You Cahn’t Get The-ah from He-ah

Megan McArdle explains why the PPACA isn’t the first step in the process of getting to a single-payer system using Vermont as an example. Basically, it’s just too darned expensive. Our present basis for healthcare spending is just too high.

10 comments… add one
  • Ben Wolf

    Strange argument she makes, that we can’t afford a different health care system because the current one sucks. It’s even stranger she prefers sticking with the system as it is, given she just admitted it is the worse option.

  • I don’t think that’s the argument she’s making. I think she’s saying that

    a) federal law prohibits Vermont from creating its single-payer system
    b) there’s not enough willingness to pay

    Hence my title (which is from an old joke about Maine).

  • Seems like the law covers (a), as McArdle mentions, by way of waiver.

    The second is going to be a tougher nut to crack. In this sense, Vermont really isn’t a good test case. It’s like Tennessee as a model for the sales tax in lieu of the income tax. Vermont is small and if you live in Vermont, you live close to another state, which in this context matters. Montana (which also flirted with the idea) is a slightly better test case in this respect as it’s more isolated.

    An oft-cited method of cutting costs through single payer is leaning on providers. Which might work on a national scale, but hospital administrators, physicians, nurses all choose where to operate. Lean on them too hard, they’ll take jobs elsewhere. This is as big a problem in Montana as Vermont, if not moreso by virtue of the difficulty recruiting personnel to Big Sky Country.

  • steve

    She seems to be making the case that single payer costs must not increase taxes, while also relieving people of the costs of their current insurance. Not doable.

    As I always note, she is not very knowledgeable abut health care. I now spend lots of time working out how we are going to change the way we practice. In 5-10 years our practice will be drastically different. The ACA is making us cut costs, while maintaining or improving quality.

    Let me give one concrete example. I am letting my mid-levels work more independently. I am taking a doc who was supervising people who really didnt need much supervision for what they were doing, and using that doc to do more in depth assessment of patients before they have major surgery, especially the elderly. We are finding that way too much testing is being done, and that often the wrong kind is being done. Also, we are taking the first steps to consider not doing the planned surgery at all. In the recent past, everyone got paid regardless of whether the surgery was a good risk or even had much chance of helping. Now, we are starting to look at the likelihood of improvement and potential costs. This has never happened before.


  • She seems to be making the case that single payer costs must not increase taxes

    I don’t think that’s the argument she’s making. I think she’s suggesting that there are levels of taxation that are politically impossible and/or it may not be practically possible to realize as much revenue through taxation as they’d need to run the program. You don’t necessarily increase revenue by raising tax rates, you know.

    I think that’s the basic political problem in the U. S. today. There’s an unlimited appetite for services and a limited appetite for paying for them.

  • PD Shaw

    @Ben, its not Megan’s argument; Vermont wants a single-payor system on the condition that it cost no more than the current system. Unlike her, I don’t think Vermont as a moderate state, but left of center. Also, Vermont is probably too small for this experiment in the sense that its healthcare market overlaps with neighboring states, and to a lesser extent so does some of its healthcare insurance market.

  • steve

    PD- But they dont want to pay more in taxes.


  • PD Shaw

    @steve, IIRC the tax on employers was going to cost jobs for smaller employers. Lost jobs are probably a bigger issue than the concept of higher taxes for the Socialist Republic of Vermont (a name a former Vermonter first gave me over 20 yrs ago)

  • michael reynolds

    Naturally Steve’s real-world, hands-on comment is ignored. It’s outside the paradigm. Actual doctor actually cutting actual costs because of O-Care? Shhh. Let’s pretend he didn’t say anything.

    Latest CBO: O-Care will cost less than projected.

  • ...

    Latest CBO: O-Care will cost less than projected.

    No shit. Instead of supporting 35,000,000 people it’s only got to supprt 7,000,000, LOL.

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