Critics of Single Payer Health Care Are Wrong

Here is an outrageous article that I read by a Forbes contributor, who speaks of himself as “promoting market-based health care solutions”. He discusses the implications of a single-payer medicare for all health care plan.

What would people be charged to enroll in Medicare? How much subsidy would they get? To make the budget balance, people would have to pay a premium that, on the average, equals the expected cost of their care. Just like Obamacare, there would have to be subsidies for lower-income families. With community rating, the healthy would be over-charged and the sick would be under-charged. None of these problems go away by shifting everything to Medicare.

The healthy would be over-charged and the sick would be under-charged. But that is precisely the point of a single-payer health care system: that the healthy buy insurance in case they need it, but in the mean time the money is used to pay for the health care of currently sick people. A functioning insurance system can not work without cross-subsidization, and he attacks the very principle of cross-subsidization. In his utopia, people should buy their own health care out of pocket. Good luck when you have a big surgery in front of you.

For people at work, there would be enormous pressure to continue the employer contribution by requiring employers to buy their employees into Medicare. That would raise the issue of exempting small business, exempting part-time workers, etc. These are the same issues we grapple with today.

Yes, employers have to buy Medicare for their workers, but the entire risk of carrying the insurance system is transferred from the individual firm to the government, which has a much larger pool of both beneficiaries as well as contributors to the system. Why would small businesses and part-time workers be exempted? The point of Medicare is to shift the provision of insurance coverage outside the employment system. An old person does not have to work if he gets Medicare coverage, and neither should a person below 65 if we have universal Medicare coverage. This guy simply does not understand the logic of a single-payer health care system.

Medicare already has an exchange. It’s how enrollees get into Medicare Advantage plans. This exchange is not going away. In fact, there would be enormous pressure to let young people participate in that exchange or a similar one. Every problem, Obamacare is currently experiencing with the exchanges will remain.

Yeah, but the Medicare Advantage approach is flawed from the beginning and poses a private insurance giveaway. It is kind of ironic that what he identifies as a problem (private insurance) is precisely the kind of solution that he would have advocated. Freud’s “disease of which it purports to be the cure” is driven on steroids, and I hope that critical readers will discern this logical and self-defeating inconsistency in the argument. In a single-payer program, you don’t have to worry about exchanges, because the government is simply the only buyer of health care services, so there is no choice required from consumers. Should young people participate in the health plan? Yes, of course.

Ignoring artificial prices and focusing on real resources,the United States actually looks pretty good. We have fewer doctors per person than the OECD average and we have fewer doctor visits. We also enter the hospital less often than people in the average OECD country and once admitted, we spend fewer days there. And even though we are spending less time with doctors and less time in hospitals, our health outcome measures are as good as – or better – than those of other countries.

Well, the US is very good, when it comes to providing high-end care, such as cancer, and only for people with generous insurance or deep pockets, of which there are not many in the country. How useful is a health care system that leaves so many people uninsured and many more underinsured? If people are visiting the doctor less often, because they can’t bear the out-of-pocket expenses, then this is fairly devastating for overall health outcomes. In the US, there are countless people who die because they lack any access to health insurance, and somehow these figures don’t show up in his analysis.

Clearly, there are countless sycophants of health care executives like this particular writer, and the goal of the left should be to be educated about the real issues in this country, and counter the narrative based on faulty premises.

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