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Jun
19

The case for single payer

Here is the case for single payer. Not saying that I agree with it, but here it is. Before you roll your eyes and click on “delete”, take a minute to consider the perspective of the single payer advocate.
I’m sitting in the only formal session of Take Back America dedicated to health care. The moderator, Roger Hickey of the Campaign for America’s Future, noted that the number one or two issue in most polls concerning election issues is health care. This being a policy conference, and health care being a key policy issue, one would think that there would be more than one session on health care, and that the panelists would include luminaries such as Paul Ginsburg of the Center for Studying Health System Change, Uwe Reinhardt, Karen Davis of the Kaiser Family Foundation, or Bob Laszewski of Health Policy and Strategy Associates.
That’s not the case. Even more puzzling, none of the panelists or attendees asked the key question – can Medicare control cost? I address that central question at the end of this post.


The folks here are advocating single payer, specifically the Jacob Hacker plan, which is a Medicare for all program.
And boy are they passionate.
Diane Archer of the Medicare Rights Center led off after Hickey’s intro. Archer noted that the stability of coverage can be rather tenuous, and many are only one step removed from losing their insurance. Archer contends that for profit health insurance puts us at risk, And her points are valid – costs are high, sick are punished becuase it forces them to pay when they rae least able to afford it.
Health plans are not incented to nor focused on providing care to the 10% of the population that uses 70% of the dollars (Archer’s numbers, not mine, but generally correct). I’d have to agree; as I’ve noted many times before health plans are not built to manage care but to select risk. And until and unless we force a change in focus, health plans are not likely to ever concentrate their efforts on care management.
Now onto Medicare for all – Archer likes it – a lot – it reins in costs, although I’m not sure how; the benefit design is satisfactory, and eligibility is easy and automatic. She also contends that most Americans support providing Americans with an option to buy into a public health care financing scheme.
Ned Lamont spoke of the need for focusing on all three parts of the problem – quality, cost, and access, and doing so simultaneously. The plan will offer Medicare for All as an alternative, and also set up a mandated health benefit design, universal coverage and low administrative costs. Lamont drew an interesting parallel between the health care system and GM. His point was that GM is seriously broken, requires fundamental repair, and therefore requires a change agent – just like health care.
Hickey’s position is that many of the candidates’ proposals will require extensive regulation of private insurers, regulation that he appears to view as unlikely to succeed.
The level of anger and frustration expressed by attendees was palpable, and loud, and high. Unfortunately the level of misinformation and misunderstanding was equally high.
For example, no one asked about Medicare’s complete inability to control costs. The core issue in health care in the US is cost; Medicare’s solution to cost is a formula that reduces provider compensation when utilization increases. And it has failed miserably to control costs – when prices are reduced, utilization increases.
Anyways, these folks are convinced that Medicare for All will solve all problems. That’s your challenge, health plans. Can you deliver better care control and cost control than Medicare?


2 thoughts on “The case for single payer”

  1. Medicare for all, or any single payer system which takes the reins from the hands of corporations, will cost us less. Where will the savings come: from the bellies of the corporations that have engorged themselves for decades at the pleasure of their boughten politicians.
    All this hoo-haw ignores that at the end of the day, the savings goes to Joe Sixpack and Minnie–not to some doctor making an easy $250K a year. Oh, and if you want to see the roots of the problem, go the Flexner Reports of 1908 where it was recommended to keep the supply of doctors down thereby keeping up the incomes of the deserving who had gone through the medical schools who hired Flexner. More endowments I guess.
    Doctors get cut back. But, they and hospitals employ fewer lawyers (good eh)and save in many other ways. I used to think doctors had brains until they let the Chamber of Commerce and NAM use them as the battering ram for the criminal “anti-tort” stuff, whose design — relieve people of their 4th Amendment Rights to jury trials — was the larger plan with the doctors as the puppets. Not too smart doc, you might need a jury one day–but now the economics of jury trial kill consumer fraud cases, thank you dr. dumb.
    The bigger the risk pool, the less we all pay. The more direct the mechanism, the less we pay (i.e. no insurers – unless you want). All medical practice governed by government, with specifically allowed vendors — all competing (hear that all you regressives-competing) to provide services, just as Medicare does.
    The numbers of distracters like the ones above, breathlessly offered and parsed to death, are legiond–and mean nothing, except they are part of someone’s propaganda set.
    Gore those oxen: AMA, insurers, managed HC, etc., and then lay out the rules. They will play! There area always enough to break a cartel. And tools include antitrust, use of medical review boards (many that do not review or anything, except meet and greet-more nests and infestations of lobbyists).
    Alexander (the Great) came to Gordia. There, according to legend, he found a great knot on an ox cart, which could not be untied as it was too big and tight. So, Alexander cut it, something no one else through deference to the “old folks” had thought of doing. William of Occam had a Razor, well not a razor as you think, but a proposition, “lex parsimoniae (“law of parsimony” or “law of succinctness”) – which might be said: look for the simplist solution, it is most likely right. Stop fiddling with the old, cut the know and go with the simplest proven solution, and all the rest bedamned.

  2. “All medical practice governed by government”
    Now THERE’s an idea the nation will rally behind.

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Joe Paduda is the principal of Health Strategy Associates

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