Austin’s ideas are sound, and I’ve echoed many of them before. So I’m not going to quibble with any of them. But I’m going to take issue with his response to critics, specifically #2:
Critique 2: This is a lot of tweaks to a broken system. Why not just nationalize the whole health system? This reason is simple: Congress and America won’t stand for it. Not now. Maybe never. For fun I could suggest the Super Committee consider nationalizing the health system (it’s not like they’re going to read my post anyway), but it sure would look politically naive. I may be politically naive, but not that naive.
Every so often, I have to remind Austin that Medicare (a single-payer system) used to be considered politically impossible, naive, and unpatriotic. Here we are, decades later, and it’s American as apple pie. Some states are even passing single-payer systems within their borders.
Now, I’m not suggesting that the Super Committee will manage to get a national single-payer system onto its lists of recommendations. But I think they should try – hard.
Here’s why. There’s little doubt that a single-payer system would be a much cheaper system overall. You’d be hard pressed to find a one anywhere that doesn’t cost significantly less per person than ours does. Yes, some other things might change that you might not like. Sometimes people might wait longer than they do here for some things. Sometimes the systems say no to procedures that we pay for here because they don’t think they’re cost-effective. But those things are done in order to save money.
And that’s the rub. These are not bugs of a single-payer system, they’re features. They exist in order to help control spending. You may not like them. You may find them politically unpalatable. You may think that they are unacceptable. But it’s a serious and proven way to reduce spending and control costs. If you’re not willing to go that far, then increased government involvement at other levels can get us some of the way there, too. I know many of you are already screaming, “No!” to that as well.
So, yes, it’s unlikely to pass. But it should be confronted. I’m hearing a lot of talk about how liberals are going to have to confront their political desires in order to reduce spending. Conservatives should have to do that, too. I think those that oppose reforms like these should be forced to recognize, publicly, that they, too, are unwilling to support changes that will reduce spending significantly, because they violate their political ideology.
Let’s own that Medicare these days, a single-payer system, is pretty much beloved. There’s talk of increasing the eligibility age to 67. It’s strange to argue, therefore, that it would be the “end of freedom” if we dropped the eligibility age to 63. And if that’s OK, then there’s at least an argument to be made that we could drop it further. You may not like it, but it’s not insane.
Sacrifices are going to have to be made. If the deficit is really this dangerous, then we should be willing at least to propose and discuss changes that are known to reduce spending. If we refuse to do even that, then we’re admitting up front that the deficit is less important than politics.
[From Austin: For the record, I was writing about a nationalized health system, just as Aaron quoted. That’s not just single payer. That’s government employed doctors and government run hospitals. I maintain that this will not happen in America, certainly not soon. Therefore, I consider it a waste of time proposing it to the Super Committee.]
