It’s an article of faith with many that a single payer healthcare system in the United States would solve the affordability problems with our system. How?
I think the reasoning is that since our European cousins’ healthcare systems are cheaper than ours (significantly cheaper: we spend 30-50% more than the next most expensive European competitor for the title) that their systems are cheaper because they have single payer systems (or full-on national health systems). I think that’s almost certainly wrong and that the causality goes in the other direction. One data element that supports that view: France, Germany, and the UK’s healthcare systems are getting more expensive, too. They’re just growing from a lower base than ours has.
So, perhaps someone can explain to me how a changing to a single payer system alone will stop the persistent cost increases we’re seeing here.
My own view is that changing to a single payer system, if it removed insurance companies from the picture entirely (that’s not necessarily the case: Germany has a single payer system and lots of insurance companies), it would create enough headroom that we could introduce the structural reforms that are required to make healthcare permanently less expensive here. But it would be a pretty short window. The whole shebang would need to be done in a single package, something that’s very unlikely given the way our poliltical system works.
IMO there are only two things that are dopier than believing that changing to a single payer system would ipso facto make our healthcare system affordable. The first is believing that we can introduce enough market forces into our healthcare system that we could make it affordable in a way that’s consistent with a reasonable level of public health. The other is that implementing the two shibboleths of the Congressional Democrats (community rating and guaranteed cover) will fix our healthcare systems’ cost problems.
I dont recall ever seeing community rating and guaranteed coverage being touted as cost reducers, but rather are intended to increase coverage. They would make coverage affordable for the truly sick, but would increase costs for everyone else. (The mandate and the public option (plus the IPAB) were seen as the cost reducing parts of the ACA.)
As to single payer, I dont see it as a magic cure, and am pretty agnostic about it. The biggest potential advantage wold be having everyone in the same system, which I think is a necessary step towards cost control. You dont really need single payer to do this.
Steve
I’m agnostic too and I’m skeptical that single-payer will be the magic bullet that its advocates suggest without major reforms in other areas, like FFS.
How? Just curious. The administrative cost angle? I’m not sure that will get you all that much. After all, if some of those administrative costs go towards denying claims, then you’ll see claims go up, expenditures go up and possibly by more than the administrative costs. That “seen” vs. the “unseen” thing.
IMO our healthcare system needs basic, structural change, something that reduces the predisposition to treat and the predisposition to be treated as well as lowering wages in healthcare generally and slowing their increase to something our society can tolerate. My view of getting insurance companies out of the picture is that it’s only good to give you a little headroom to make the necessary basic changes. I don’t expect much out of it. Just a little temporary headroom.
There are any number of ways to address each (the predisposition to treat and the predisposition to be treated). The former could be addressed by a capitation system or a full-on national health system. Since, as steve has pointed out any number of times, much “demand” is actually physician-created, I believe that’s the end that most needs addressing.
The obvious solution to reducing the predisposition to be treated would be increased out-of-pocket payments, presumably on some sort of sliding scale. Unfortunately, I know of no study that has ever found that increasing the cost to patients results in patients deferring non-essential care rather than both essential and non-essential care.
I’m sorry, I’m asking why should there be any headroom?