Speaking as a social libertarian and a fiscal conservative, here are some arguments against single-payer.
1) Medicare was originally sold as a limited health system for the elderly. The government promised that medicare rates would be comparable to regular rates. That was shown to be wrong within two years. Opponents to the original Medicare legislation shouted about this before the law was passed, but not enough people listened.
2) The government is not as efficient as a loosely-regulated market. (Note that I said loosely-regulated, not unregulated. Our financial meltdown shown what happens when you take a system from loosely regulated to (essentially) unregulated. You've got to have rules, and those rules MUST have sharp pointy nasty teeth that include cornhole-the-bastard-with-a-chainsaw financial and criminal penalties for willful malfeasance.)
3) Disruptive players change the rules in any field. Single-payer makes it harder for a small disruptive player to change the health care game. Not impossible, but more difficult.
4) Government influence does distort the field. As an auto supplier employee, I can tell you that everything that's being said in the news about how GM is now a tool of the government and is now building cars to satisfy social goals rather than business goals is completely true. It's percolating down to the suppliers as well. GM won't survive. Neither will Chrysler. (Something called GM will survive, but it'll be a shallow creature on financial life support until Kia buys it for the Cadillac brand...)
5) Single-payer establishes nation-wide rules. These rules are ponderous, weighty, annoyingly difficult, and EXPLOITABLE. They're also inflexible, or at least don't change quickly. There was a blog post somewhere on how people will game any system...
6) There's a temperament that says "Our roads are crap. Our public officials are corrupt. Public schools are useless. The government is not responsive to the needs of ordinary losers like you and I." If you believe this, single-payer will scare the crap out of you. I incline this way myself.
I think that the real problem with our system is that it's a hybrid. Bulk discounts are fine. If the government said "We'll get you 10,000 poor patients for your clinic, and guarantee that you'll get paid, but we need a 10% discount off of the reasonable and customary rate," you could figure out a way to deliver that service. Poor people will mind waiting in line and will gripe about being treated like cattle, but I don't really care about that.
But that's not what happens.
Today, the government pays the provider $2.50 for an hour of psychiatric counseling. No physician, counselor, psychiatrist, or social worker can live on that, especially if they have college loans. So these people are forced to game the system. They're required to provide more services if they want to eat. The providers then look for other sources of income. That's the private insurance patients. Result: our private rates go up. Once a care provider starts gaming the system, once he realizes that he can make money through providing services rather than health care, they often enter the financial greed death spiral.
The current legislation in the House scares me because it appears to take our hybrid model to new heights. The end result will be a greater transfer of money from US citizens to big pharma and big insurance. The public option will help, but as the legislation specifies that the government will not negotiate drug prices it won't help enough.
There are excellent examples of single-payer systems, such as Denmark or France. Problem is, due to our entrenched business interests, we can't get there from here.
There are excellent examples of completely market-driven health care. Look at Singapore -- one of the longest life spans in the world, and 3% of their economy is spent on health care. Think about that: 3% of the economy, and an average lifespan of about 80 years. Problem is, due to our entrenched Medicare/Medicaid interests, we can't get there from here either. Seniors vote!
We have met the special interests. And they is us.
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Potential problems with single-payer
Date: 2009-07-25 01:34 pm (UTC)1) Medicare was originally sold as a limited health system for the elderly. The government promised that medicare rates would be comparable to regular rates. That was shown to be wrong within two years. Opponents to the original Medicare legislation shouted about this before the law was passed, but not enough people listened.
2) The government is not as efficient as a loosely-regulated market. (Note that I said loosely-regulated, not unregulated. Our financial meltdown shown what happens when you take a system from loosely regulated to (essentially) unregulated. You've got to have rules, and those rules MUST have sharp pointy nasty teeth that include cornhole-the-bastard-with-a-chainsaw financial and criminal penalties for willful malfeasance.)
3) Disruptive players change the rules in any field. Single-payer makes it harder for a small disruptive player to change the health care game. Not impossible, but more difficult.
4) Government influence does distort the field. As an auto supplier employee, I can tell you that everything that's being said in the news about how GM is now a tool of the government and is now building cars to satisfy social goals rather than business goals is completely true. It's percolating down to the suppliers as well. GM won't survive. Neither will Chrysler. (Something called GM will survive, but it'll be a shallow creature on financial life support until Kia buys it for the Cadillac brand...)
5) Single-payer establishes nation-wide rules. These rules are ponderous, weighty, annoyingly difficult, and EXPLOITABLE. They're also inflexible, or at least don't change quickly. There was a blog post somewhere on how people will game any system...
6) There's a temperament that says "Our roads are crap. Our public officials are corrupt. Public schools are useless. The government is not responsive to the needs of ordinary losers like you and I." If you believe this, single-payer will scare the crap out of you. I incline this way myself.
I think that the real problem with our system is that it's a hybrid.
Bulk discounts are fine. If the government said "We'll get you 10,000 poor patients for your clinic, and guarantee that you'll get paid, but we need a 10% discount off of the reasonable and customary rate," you could figure out a way to deliver that service. Poor people will mind waiting in line and will gripe about being treated like cattle, but I don't really care about that.
But that's not what happens.
Today, the government pays the provider $2.50 for an hour of psychiatric counseling. No physician, counselor, psychiatrist, or social worker can live on that, especially if they have college loans. So these people are forced to game the system. They're required to provide more services if they want to eat. The providers then look for other sources of income. That's the private insurance patients. Result: our private rates go up. Once a care provider starts gaming the system, once he realizes that he can make money through providing services rather than health care, they often enter the financial greed death spiral.
The current legislation in the House scares me because it appears to take our hybrid model to new heights. The end result will be a greater transfer of money from US citizens to big pharma and big insurance. The public option will help, but as the legislation specifies that the government will not negotiate drug prices it won't help enough.
There are excellent examples of single-payer systems, such as Denmark or France. Problem is, due to our entrenched business interests, we can't get there from here.
There are excellent examples of completely market-driven health care. Look at Singapore -- one of the longest life spans in the world, and 3% of their economy is spent on health care. Think about that: 3% of the economy, and an average lifespan of about 80 years. Problem is, due to our entrenched Medicare/Medicaid interests, we can't get there from here either. Seniors vote!
We have met the special interests. And they is us.
==ml