On blogging, single-payer, and Harold’s post

I’ve been getting quite a bit of email since Harold’s post on Saturday. A number of you have asked why I’m not irate, and why I’m not more supportive of single-payer in general on the blog (especially given this)?

Well, first of all, I’ve already said my piece on this issue. And if you don’t think we blog about it here, you’re not paying attention. But I’ll say it again. I think single payer systems have a lot of positive things going for them. They are, of course, universal. They allow for major systems level experimentation and control. They can be used to change the delivery system fundamentally . Many other countries use them successfully. Ours does, too (Medicare), regardless of the rhetoric you hear.

But they aren’t going to happen here right now (see again). Since the goal is a better health care system, I prefer to discuss a range of options that are politically possible. That has made some of you angry, but as I told a group recently, you can’t talk about health care policy these days without ticking someone off. If my goal was to have everyone love me all the time, I’d do something else.

I have a lot of respect for many committed health care reform advocates (on both sides). Because of that, and because I want this blog to be about research, and not advocacy, I spend very little time talking about them directly. But, full disclosure, I belong to some organizations that do have advocacy arms. I’m a current member of the American Academy of Pediatrics and the American Medical Association. That doesn’t mean that I agree with all of their positions (nor they mine), so I ask that you judge me by my writings, and them by theirs. Same goes for other organizations I have belonged to in the past. And that’s all I’m going to say about them.

But I will comment on single-payer. Yes, I think single payer health care systems are often great ways to achieve universal health care that is of excellent quality. But for containing cost? There’s no magic about single-payer there (again, Medicare). And this is where the advocates and I diverge. They claim that the administrative savings will pay to cover all the uninsured. Maybe. But, even if that’s true, we will still be spending $2.6 trillion on health care, and costs will not be slowed in the future.

Less honest single-payer advocates ignore the issue entirely. More honest and thoughtful single-payer advocates sometimes address it by talking about central planning, global budgets, and transition away from any fee-for-service care. They also talk about moving to an all-non-profit-facility delivery system. And if you think single-payer is unpopular now, wait until people start hearing about those things.

I get why many on the right are uncomfortable with this. There are days I am, too. But I’ll concede one point: if Medicare is so awesome for people age 65 and up, why is it socialism for someone who’s 64?

Anyway. Since it’s not going to happen in the near future, and I want the health care system to be better now, we discuss a wide range of ideas here, from all comers. We try not to guess, nor impugn, the motives of others as they push for change. We try to see the positive and negative of all proposals. We bring evidence to bear when it’s available. We listen to you, especially when you make constructive fact-based arguments, and we correct the blog or change our minds when it’s approproate. It’s what we’ve always done, and what we will continue to do in the future.

That’s The Incidental Economist way.

AEC

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