The Devil Is In the Details

In his latest Washington Post column Robert Samuelson worries about what none of the proponents of “Medicare for All” seem concerned about—the details:

The popular appeal of a single-payer system to solve the nation’s health-care problems is no secret. Everyone would have insurance, recognizing — as Sen. Bernie Sanders (I-Vt.) continually tells us — that health care is “a right, not a privilege.” Our medical expenses would be paid by some central agency, eliminating the wasteful overhead of today’s insurance companies that drives up costs and premiums.

Presto, problem solved.

Oh, were it that easy.

and ends up at the conclusion I arrived at 25 years ago when Bill Clinton’s attempt to reform the health care system fell on its face:

It’s very hard to control costs when all health spending is considered a “right.” But the alternatives to single payer all suffer from some political or moral defect. The real point is that our choices are all bad in some way. Our unenviable task is to discover which is the least bad.

The key problem is that in order to control costs you’ve got to be able to deny care. In a country as diverse as ours that’s deeply problematic from a political standpoint. Whenever any member of any racial, ethnic, or religious minority is denied care, he or she will inevitably believe it’s because of his or her race, ethnicity, or religion. Faced with this identical problem 35 years ago the insurance companies decided not to control costs.

There is no national consensus for cost control and not enough respect for authority to simply accept whatever the powers-that-be declare.