Arnold Kling  

My Case for Single-Payer Health Care

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In an op-ed picked up by the Providence Journal, I write,

I am not among the many who believe that single-payer health care is the best solution. However, I think that an experiment with single-payer coverage [by a single state] would bring out the pros and cons of government-provided health insurance. Moreover, it would force the single-payer advocates to finally define what it is that they are talking about.

In reviewing health-care policy issues, I have found at least three versions of single-payer health care under discussion: one that is doctor-friendly, one that is doctor-hostile, and one that is doctor-limiting.

Right now, single-payer represents a "grass is greener" model, where advocates are free to tell us how wonderful everything is in Canada, the UK, France, or wherever. I want to see a state in the United States implement it, with our culture and our technology. Then we can talk about how the system really works, instead of people's fantasies about how it works.

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COMMENTS (5 to date)
Randy writes:

Well said! I nominate Massachusetts.

alcibiades writes:

If people could accurately judge the real effects on their wellbeing of policies, we wouldn't have any number of government programs, let alone universal healthcare. The problem, as always, is that people -- due to whatever psychological quirk -- tend to cut the government a lot of slack. (tribalism?)

So let's say Mass. instituted a single-payer system. Even if it overall hurt people, it could be interpreted in a positive light by the "moral" masses. Or, if it's a total mess and perceived as such, "moneyed interests," etc. could be blamed, calling for further intervention. And of course, the long-term effects on supply of healthcare professionals and the like would not be factored into the equation at all in terms of the voting public.

The one thing that will happen if we allow the government to step further into our lives however is that it will be treated as a "given," and will stay there, and probably expand to fight against "health care crises" and the like...

superdestroyer writes:

Why pick Rhode Island? Why not pick the state with the lowest percentage of employer provided health "insurance" along with the lowest percentage of those who get their health care already from the government. Finding this state would limit the number of people affected by a single payer.

John Thacker writes:

Professor Kling,

What about TennCare? It allowed eligibility for non-Medicaid eligible recipients. It's a good example of a state experiment in universal health coverage, though not precisely single-payer. Tennessee paid a flat rate per enrollee to HMOs, who then managed the coverage. I assume you discuss it in your book, but perhaps I've wrong.

MjrMjr writes:

A one state experiment is a nice idea, but I think the problem of adverse selection would doom any such experiment to failure. IOW, as soon as it starts every uninsured person with serious health problems who could fly, drive, walk, crawl, or hobble themselves to that state would do so. Ought such an experiment be limited to people who are already living in the state? This is an important that can't be overlooked. The funding mechanism would also be very important. A payroll tax? Property taxes? Corporate income tax? Sales tax? The devil could be in the details.

The "fairest" way to do it might be to determine the overall level of current health care spending, then fund a single payer system at the same level via a means of taxation that most closely matches who spends what right now. How this could come about politically I have no idea. I'm convinced that, for example, Medicare Part D was written and implemented by people who have no interest in seeing any gov't program actually work.

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