Panda Forgets Single-Payer
(In which we mostly correct the Panda Bear.)
Major points to Panda Bear for his passion, but his health policy leaves something to be desired, I must admit. His latest rant is good–and I agree some of it in theory, but he doesn’t seem to be well-versed in the single-payer “woo,” so here we go:
The key thing to keep in mind is that the various plans proposed to insure the entire nation will do nothing to lower the cost of medical care because they are just another scheme to shift the costs from one set of consumers to the other.
Actually, that’s not correct, Panda. Single-payer plans have consistently been evaluated and shown to cover everyone while saving money. They do this by cashing in on the massive savings associated with administrative waste (probably at least $100 BILLION), allowing drug price negotiating, and setting global budgets for health spending. (See the California Health Care Options Project, The Vermont Single-Payer Study, The Maryland Single-Payer Study, Massachusetts Health Care Studies, and Maine’s Single-Payer Microsimulation.) Just to be clear, these analyses were done by The Lewin Group and Mathematica Consulting, not single-payer supporters.
The only difference will be that instead of half, every single health care dollar will take a trip through the federal sausage mill.
60% of health care dollars already take a trip thru the federal sausage mill–yes, 60%–and when they go to the Medicare mill, you actually get more sausage (health care) for your buck. There’s lower overhead costs compared with most private insurers–no advertising, no huge executive salaries, no profit demanded by investors.
The money is going to come out of somebody’s pocket and it’s not going to be the government which has no pockets, just hands to grab from one to give to another
This is how insurance works–not just health insurance, but car insurance, home owner’s insurance–all of it. It’s risk pooling. And the bigger your risk pool, the better to keep the system going. Money for our health care system comes from the citizens, whether it’s from Medicare taxes or loss of income from businesses providing health insurance (the businesses get to write off the health insurance bucks).
This is why the concept of Health Savings Accounts (not to mention privatizing Social Security) invokes such howls of rage from our ruling elites. Not only do they hold the people in contempt thinking them incapable of planning for their own future but the money tied up in these accounts and owned by citizens is just another chunk of money that cannot be stuffed into the voracious maw of the political influence machine.
I’m against HSAs because they won’t do squat for our problems. 80% of health costs are from 20% of patients–those are obviously our sickest patients–and they’re going to spend thru their HSAs within the first 2 days. HSAs are a great tax-free way for the rich to protect their money from taxes, but like I said before, they’re focusing on a leaking faucet when there’s a Niagara Falls right next door. Also, sure, an HSA might make someone think, “Should I really go to the doctor for this cold? Maybe it’s a virus.” Okay, so you’ve saved the system 50 bucks. But what consumer patient, when truly sick, is in any state of mind to decide if he needs the CT scan the doctor is recommending? Or if she should be admitted? Come on. (It’s a myth that more consumer information improves health care decisions, anyway.)
It would be demoralizing to our nation to have the disparities of medical access so wide that the poor and ignorant suffer or die from conditions that those who can think and plan ahead easily eacape. We will, unfortunately, always need to give medical care as charity.
Awkward! 18,000 people die each year from lack of access to proper health care. You’ve never seen an uninsured diabetic come into your ER with a nasty foot ulcer or infection that eventually leads to amputation, Panda? Come on. And survival rates after amputation suck.
I don’t think we will, fortunately, always need to give medical care as charity. There are tons of other nations able to provide for health care for their citizens, because it’s a priority for their countries. We can make it one too, if we want to.
There are many conflicting forces in medical care, each one trying to stiff the other with the bill. The insurance companies want to pay as little in claims as possible which is understandable given the nature of their business. The medical industry, from physicians to the lady mopping the hospital floors, would like to get paid fairly for their services. The government wrings its hands at the cost but at the same time would like as many people dependent on government as possible. The people want all the medical care they can eat but they want somebody else to pay for it.
You’ve really gotta read Money-Driven Medicine, Panda. You’ll love it.
Bwah hahha hahh Bwaahh….Letting the government get 100 percent involved is going to result in massive savings in adminstrative waste? Har har bwahhhaaa…stop, yer’ killing me!
You know Graham, technically, if you really want to eliminate adminstrative waste you would go to a straight fee-for-service with no insurance at all. In other words, when I change the oil in my car the only paperwork required is the receipt.
To say that the gubbmint’ is not going to want to manage, oversee, measure, contend, and punish (the things which require paperwork and from whence red-tape is born) is to not understand the nature of bureaucracy. The federal nanny is not just going to give money away with no strings attached. Maybe the paperwork burden will be less for the patients but it will not be for the producers of medical services.
The evidence is clear in other countries, even if you don’t want to believe it.
And I wouldn’t advocate a straight fee for service system–the whole point of insurance is to pool risk.
I’m not sure where you got the idea that the government’s single-payer wouldn’t be involved in overseeing or measuring health care, Anonymous. Try everyone’s favorite health policy joke, Canada. Physicians have one form that they fill out, usually electronically, to bill for their services, and they are required to be paid within 30 days. Less paperwork for providers? Absolutely.
The idea is to pool risk, not inevitability. Pooling risk is getting together with a group of low-risk individuals and deciding to each pay a little something something against the unlikely possibilty that calamity will befall one of you. Health insurance, as it is currently constructed for most people, is cost-shifting because the pool includes people who have a 100 percent chance of drinking deeply from the pool (which is why insurance companies struggle mightily to not insure these people).
Major medical is risk pooling. It’s not expensive and the cost is reasonable, for most people, given the risk. I’d sleep soundly with only major medical because, poor as I am (currently) I know that I have enough access to credit (the other key to economic prosperity) to not be ruined if someone in my family needed medical care up to the deductible of my policy.
I repeat: People, including the poor, need to pay for their own low-frequency doctor visits and generally low-cost standard medications. Everybody, includng the poor, should have major medical insurance. Paying huge sums to give people access to primary care which will have no effect (statistically) on their need for major medical spending later on is throwing good money before bad.
Now, if you want the taxpayers to subsidize major medical insurance for the poor and free care for those who are out of luck, well, I’ll meet you half way and agree that this would be a good thing. But most people in our country are not poor.
you know what’s funny about conservatives and how almost all universal healthcare skeptics are conservatives? they go on and on and on about how much greater we are than any other country in the world. but, the funny thing is, they’re the first people to absolutely, flat out believe that we are the only industrialized country in the world that can’t make universal health care work, and are so incompetent in making it work that we shouldn’t even be allowed to get to the point where we’re considering how to make it work.
i don’t understand the argument that the insurance companies are better than the government with regard to health care delivery. aren’t we already doing it the insurance company-business model way? isn’t it already failing miserably?
Whoa there, anon. Conservatives believe, fundamentally, that in the long run the people are better served living in a country with limited government and one where self-sufficiency and individual responsibility are the ideal towards which we aspire, not something that we run away from in our desire to turn the nation into a dependocracy.
The reason why the United States is so bad at delivering the entitlements which are the expected birthright of the Freeloader Kingdoms Across the Water is that the organizing principles of our society are (still are) against this kind of thing. If we’re going to be just another decaying nanny state then so be it (because we’re certainly heading there) but that’s definitely a step backwards from our founding principles and the ideal society.
The ideal society is not one where the mob expects the labor of other to support them. When you arrive at a good solution to only help those in need and exclude the freeloaders then drop by my blog and let us know.
But the argument that “we’re the greatest country in the world so we should be able to make ourselves into the best nanny state ever with all kinds of benefits n’ things” is not part of the conservative ethos and, as is typical, you are projecting what you want the arguement you want to make rather than arguing that you need to make (also known as the Straw Man argument).
Insurance companies do not deliver health care. They pay for as little of it as they possibly can. If you think the government is any different you are mistaken and don’t really have an idea of the way things are.
Just for your information, many physicians will not take government-insured patients (medicaid) because the payments dictated by the government do not cover the expenses of the visit (overhead, etc.) and have an opportunity cost in lost revenues that result from time lost in compliance functions. If you have ever done a medicaid well-child check you know what I’m talking about.
The difference is that you can, if you get fed up, tell an insurance company to pound sand. The government can fine and imprison you for violatiing the complex and contradictory regulations that many of you swear will magically disappear if the gubbmint’ takes over completely.
Need to fix some of those links – I wanted to read those!
About single-payer proposals, would these function on a national level or would the national government kick the ball to state governments to actually implement the plans? I’m curious about this because some states are obviously much richer than others: you identified a few above (the ones with single payer plans). How would the poorer states (like Louisiana, where Panda Bear and I are) effectively cover everyone? While Massachusetts hopes to cover 95% of its uninsured within three years (and Mass can, because of massive windfalls from previous years), state estimates project that the amount of state and federal money in Louisiana earmarked for health care can only cover 40% of the uninsured if we also adopted a mandate-based system where everyone has a state-funded insurance policy. Where is the money going to come from to cover the rest – from other states?
I’m liberal and I believe in universal health care, but I’m also a skeptic. Skepticism is a part of science and medicine: it’s useful to question interpretations and ideas when the skepticism is meaningful. On the other hand, you have to take a broader look at the measures used to measure health care globally. It is very, very true that the U.S. spends so much more money on health care but doesn’t rank at the top with respect to life expectancy or infant mortality. However, you also have to pay attention to who does, why they do, and what they sacrifice to have good results by these measures.
All of the countries who have higher life expectancies than the U.S. are much, much smaller countries with more homogenous populations; by the nature of bureaucracy, it’s much harder to take care of a larger number of people than a smaller number, and it’s easier to take care of people who are more similar in cultural beliefs and priorities. If you want a more fair comparison of life expectancies, you might consider comparing the U.S. to countries of comparable size or larger and then comparing their costs. The major exception in these comparisons would be Japan, as Japan is a reasonably large country and has a life expectancy of 81.25 while the U.S. has 77.85.
I have no doubt that instituting universal health care will have an effect on reducing the mortalities such as those that Graham mentioned: the 18,000 who tied for lack of access. However, I don’t think that we can yet deliver universal health care in a manner that is as cost-effective as in other smaller countries, particularly since we funnel vast amounts of money into research and development for new treatments and salaries for health care workers (mainly physicians), all of which translates into higher costs. One thing that is rarely addressed is the skill differential between U.S. physicians and those in countries with much smaller physician salaries: at least from the standpoint of medical education, many foreign medical graduates entering U.S. medical residencies are often much less well trained or prepared and may lack the refinements in diagnostic ability afforded to U.S medical graduates. Frankly, I think it’s a good thing that U.S. physicians are paid a lot (not merely out of self-interest). On the other hand, it’s better to get care than no care at all.
see, i don’t think conservatism makes sense (from my point of view). i mean, the reason we have a society in the first place, rather than anarchy, is that it affords the common person rights they otherwise wouldn’t have. without rules, there are going to be some who, with a combination of skill, luck, ruthlessness and selfishness, commandeer common resources and take advantage of others. and there are going to be some who, strictly due to chance, encounter terrible misfortune like lightning burning down their houses, or tumors metastasizing in their brains. no one person (unless they are in that greedy lucky camp) will have the resources to withstand a stroke of extraordinary bad luck, but each person recognizes that it could happen to any of us. therefore, we pool resources to afford every person protection (against bad luck and the malice of others).
would the conservative really say that the unlucky victims who have no way to survive the random brutality of nature (or of their fellow human beings) should simply not trouble us? or would they be so naive as to believe that it’s within the capacity of everyone to build their own fortress and fortune to deal with whatever unlikely atrocity may befall (which, even if possible, would be an astonishingly inefficient use of resources)?
sure, there’s a gray area. no one likes the idea that someone is living off society without contributing. but from my point of view, affording every citizen a good education and health care (which more than anything else maximize their ability to contribute back to the system), and minimal food & shelter to survive hard times, is the no-brainer best course of action for society.
i also think that if we had a functioning, competitive public education system (including the competent teaching of civic values and responsibility) and a perceived equality of opportunity for all people, then “freeloaders” wouldn’t be a problem because there would hardly be any.
if conservatives really wanted to complain about taxes, i should think they’d complain more about the massive corporate handouts that undermine their much-lauded “free market” forces. like $10 billion in taxpayer money that went to subsidize corn farming last year (of which about $500 million was accounted for just by high fructose corn syrup production–really serving the taxpayers well!). or, you know, the $420 billion spent so far on the war in iraq. that’s small government for you, right?
You don’t understand conservatism and are building another straw man that you may knock down triuphantly.
That’s the root of your problem. Any other discussion is probably useless until you educate yourself. May I suggest The National Review (print and online)?
Tim, are you comparing conservatsim to anarchy?
Well now that’s an interesting stretch…
The amazing thing about comparing conservatives to anarchists is that it has been conservatives who are, traditionally, for old-fashioned law and order and the liberals who have been the strongest advocates of the criminal-as-victim.
In brief, conservatives believe that mankind cannot be perfected and in this sense, our society has no history. In other words, you can drop me back in the 3rd Century AD and I could predict how people are going to act based on immutable human nature. With this in mind, conservatives are leery of abandoning traditional cultural and economic practices which have withstood the test of time in favor of the new and different. You can, of course, be too conservative (the Taliban, for example) but I think only a bufoon would say that most of the current social pathologies that we currently enjoy are the result of a strict adherence to traditional conservative philosophies.
Out-of-wedlock birth, low educational standards, the collapse of the family, drugs, violence, the general egotism of our culture, the exploding costs of the welfare state…not exactly things that the conservative movement hasn’t been warning people about ever since I can remember.
I think a lot of you folks, Graham included, live in sheltered liberal enclaves and wouldn’t know a conservative if he bit you on the ass.
Aaaaand as this thread has devolved, I’m closing it.