Arnold Kling

Single Payer in the U.S.?

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Dr. Doom... Should Empirics Determine the ...

'Jane Galt' writes,


There are some serious constraints that I think would have to be considered by anyone trying to design a national health care package:

1) It cannot provide less, or less rapid, coverage than the typical American policy does now.


You don't even have to go past number 1. It's a show-stopper. As we just saw, and as I have pointed out many times, the component of our health care finance system that is in the worst shape is the component that is publicly funded. Maintaining the current level of availability of health care services under Medicare is not going to happen. Maintaining it under "Medicare for all" is not going to happen, squared.

If politicians thought that they could take over the health care system without making huge cutbacks in availability of services, we would already have a single-payer system in Woodstock-nation states like Massachusetts or Oregon. Single-payer in the United States is a chimera, like energy independence. Single-payer's political appeal here could never survive a serious attempt at implementation.


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COMMENTS (8 to date)
K writes:

'If politicians thought that they could take over the health care system without making huge cutbacks in availability of services, we would already have a single-payer system in Woodstock-nation states like Massachusetts or Oregon.'

Not quite true. First, politicans always think they can do anything. It is not good judgement that is holding states, blue or red, back. It is the mobility of our citizens.

The problem was foreseen by Hillary's team. Given a choice, the healthy will not pay for health insurance when they are young and feel immortal. And many highly trained medical workers will move to other states to avoid state plans - people are mobile in the US.

Both state and federal level schemes must also deal with the fact that many people do not exist - unknown illegal immigrants - but are entitled by law to medical care when they need it. Try collecting insurance premiums from them.

People are much less mobile between nations. So a single-payer mandatory scheme for the entire nation seems* more practical if it is funded from general revenues rather than individual premiums.

Since Bush has few principles about domestic policy he will probably sign a single-payer bill in 2008. It makes little sense for the Democrats to pass it until shortly before the elections.

*Notice the weasel word 'seems'?

Andrew writes:
Woodstock-nation states like...Oregon

Hey Arnold, hop on a plane and stay for a couple of months. Oregon is hardly a Woodstock-nation state. Or are you basing this on the (failing) Medicare-based Oregon Health Plan experiment?

Mr. Econotarian writes:

Perhaps more correct to say that Portland is a Woodstock-like City-State? ;)

Matt writes:

If single payer was more productive, then why does the Veterans Administration maintain a separate hospital system?

I think a special segment of medicine, the non-cronic medical clinic, can be insured for about $150/month. Such a clinc can cover acute but non serious conditions and routine medical exams.

If the AMA was as serious about universal coverage, then they would at least break off the acute medical clinic as a separate business model and have that insured. But the AMA will not do that, they will always add on to the collection of expensive procedures in the hopes of getting larger chacks and spreading the cost over flat rate payers.

Before the government jumps in with any increase or dsecrease in coverage, I need to see the AMA break apart the conglomerate.

Daublin writes:

I agree, Matt. The discussions all seem to talk about "health care" as if all procedures counted as the same. If you focus on just the cheap stuff, then you can come up with an inexpensive program where all the routine stuff is covered for free.

We could have a system where, for things like ear infections, you walk into a clinic and do not even show ID at all. This idea is humanitarian, and it is affordable. It is also completely dead in U.S. politics.

TDL writes:

Would it not be more appropriate to directly pay for the "cheap stuff" and have insurance cover the unexpected, expensive costs? Isn't insurance supposed to function in that manner? I see part of the problem being the belief on the part of most (many?) consumers that health insurance is supposed to cover everything. Why do we need expensive bureaucracies to pay our $100 annual check ups for us? Doesn't this just raise the costs of the "cheap stuff", which can be paid for directly (and not have to go through a third or even fourth party)?

Regards,
TDL

Which calls for one more chorus of one of Brad DeLong's Greatest Hits:

My two cents' worth--and I think it is the two cents' worth of everybody who worked for the Clinton Administration health care reform effort of 1993-1994--is that Hillary Rodham Clinton needs to be kept very far away from the White House for the rest of her life. Heading up health-care reform was the only major administrative job she has ever tried to do. And she was a complete flop at it. She had neither the grasp of policy substance, the managerial skills, nor the political smarts to do the job she was then given. And she wasn't smart enough to realize that she was in over her head and had to get out of the Health Care Czar role quickly.

So when senior members of the economic team said that key senators like Daniel Patrick Moynihan would have this-and-that objection, she told them they were disloyal. When junior members of the economic team told her that the Congressional Budget Office would say such-and-such, she told them (wrongly) that her conversations with CBO head Robert Reischauer had already fixed that. When long-time senior hill staffers told her that she was making a dreadful mistake by fighting with rather than reaching out to John Breaux and Jim Cooper, she told them that they did not understand the wave of popular political support the bill would generate. And when substantive objections were raised to the plan by analysts calculating the moral hazard and adverse selection pressures it would put on the nation's health-care system...

Hillary Rodham Clinton has already flopped as a senior administrative official in the executive branch--the equivalent of an Undersecretary. Perhaps she will make a good senator. But there is no reason to think that she would be anything but an abysmal president.

Tom West writes:

It cannot provide less, or less rapid, coverage than the typical American policy does now.

You don't even have to go past number 1. It's a show-stopper.

Um, isn't this obvious? I'm a strong supporter of the Canadian health care system, but Jane's list is pure craziness.

The purpose of universal health care is to provide 90% of the health outcomes at 50% of the price. The *whole point* of rationed health care is to eliminate that incredibly expensive 10%. It's no miracle. It simply allows nations and individuals not to bankrupt themselves on health care while maintaining reasonably good health outcomes. The USA can afford it (well, sort of...), the rest of the world can not.

If the only way single-pay health care can be sold in the United States is by pretending it's gold plated, then give up. If the Americans want (and are willing to pay for) a Porsche, then they are not going to be happy with a Toyota Corolla, and pretending the Corolla is a Porsche is a serious disservice.

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