Arnold Kling  

An Alternative to Single-Payer Health Care

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Single-Payer Health Care... War, Peace, and the Economic G...

Senator Tom Coburn offers a market-oriented alternative.


Under the Act, Americans would be eligible for a tax rebate to purchase health insurance. The “Medi-Choice” rebate would be made directly to a patient’s health insurer and would be worth $2,000. Families would receive a $5,000 tax rebate.

The tax rebate walks and talks like a voucher. The proposal also would reduce the more onerous state regulations by allowing people to by health insurance from other states. It would move us away from employer-provided health insurance and toward an individual market. Then we would see whether the market would fail, as the Left believes is inevitable, or whether it would work.


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COMMENTS (8 to date)
Lord writes:

A credit might at least have a chance working. A rebate is simply stupid.

John writes:

Forgive my ignorance, but what is the difference? and why would one work but not the other?

Ron writes:

Single payer, tax credit, private vs public financing are all some what of a straw man. The argument that private insurers spend 10-20 percent in overhead cost while Medicare spends only 2-3% over looks the huge cost to hospitals of meeting Medicare, Medicaid and other government regulations.
Eventually any third party insurers, in particular, a single payer or government program will try to manage its costs by restricting access, and “enforcing” preventative care. Think smoking bans, trans-fat bans, what’s next on their list? And I am sure there is a next. Perhaps obesity elimination, elimination of high risk activities? I’ll give up my charbroiled steak when they pry my steak knife from my cold deal fingers. Its not hard to come up with some possibilities’.

As to the wonderful Canadian and European system, I lived in Seattle for a few years, the flow was Canadians coming to the U.S. to get healthcare, mainly surgery, because of the wait time in Canada. The rise of “medical tourism” in India and Asia is primarily from Non U.S. sources, although there are more American going because of the our high cost, which is the real problem, not how we pay for it.

While some savings may be made by improving how we finance health care that is not the crux of the problem. Modern medical is expensive and essentially a monopoly (elitists) run system, only MD’s, (Physician Assistants (PA’s) and Nurse Practitioners need to be affiliated with an MD), can write prescriptions, admit patient’s to hospitals and perform surgery. The only real way to significantly decrease medical cost is to expand the number of “gatekeepers”, give PA’s and Nurse Practitioners the ability to write prescription, perform some surgeries, admit patients to the hospital. Stop the AMA’s oversight of Medical Schools thus expanding the number of doctors. Eliminate the need for prescriptions for many more drugs, that is, expand the role of the pharmacist, most new pharmacist are now PharmD’s that is the “equivalent” of a PhD in pharmacy. Let patients order their own lab and Xray test, it’s a sad but true commentary on modern medicine education that 80% of what doctors do is check to see if the lab work is within normal limits, the limits which are printed out on the report. Very few non-radiologist physicians can read an Xray, they rely on the radiologist interpretation comes with the xray results, in fact 80% percent could of medical care could be programmed into a computer. Of course the problem is the other 20% and knowing which 20% needs a higher level of care. There will always be a need for well trained health care providers, they just don’t all need 15-20 years of training.

As a last thought, if health care is a right, what are the responsibilities that are attached to it. Rights do not come without responsibilities’. Arguably if health care is a right all have to help pay for it, but then the individual has a responsibility to live a “healthy lifestyle”. Think about what that means!

Maniakes writes:

I think the difference is that a rebate is one-time-only but a credit is every time. The problem with either is there are 300 million Americans, and giving each one $2000 would cost $600 billion.

Jessica Daniels writes:

Healthcare...what are we doing and how do we fix it? The age old question for Americans. Along with the infinite list of other problems that this great country has to shuffle through. As an American it is a disappointment that we have yet to figure out an error proof way of implementing, controlling, and maintaining issues such as healthcare and wages for everyone in every income bracket. Someimes I why we put greater media attention on saving other countries...when in fact, within a 60 mile radius of any American you most definitly have a chance of seeing 'third world like' conditions for a HUGE number of our own people. And some NOT by CHOICE. Its America...affordable healthcare should be available to anyone and everyone. Rebate or credit...figure out something!

Dale writes:

Ron mentions rights coming with responsibilities. I disagree. Rights are rights, and are not subject to someone else's proposed responsibilities and their definitions. More correctly, it is privileges that come with responsibilities.

Ron writes:

Let me clarify my position, Dale is only partially correct. There are few if any absolute rights unless you are Robinson Crusoe sans Friday. Any right you claim that is independent or does not require acquiescence or effect other people does not have responsibilities, i.e. right to your own body carries no responsibilities, use or abuse it at will, arguably there are legal and family affects that may be involved. However, when you claim a “right” that affects other people that right carries responsibilities. As for a right to healthcare you have a “right” to as much healthcare as you can personally pay for out of pocket, but when you use insurance, government programs or charity responsibilities attach.

Matt G writes:

As Ron stated:

"As to the wonderful Canadian and European system, I lived in Seattle for a few years, the flow was Canadians coming to the U.S. to get healthcare, mainly surgery, because of the wait time in Canada."

I will take this oppourtunity to focus on the subject of our healthcare system as a whole, and that despite its flaws things could be much worse. With friends in Canada and the majority of my family living in England, I can personally vouch for them that the "Free National Healthcare" system only creates poor healthcare and an extremely expensive lifestyle in both countries. Imagine having to wait 3 years for surgery, as my friend in Vancouver was told, simply because without privatized healthcare there is no incentive to which our natural greed is in love with. Also, with 12-20 million illegal people in this country using our hospitals, schools, dmv's, roads, etc... and not paying for it, one can only imagine the kind of debt and unstability free national healthcare will plunge our nation into. No matter how much liberals or conservatives bitch about our system, (mostly liberals) our system has created the best doctors in the world, and taking the system away that created such wonderful doctors would be a disservice to not only ourselves but the people of third world countries that many of our doctors so often preform pro bono work in.

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