Topic: Politics & Elections
Napoleon advised that one should never interrupt the enemy while he’s making a mistake, so probably I and all conservatives should just keep quiet about the Democratic Party’s growing craze for single-payer healthcare: “Medicare for All,” as Senator Bernie Sanders (Bolshevik, Vermont) has dubbed it. But single-payer is such an extravagantly bad idea that I just can’t resist pointing out how dumb the Dems are for embracing it. So let’s review.
The cost, of course, would be astronomical. Sanders & Co. speak vaguely of taxes on the rich and on such nebulous activities as “speculation” which would finance single-payer, but nothing they propose comes close to covering the bill. Indeed, no one’s really sure how much it would cost. Estimates range from $2.5 to $3 trillion per year. Accepting the lower number puts the price tag at $25 trillion over ten years. That’s serious money. Sanders’ plan is short on specifics but his tax proposals would raise only $14 trillion over ten years.
The claims that single-payer would be cheaper than the current system also seem dubious. The administrative costs of a system covering all 320,000,000 Americans would be astronomical, particularly in view of the facts that the job would have to be farmed out to private companies. And guess what? Those companies would expect to be paid for their services. So though single-payer would abolish private health insurance companies, it would replace them with a vastly expanded medical services industry. As Jay Cost has pointed out, this kind of private-public partnership has been tried many times before and has a vexed history. Flush with cash, the huge new medical services industry would be in a prime position to lobby and influence the government. Sanders & Co. claim that a single-payer system would put the government in the driver’s seat, with power to negotiate better healthcare deals for Americans. More likely, though, the system would come to be administered in the interests of those who operate it.
Then there’s the claim that a single-payer system would be more cost-efficient than the current private-public system. But as the Washington Post notes, there’s much less to this assertion than meets the eye. On a per-capita basis US government healthcare systems like Medicare spend more than Canada, Australia and Britain each spend through their entire healthcare systems. In other words, the US spends more per head to cover a portion of the US population than those other countries spend per head to cover their whole populations. Expanding Medicare to cover everybody wouldn’t automatically change that. Something else would have to give.
This brings us to the claim that a single-payer system would empower the government to control costs, e.g. by setting reimbursement rates and prices. Here again, though, the more closely one examines this claim, the more dubious it looks. Through programs like Medicare and Medicaid, the government already wields a big stick in the healthcare sector of the economy. But its influence is tempered by realities both economic and political. Obviously, there are limits on the power of price controls: set prices too low and the supply of goods and services that constitute the healthcare system would shrink. Only large medical conglomerates, able to achieve economies of scale, would tend to thrive in such a system. Small medical practices, clinics, laboratories and hospitals would be driven out of business. And this brings us to the real reason why the federal government’s leverage over healthcare costs is and would be less than total: the extreme political perils of taking a hard line on healthcare spending. As the WP puts it:
Doctors and hospitals have effectively resisted efforts to scale back the reimbursements they get from federal health programs. Small-town America does not want to give up expensive medical facilities that serve relatively few people in rural areas. A tax on medical device makers has been under bipartisan attack ever since it passed, as has the “Cadillac tax” on expensive health-insurance plans. When experts find that a treatment is too costly relative to the health benefits it provides, patients accustomed to receiving that treatment and medical organizations with a stake in the status quo rise up to demand it continue to be paid for.
In short, all the economic incentives would be for cost control while all the political incentives would be against cost control. That’s the political reality of a single-payer system and it’s a circle that can’t be squared. Once the government takes control of the entire healthcare system, it will be held entirely responsible for every physician forced into early retirement, every hospital closed, every treatment denied. So, politicians being what they are—beings desirous of being reelected—they would shrink from the rigors of cost control.
But the single-payer mob believes that it has an ace up its sleeve: The American people support single-payer! Naturally, though, that support depends on how the question is put. Ask Mr. & Ms. Average American if they want free government-provided healthcare and they’ll probably answer yes. But ask them if they’d like having their taxes substantially raised to pay for it, or if they’re willing to accept some one-size-fits-all healthcare plan in place of their current coverage, and you’re likely to get a different answer. The truth is that most Americans are fairly well satisfied with the healthcare coverage they have now. Why, for instance, would a family of four with decent employer-provided coverage cheer at having to pay higher taxes for Medicare for All? The costs being revealed, the details being spelled out, the cries of outrage, woe and anguish would soon drown out the tinny bandwagon music of the single-payer circus.
And there would be plenty of woe and anguish for sure. One thing that Sanders & Co. have so far failed to explain is this: How would the transition from the current system to single payer be managed? How long would it take? How much would it cost? How disruptive would it be? What about the economic fallout? The US healthcare system is one-sixth of the national economy. It is a mechanism of astonishing breadth and vast complexity. The idea that it can be neatly pivoted onto a new axis by some dim old codger and his congressional colleagues is beneath criticism. Remember Obamacare’s inaugural pratfall? Expand that by five or six orders of magnitude and you’ll get some idea of the chaos that would surely accompany any attempt to implement a single-payer healthcare system in the United States.
So, as a conservative, looking at the thing from a purely partisan point of view, I fervently hope that the Democrats make single-payer the keystone of their political platform. Like gun control, single-payer is an idea both ideologically addictive and politically toxic. And the Left appears to be hooked.
