment that can erode profits. A single-payer system insures everyone through one pool, which limits risk and guarantees that healthy and young participants balance out the needs of the sick and old.

Another noteworthy element of the national health insurance plan in Taiwan is the absence of waiting times. Republican policymakers consistently but wrongly assert that with every single-payer model, healthcare has to be rationed or a shortage will occur. Nothing is further from the truth if the model is structured correctly. During the 2008 presidential campaign, one can recall Gov. Sarah Palin alleging that death panels would be used as a result of the then-proposed plan of Obamacare, which in hindsight has never occured! In Taiwan, those individuals who overuse outpatient services compared to the average are subject to a staggered copay. Such a policy inhibits excessive demand and alleviates the burden on physicians. Following the implementation of Taiwan’s single-payer system, the average hospital admission rate increased from 110 per 1,000 in 1994 to 120 per 1,000 in 1996 — a very modest increase.

After accounting for all of this evidence, what exactly has been proven? Well, for starters, it proves Republican policymakers are willfully ignorant. Their policy position is a farce. Its only purpose is to serve the rich and powerful, so they continue to ignore the abundant evidence in support of a single-payer healthcare system to appease the moneyed interest that keeps them on a leash for the dogs they are. When handling as important an issue as healthcare, Republican policymakers are spineless in defending the American working-class and dishonorable in their duty as public servants.