At the Wall Street Journal Chris Jacobs of Juniper Research has an op-ed in which he notes that Democrats are moving towards endorsing a single payer healthcare system:
Conventional wisdom in Washington holds that so-called moderate Democrats who haven’t endorsed Sen. Bernie Sanders’s single-payer healthcare plan support many coverage options.
But a white paper on healthcare reform from Oregon’s Ron Wyden, ranking Democrat on the Senate Finance Committee, shows that this is false. The report, released July 30, mentions the word “profit” or derivations thereof 185 times in an 86-page document, echoing New York Mayor Zohran Mamdani’s rhetoric demonizing wealth. The outlined policies also resemble those of Mr. Mamdani and Mr. Sanders—proposals that Democrats previously rejected as too costly and disruptive, and that would move the country toward a fully government-run system.
The Wyden document begins with a discussion of “consumer-friendly enrollment.” It proposes “a more standardized or centralized platform that creates a consistent enrollment experience across coverage programs,” suggests that “existing enrollment processes in the employer market can be burdensome for workers,” and raises the idea of including employer coverage in this “more standardized employer platform.” The apparent attempt to integrate businesses and employer coverage into a government-run enrollment architecture resembles the purchasing alliances that defined Hillary Clinton’s failed healthcare proposal in the 1990s.
That raises a more fundamental question: what mechanism prevents the amount being paid from continuing to grow faster than the resources available to pay it? I don’t object to a single-payer healthcare system with one proviso: healthcare costs must be controlled.
Some do it better than others but there are no single-payer systems that do not at least attempt to constrain costs. The biggest problem with single-payer in the United States is that the Congress has abandoned attempting to control healthcare spending on the programs it subsidizes.
Our problem is that the incentives of patients, healthcare providers, and those who pay for healthcare are not properly aligned. My own preference would be for a system that resembles Italy’s, a capitation system in which primary care physicians are compensated based on the number and demographics of their patient base. I would go farther, however, and have specialists compensated through primary care physicians. That would align the incentives of patients, primary care physicians, specialists, and those who pay for care.
A system in which the government merely foots more of the bill without increasing taxation to pay for it may be appealing but is impractical.
For the last several years, we’ve had a single provider system here in Knox Co., Ohio. The local county hospital has purchased all the private practices in the County, and all MD’s are hospital employees. (I believe the few medical marijuana clinics are private.)
Moreover, the local system has just been purchased by Kettering.
My sisters (both RN’s) tell me the same consolidation is happeniNG in NH.
Because of medical misconduct, we lost our family practice physician of some 30 years, and it took the local Hospital more than a year to get us another regular doctor. In the meantime, we made do with a “traveling doctor (??)”\,” who was uninterested in our concerns.
So, what would a single payer vs. single provider look like. The universally despised, and highly politicized British NHS?
Since Congress would be in charge I dont see anyway to guarantee slower increases in spending. That said, spending on private insurance has increased at a faster rate than that of Medicare over the years. Spending has slowed since the ACA passed but predictions are that it will increase again. In places where they have universal health care with lots of govt intervention they do try to address spending and I am not sure why the US wouldnt. ( link goes to just one of dozens of papers documenting the difference.)
https://www.beckershospitalreview.com/finance/private-insurance-prices-grew-47-faster-than-medicare-rates-5-notes/
I am agnostic on single payer. It turns out there are few true single payer systems. Opponents cite the bad parts in the NHS or Canada. Supporters cite Taiwan, Australia and occasionally Italy. Of note, in the places that are used as negative examples by opponents, people in those countries are generally happier with their health care than are people in the US.
The system in Italy is similar to what some networks out west were using for a while. They were the darling of health care writers for a while. However, they arent anymore. They are just another system now and are no longer cheaper.
Steve
Steve:
The issue is not “can we” but “will we”. Experience with SGR suggests we will not. EVERY single-payer system tries to control costs. As I noted some are more successful than others.
What some are promoting as “Medicare for All” is nothing of the sort. It is a single-payer system entirely supported by the federal government. I see no way such a system can succeed without controls.
Our current “system” has not been good at holding down spending. Are you advocating we stay with the status quo? I dont think so. Our current system is a fractured agglomeration of many systems, all with their own issues, with the private part of the system most expensive.
On the other hand, what we see in every first world country with decent medical care is that they cost a lot less than ours and they have essentially universal health care. (Yes, you can quibble around the edges.) I am actually agnostic about single payer but I do think we dont really do better at health care spending absent a universal system. In the ideal that would have been a free market system but everywhere it’s been tried to any extent it is more expensive and provides care to fewer people.
So I think Medicare for All or any other option will depend upon the details of implementation. Could work, could fail. With our current Congress I would expect it to get filibustered anyway if the Dems win and try to pass it and as we know Republicans largely dont care about the issue. I think this is like our debt, a big part of it actually, and it wont be addressed unless there is some crisis.
Steve
You left out something crucial: every single one of them controls costs.
“Medicare for All” cannot succeed without cost control and Congress has proven unwilling to control costs.
As to alternatives, just read what I wrote. Cost control is achieved by establishing a budget and aligning the incentives of the government with those of providers.
I thought noting they cost a lot less than ours adequately implied they control costs, but I guess not. Anyway, what’s your alternative, private insurance? KFF runs the numbers occasionally and the last time they did they estimated we would save about $350 billion in health care spending so if your issue is spending you should be prioritizing replacing the private system with Medicare
If Medicare becomes Medicare for All will Congress start advancing costs at the same rate the privates were? I dont know. Not sure why they would. What I do think is that if they do want to address spending it will be easier if we are in one system and not our current patchwork system.
Steve
Silly man! You’re assuming that “Medicare for All” actually means Medicare for all. That’s so 1970s. It doesn’t. It’s a slogan. It means 1) everyone is under the same plan; 2) no copays, deductibles, or premiums; 3) present Medicare reimbursement rates are used as a starting point and adjusted annually. If you don’t believe me cf. Bernie Sanders’s bill. It’s unworkable and unaffordable. Not to mention the moral hazard aspects.
I recognize that the plan I described would appeal to no one and, consequently, is unrealistic. But it would be workable and affordable.
Meh, the original proposals looked different than the final ACA. It’s easy to make wild claims. People can say stuff like “we already won the war” or “the strait is open” but eventually you have to face reality. And again, you are lobbying for the status quo.
Steve
Now I’m confused. We haven’t been talking about the Affordable Care Act. We’ve been talking about “Medicare for All”. Bernie Sanders has been rather clear about what he means by it and it isn’t Medicare for all. The chap running on the Democratic ticket for U. S. senator in Michigan has echoed that definition.
For some reason you seem to think that what they are fantasizing about now is what would be made into law. The Sanders proposal doesnt really offer any funding proposal. If they want to offer everything in his proposal they are going to have to increase spending on national health care. I think it’s one thing to tell people your taxes will increase but your pay will increase to offset that since your company wont be paying. I think it’s a hard sell but maybe doable. It’s an almost impossible sell, I think, to tell people that the tax increase will be much larger than your pay increase.
The ACA was followed by a 15 year of leveling off of health care spending. It has increased at about the same rate as inflation, something not seen since the 60s. It still got demagogued by the GOP and few people are aware of this leveling. I think even fewer are aware that growth in spending of Medicare (and Medicaid), per enrollee, has been much slower than private insurance costs.
“Per enrollee spending by private insurers grew by 96.5% from 2008 to 2024 — much faster than both Medicare and Medicaid spending growth per enrollee (59.5% and 51.6%, respectively). In general, private insurance pays higher prices for healthcare than Medicare and Medicaid.”
As you may or may not know Medicare for All, meaning extending it to everyone in its largely current form, has been advocated by some people for a long time. I see no way the Sanders version passes. I dont really think the more standard version can pass either as even though it would save us money it would be viewed by too many Americans as too much government, ignoring that its what the rest of the first world does and they get good care at 2/3-3/4 of what we pay. But if they have nay chance of passing this into law it will have to look a lot less like the Sanders version.
https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#Cumulative%20percent%20growth%20in%20per%20enrollee%20spending,%20by%20private%20insurance,%20Medicare,%20and%20Medicaid,%202008-2024
Steve
What you are doing, steve, has a name: reversing the burden. That Sen. Sanders means what he says is a weak assumption; that he and his supporters don’t is a strong one and poses on you the burden of demonstrating that they don’t not on me of proving that they do.
BTW, why does everybody ignore that actual Medicare for all means spending more on healthcare for present Medicaid recipients? And the indigent definitionally cannot pay for healthcare.
Maybe, but I think there is a sufficiently large number of proposals that were going to give us two chickens in every pot and unicorns that when faced with having to be turned into law were significantly changed. Its what happened with the ACA when they had to actually put it into law. (This was also true of the implementation of Medicare Part D, though maybe to a lesser extent. On the non-medical front remember all the worry over the New Green Deal and how it was going to bankrupt us?) Maybe this time will be different.
Anyway, as I said, it will get filibustered so it has no chance of becoming law. Even if they went with the older plans for universal Medicare, which could possibly generate broader public support, I dont see the GOP not filibustering it and I dont see a 60 member Senate majority anytime soon. Maybe if the strait stays closed and oil hits $150-$200?
Steve