Single Payor Is Nice But . . .
Posted by Chris Martin at 12/21/2009 11:17 AM 
Categories: Health policy, Politics, biPartisanship
Tags: You guys are not making it easier
Categories: Health policy, Politics, biPartisanship
Tags: You guys are not making it easier
It would be really nice if the left got serious about health care cost control.
Sure Wonks Anonymous is convinced that the Health Insurance industry is dysfunctional. He can even prove it using standard economic methodology. Wonks Anonymous is not particularly persuaded that simply striking a blow against the corporations will solve all of our problems.
In particular medical providers have shown themselves to be quite capable of fleecing the government and providing excessive, even harmful, medical care. The system of small providers and small groups of providers providing uncoordinated fee for service medicine is draining our finances and ruining our health.
Moderate proposals to solve this are ineffective and noxious. That would be to impose more price controls on fee for service providers and force sick people to spend up to 20% of their income on fee for service medicine before insurance kicks in.
Yet Wonks Anonymous has seen nothing on the left that even begins to deal with the problems of fee for service medicine. On the left the general stance has been that the elimination of insurance companies will free up the resources needed to provided everyone with all the tests and treatments that they can imagine at no extra cost.
This is not going to happen folks. Your insistence that it is only makes you look like fools. Wonks Anonymous has a serious treatment of this topic to be found here but he does get lonely.
Sure Wonks Anonymous is convinced that the Health Insurance industry is dysfunctional. He can even prove it using standard economic methodology. Wonks Anonymous is not particularly persuaded that simply striking a blow against the corporations will solve all of our problems.
In particular medical providers have shown themselves to be quite capable of fleecing the government and providing excessive, even harmful, medical care. The system of small providers and small groups of providers providing uncoordinated fee for service medicine is draining our finances and ruining our health.
Moderate proposals to solve this are ineffective and noxious. That would be to impose more price controls on fee for service providers and force sick people to spend up to 20% of their income on fee for service medicine before insurance kicks in.
Yet Wonks Anonymous has seen nothing on the left that even begins to deal with the problems of fee for service medicine. On the left the general stance has been that the elimination of insurance companies will free up the resources needed to provided everyone with all the tests and treatments that they can imagine at no extra cost.
This is not going to happen folks. Your insistence that it is only makes you look like fools. Wonks Anonymous has a serious treatment of this topic to be found here but he does get lonely.
Single Payer is attractive to liberals (aside from actually providing truly universal health care) because there is a huge chunk of money wasted in administration that dwarfs all of the cost savings in currently proposed health care reform legislation. While this may not solve the problems in the health care market and long term cost growth would probably still be unsustainable, in the short and medium term administrative costs are one of the biggest easily visible targets.
Beyond administrative costs, single payer makes other reforms easier. U.S. prices for drugs and medical procedures tend to be much greater than prices in the rest of the developed world. With single payer, price controls are more likely to occur than without it (see Medicare which "underpays" doctors).
Once the market is under greater government control, this also helps to transition toward a better payment model. Ontario has had success with Family Health Teams [1], which may be similar to the Accountable Care Organizations that you have been advocating.
[1] http://healthcarereform.nejm.org/?p=2612
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