Today I saw this
http://khn.org/news/tab-for-single-payer-proposal-in-california-could-run-400-billion/
I’m working on a higher quality blog post for the main site on this, but for right now I’d like to point out a novel idea. Consider this quote from the article
A single-payer system likely “would be more efficient in delivering health care,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. (California Healthline is produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.)
But the proposal expands coverage to all and eliminates premiums, copayments and deductibles for enrollees, and that would cost more money, Levitt said. “You can bet that opponents will highlight the 15 percent tax, even though there are also big premium savings for employers and individuals,” he added.
We always hear this. “Single payer health care will save so much money because of all the efficiencies that you can get from central management”
Is this true? Well it just so happens we have a real-world example: HMOs. For example, Kaiser Permanente, the entity referenced in the above quote.
(an aside for non-US readers: in the US, health care is generally privately provisioned, and fee-for-service. That is, if you want a doctor to do a thing, you give them money, and they do the thing. Most people have some kind of health insurance, and this tends to take one of two forms: HMO or PPO.
PPOs are standard, and flexible. In a PPO, the insurance company develops a “network of providers”, a set of doctors who have agreed to work with the insurance company. You are strongly encouraged to go see one of these doctors. If you choose to see a different doctor, “out of network”, your insurance will cover a smaller fraction of the cost. This remains fee-for-service, it’s just that insurance pays.
HMOs, on the other hand, take a very centralized approach. They are one large company responsible for catering to your health needs. In an HMO, you can only go to doctors at facilities run by the HMO. If you need a specialist, you must get a referral to a specialist who works for the HMO. Since everything is integrated, it’s easier for multiple doctors to coordinate and work together. However, your choice of doctor is severely limited. With a PPO, if you don’t like your doctor you can get a new one. Under HMOs, your choices are limited)
The description of HMOs sound a lot like single-payer health care writ small. You give lots of money upfront to an organization like Kaiser (you pay lots of money in taxes to the government to support health care), and in return you go to Kaiser-affiliated facilities (government-funded hospitals) where all of your care is provided to you by one entity. The centralization facilitates efficiencies as bureaucracies are cut, and your needs are taken care of as best they can.
So, approaching the problem from a different point of view: Single-payer government-provided health care is more-or-less the same as if everybody signed up for Kaiser.
This gave me a deliciously trollish idea, an argument to bring out whenever relevant. Let’s say you’re arguing with some commies who insist that single-payer is the best/only solution. Pose to them this hypothetical:
“Would you be in support of a law that gave $HEALTH_INSURANCE_COMPANY a legally-mandated monopoly in health care, at the cost of forcing them to become a non-profit organization?”
Imagine one way to implement single-payer government-provided universal health care:
1) Give Kaiser a legal monopoly on health insurance
2) Legally require Kaiser to be a non-profit.¹
I suspect that most of your commie friends would be incredibly opposed to this idea, and yet it is fundamentally the same thing as a state-run single-payer health, with two caveats
a) You aren’t legally required to opt-in. You can still pay expenses out-of-pocket instead.
b) Instead of the health system being run by whoever is friendliest with our elected representatives, it’s run by people with a proven track record of success in that field.
I suspect this argument generalizes, too. You could apply it to any realm of government service provision that you can think of. It might help a handful of the smarter, more intellectually ethical folks see things from a different perspective.
1. Kaiser IS ALREADY A NON-PROFIT. So much for “greedy health insurance corporations ruining everything in their greedy corrupt quest for more profit”
