• What the Super Committee can really do: a response to the response

    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.]

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    • “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.”

      I think it’s nearly as bad to concede this point as it is to concede that national insurance is impossible. Wait times and denied treatments are features of private health insurance as well, except that they’re tuned to maximize profit instead of cost/benefit ratio. The same drugs that aren’t covered by the British NHS aren’t covered by American insurance absent massive co-pays, with drug companies pitching in co-pay assistance that lets them deduct charitable contributions to themselves while getting the insurer’s contribution as well. Insurance companies also profit when patients delay or don’t receive treatment because of bureaucratic barriers just like national health systems reduce costs by making folks wait.

    • I have several comments about this post.

      “It’s American as apple pie.” Many people don’t believe Medicare is American as apple pie. Who, when they think of the most characteristic aspects of America, thinks, “oh, yeah, Medicare. America wouldn’t be America without Medicare.”?

      “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. ” Frankly, I don’t know if a single-payer system would be cheaper than our current system. I actually believe that the mix we have may be the worst possible situation and moving either to more competition or less competition would reduce costs. However, everyone in the world has cheaper health care than the US. Those nations have a wide range of health care systems, too. I don’t think all of them have single payer. So it’s possible to have lower costs without single payer. Also, correlation does not imply causation.

      “Let’s own that Medicare these days, a single-payer system, is pretty much beloved.” By whom? I’d like to see a poll broken down by demographic groups. I imagine the people who love it are all on it or near retirement. It’s not hard to love something that greatly benefits you at the expense of others.

      Finally, I disagree with the notion underlying this entire post that the only way to save money is to move towards socializing medicine, and anyone who disagrees with socializing medicine, really doesn’t want to solve the problem. Your detractors may believe that there are other, superior solutions to this problem.

      • Jeremy:

        Exactly where can you find cheaper health care than Medicare, VA, and medicaid for the same benefits? There is no shortage of data for this. I would think that it would also follow from basic logic (no profit, less cost).

        As for the beloved part, I suggest google. People like single payer better than private care. The fact that you think people are getting it at the expense of others intrigues me. The last time I checked, my paychecks included a mandatory deduction for medicare. I would consider this a federal tax. Likewise, my parents also pay for the privilege of having medicare.

        In any case, whenever I received my private health care through my employer I was also getting it at the expense of others due to an employer tax break.

        If there is a better solution, they are free to present it. I haven’t seen it. Saying “free-market” or “reform” isn’t a solution when there is a solution known to work.

        -MV

        • “People like single payer better than private care.”

          SOME people like single payer better than private care.

          I should have been more clear when I said “at the expense of others.” What I meant was people who are receiving it now or are about to, are going to receive a much higher value than they put into it. I didn’t mean to imply that people pay nothing for it.