But what really makes these proposals troubling is the psychological effect that they would have on the population and its relationship with the government.

To see why, consider the Key & Peele sketch from Season 4 where an elderly man in the hospital wakes up from a successful heart transplant, only to find out that the heart surgery was paid for and made possible because of the Affordable Care Act. The man, enraged at the prospect of having “big government in [his] body”, then tears open his chest and rips his own heart out. Key & Peele rarely got explicitly political, and it seems that the duo intentionally kept their own political views ambiguous in order to appeal to a broader audience, but the sketch does illustrate an important dilemma: How does a person deal with being in a position of having their life saved by a government program that they have vehemently opposed? The sketch, obviously, goes to absurd extremes for the sake of comedy, but the situation it depicts is very real and is a good example of a more general psychological dynamic that is inevitable when it comes to things like universal health care.

Obviously, no one in real life is going to literally rip their own hearts out in protest of universal health care. The more likely scenario, rather, is that opponents of “big government” will suffer from severe cognitive dissonance in the event of a newly-imposed mandatory single-payer health care system (i.e. a system, like the one Sanders proposes, where the government pays for everyone’s medical expenses). At first, they’ll probably refuse to go to the doctor for anything, or they’ll insist on paying out of their own pockets, but eventually they’re going to need an expensive life-saving surgery that they won’t be able to pay for, and then in comes Big Brother to save their lives by personally paying for their surgery in full. How would a person, in real life, react to this? Obviously the reactions will vary, but as a general rule it’s very difficult to resent someone who has literally saved your life. More than likely, opponents of single-payer will have a very reluctant change of heart once they’re personally saved by it.

More generally, having a person (or group of people) paying for your health care, education, or other basic necessities makes it very difficult to be resentful or suspicious of that person or group. After all, they’re doing you a huge favor by making your life better and easier - maybe even literally saving your life - so how could you be so ungrateful? It’s one thing when the entity paying for these things (like a private insurance company) charges you money in exchange for paying your bills, but if the government is doing it for you for “free” (except for the taxes that it already takes from you anyway), how can you object? Having the government “taking care” of you has the psychological effect of fostering a sense of loyalty to the government, making it much more likely for people to tolerate abuses of power that normally would have sparked suspicion and outrage.

This isn’t speculation - we can look at the American people’s response to the 9/11 terrorist attacks as a case study. After the attacks, the government stepped in and promised to protect us from further attacks, which caused even conservatives - who have traditionally been anti-big-government - to support unprecedented expansions of state power at the expense of civil liberties. The attacks, and the government’s promises of protection, fostered a sense of patriotism and blind loyalty that led even the most vehement small-government types to look the other way as the government set up an ever-expanding mass surveillance apparatus and started expensive and destructive wars based on very questionable premises. It wasn’t until the election of Barack Obama in 2008 that conservatives (and even then, only a vocal minority that seemed to be motivated more by animus against Obama himself than by anything else) regained their traditional suspicion of centralized authority.

There is little doubt that Bernie Sanders’s proposals to combat income inequality - free college education and a mandatory single-payer health care system, among others - would similarly condition Americans toward loyalty to the federal government in general, and to the Democratic Party in particular. Uncle Sam/Big Brother/whatever may have been shady and abusive in the past, but if he’s (say) protecting me from terrorism or literally saving my life by paying for my health care, maybe he’s not so bad after all. This is basically a large-scale manifestation of Stockholm syndrome, which is especially dangerous in a country with a government as large and powerful (and with as shady a history) as ours.

Having a for-profit health insurance industry may seem bad, but the difference is that private insurance companies have the pressure of competition to keep them in line and can at least be regulated to prevent abuses. The federal government, on the other hand, is ultimately not accountable to any larger authority to keep it in check, and thus must be counted on to regulate itself. It may be objected that it can be kept in check by the voters, but that’s hardly comforting when the vast majority of abuses have been done in secret by government agencies that are not affected by elections - when was the last time you saw an option for “head of the CIA” on your voting ballot? Government agencies have a nasty history of doing unspeakably horrible things when left unchecked, even in the realm of healthcare. The most infamous of these healthcare-related abuses is the Tuskegee Syphilis Experiments, where 399 African-Americans with syphilis were studied, under the false pretense of being free medical care for “bad blood”, without ever being given treatment for over 40 years in order to study the effects of syphilis on the human body.  It would be naive to assume that the US government is above doing such awful things now, especially as they continue to indiscriminately kill civilians (and, ironically, bomb hospitals) with drones overseas.