The editors of the Washington Post go off on “Medicare For All”:
SINGLE-PAYER HEALTH care can work. Government-run systems operate in other industrialized countries and often achieve comparable or better overall results, for less money, than the health-care patchwork in the United States. So why aren’t Sen. Bernie Sanders (I-Vt.) and Sen. Elizabeth Warren (D-Mass.) proposing something that resembles those systems?
The two presidential candidates promise far more generous benefits than other countries offer. They pretend that the United States wouldn’t have to make any of the trade-offs other nations have had to make. They promise fantastically generous benefits, no premiums, co-payments or other cost-sharing, and a miraculously low price tag. It’s fiction.
All Americans should have decent health-care coverage. They should also have good schools, good roads and world-class universities. Nations with single-payer plans have had to make real-world compromises among these various needs. If the Warren and Sanders plans sound too good to be true, it’s for a reason.
Let me make some scattered observations. We can’t reduce the cost of our health care system without reducing somebody’s income. Some of those somebodies will be in the insurance sector but most of them will be in the health care sector.
What’s the fixation with centralization? Here are the populations of some of the countries with which people routinely compare the United States:
and here are the populations of some U. S. states:
The total U. S. population is something like 330 million. Get the point? Those countries are more like states than they are like the U. S. as a whole. We are also much larger physically and enormously more diverse than any European country. We are very nearly as large and diverse as all European countries put together.
If we’re seriously considering a single payer system, why not a system more like that of Canada, a country which we resemble culturally much more than we do France or Germany. Canada’s system is run by the provinces.
Administration of Canada’s system costs about half as much as ours. We simply are not going to realize savings in administrative costs beyond Canada’s. I would be astonished if the savings in administration from going to a single-payer system here would even match that and the financing assumptions of practically every body’s plan makes that assumption. Everything our government does costs more than anywhere else. Why should health care be an exception?
There are actually good reasons why a single payer system is not a good fit for the United States and I usually summarize them by saying that we don’t have enough social cohesion. That covers a lot of territory including a greater emphasis on individualism, diversity, and a long-standing culture of political incompetence. We don’t trust our government for good reason.
I’m actually more concerned that every American should have access to decent health care than I am that they should have access to decent health care coverage. Framing it that way conditions the discussion.