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Jul
3

From free markets to single payer

Richard Eskow didn’t want me to have all the fun.
He’s taken the arguments against a libertarian free market health care funding and delivery system to their logical conclusion – no insurance for most of us, lots of bankrupt folks, and then a single payer system.
Libertarians, you have been warned!


10 thoughts on “From free markets to single payer”

  1. Once again shows how all roads ultimately lead to a single-payer plan. The libertarian road just takes longer and is more painful for everyone.
    One day you’ll see the light. The time has come for one plan, one payer, universal care.

  2. “The time has come for one plan, one payer, universal care.”
    Oh, you mean Ein plan, Ein payer, Ein care?
    Got it.

  3. Yes, that’s what I mean. Got any better ideas? Let the market take care of everything? End all mandates? Unrestricted pricing? I’ve heard it all. Fact is our distribution of wealth and income is so unequal and the cost of health care so high, there’s no other system that will control costs, spread the costs and provide anything close to universal coverage.
    Even in private markets you can normally find lowerer cost items – cheap used cars, small inexpensive homes, refurbished PCs, cheap food. Where does one even find inexpensive healthcare? Even if you’d be satisfied with 1960s-era healthcare, where can you find it? Modern healthcare is all or nothing. It’s intensive and expensive. Verstehen sie?

  4. “Where does one even find inexpensive healthcare?”
    So you have not really “heard it all” – have you? And of whatever you have heard, you dismiss the part you don’t want to be true.
    At least you know the problem is expensive health not expensive insurance. So long as health care is expensive, insurance will be expensive. And no payer will be able to afford that cost, whether private or public, whether multiple payers or single payer. So your “solution” is no better than an aspirin. When it wears off, you still have the disease. What then?
    “Where does one even find inexpensive healthcare?”
    Oh, please.
    Have a nice day.

  5. Stella – yes, the problem is expensive healthcare. There are also unnecessary expenses in the private insurace system.
    If costs are spread around and we stop wasting so much on defense, Iraq, corporate welfare, etc. we can afford universal healthcare. It would be much cheaper and better under a single payer system than under the current mix of payers.
    Single payer could reduce both insurance expenses and healthcare claim expenses. It’s such a no-brainer I don’t know why we’re even debating it.
    A single payer has more clout to reduce provider fees, reduce drug costs and improve treatment patterns. Other countries pay far less than us for the same prescrption drugs. Medicare’s fee schedules are lower than the fees negotiated by private insurers. If physicians and hospitals don’t like it, don’t see Medicare patients. Of course if 97% of the population were covered by Medicare, there wouldn’t be many places to go. Set up shop in Canada or Europe? You’d be in for a rude awakening. You’d earn more here accepting Medciare payments. Leave medicine? Fine, we’ll train more docs. Maybe they’ll actually care more about patients and be less concerned about portfolios, vacation homes, and side businesses. Maybe they’d be more willing to follow proven treatment protocols rather than local customs.
    A single payer can more easily collect data because they’ll own all the data. This would improve research. They could track patient records their entire life, could track provider quality metrics, track outcomes, direct care to the most cost-effective settings, etc.
    Then there’s reduced insurance expenses, including the elimination of profits, marketing expenses and commissions. On top of there are millions in productivity savings when businesses and workers can stop worrying about health insurance and get back to work.
    Don’t like governemnt control? I’ll take my chances. It’s our best bet at this point. I’ve seen too much in the private insurance market. It’s time to put the American people first and losen the stranglehold of the AMA and private insurers.

  6. “It’s such a no-brainer I don’t know why we’re even debating it.”
    Just exactly as I said before – whatever you hear, you dismiss the part you don’t want to be true. And then you “don’t know” why anyone might not agree 100% with you. A real puzzle for you, isn’t it?
    Anyway, you seem to be the one who leaped in to “debate” this. That is, you rattled off a number of socialistic bromides . . . but that’s a whole ‘nother issue that really does not belong on this board.
    “Don’t like governemnt control? I’ll take my chances. It’s our best bet”
    No, I don’t. And no, it’s not.
    You continue to dismiss whatever you don’t want to be true. In this case, it appears you don’t want certain facts to be true about our government’s biggest existing health insurance programs, Medicare and Medicaid. These programs are rapidly being crushed by the cost of health care (Medicare alone has a $60 Trillion unfunded liability) and are far from effective in meeting the needs of their elderly and poor populations because of fraud, waste, federal budget politics, political corruption, organizational inflexibility, bureaucracy, and the massive amount of laws & regulations that govern all they do. Is there a single reason to suppose that our government can do a “better” job with health insurance if it controls all of it? I think not.
    BTW, I favor universal health care. I also favor universal health insurance to pay for that health care. I do not confuse health care and health insurance. I believe that any universal insurance scheme whether public or private CANNOT succeed in this country, unless the costs of health care are reduced and the annual rate of growth in those costs is brought down. I favor a substantial role for the private insurance sector in any universal health insurance scheme – as in France or Germany. IMO, a basic public insurance plan that can be supplemented by private insurance is a more reasonable alternative to the enormous bureaucracy that results within a fully-centralized system such as in the U.K.

  7. Stella – It’s a little scary but we’re not too far apart. You’d have “a basic public insurance plan that can be supplemented by private insurance” and I’d prefer a more comprehensive public plan. Copays and any extras could be funded by a tax deductible health savings account (with a $2000-3000 annual limit). The accounts for poorer people would be partially funded by the government via a sliding scale match. The accounts could also be funded by employers. Any extra spending would have no tax advantage.
    Supplemental insurance leads to tremendous adverse selection. I also have a feeling your basic plan would be so skimpy, almost everyone would need to buy supplemental insurance to have anything close to comprehensive coverage. Seems like we’d be taking 2 steps forward and 1 step back. I understand you’re desperately clinging to our dysfunctional private insurance system. But if you’d step back and think about it, I think you’ll agree that a more comprehensive public plan would be a better solution – it’s simpler for patients and providers and everyone is more fully vested in the outcome.
    BTW, Medicare is the best insurance system in the country. It has controlled costs much better than private insurers and has much lower admin costs as well. Any large system has a certain amount of bureaucracy (which I don’t dismiss). But it’s nothing compared to the cumulative bureaucracy, waste, fraud and corruption found in the private system.

  8. “I also have a feeling your basic plan would be so skimpy, almost everyone would need to buy supplemental insurance to have anything close to comprehensive coverage.”
    Apparently you have no argument, so you just make stuff up.
    “BTW, Medicare is the best insurance system in the country.”
    And you’re also pretty good at ignoring facts you don’t want to be true.

  9. Stella – You obviously have no persuasive responses to my arguments and must rely on attacking the messenger. I know the facts. I’ve been in the industry nearly 20 years and have come to the conclusion that all things considered, the time is right to adopt a Medicare-for-all type of system. It’s our best bet. I didn’t think so in the early-’90s. But in 2007 I do.

  10. “I’ve been in the industry nearly 20 years and have come to the conclusion that all things considered, the time is right to adopt a Medicare-for-all type of system. It’s our best bet.”
    Sorry, that’s no bet; a move to universalize Medicare with all its flaws would constitute an irresponsible gamble with the future of health care in this country.
    The expression of your beliefs is just that – an expression; it does not constitute an argument. Yet you expect others to accept your beliefs for no better reason than you have “been in the industry nearly 20 years.” la-di-da.
    “I understand you’re desperately clinging to our dysfunctional private insurance system”
    That’s what you understand is it? Then you haven’t even been reading my comments. Perhaps it would be better for you not to admit being old enough to have 20 years’ experience doing anything – with no more to show for it than you have produced.
    On the other hand you have neatly illustrated one of the observations I did make – that many people ignore the things they don’t want to be true. You have a lot of company.

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Joe Paduda is the principal of Health Strategy Associates

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