I’ve been having a back-and-forth on another blog about the prospects for a single-payer healthcare system in the United States and I wanted to solicit some opinions here. One of the arguments made for a single-payer system is that having everyone within a single-payer system will reduce costs. My view is that under certain rather stringent circumstances that might be the case:
- Providers accept a pay cut.
- There is enough unused capacity in our healthcare system to provide care of at least present quality to everyone.
- We close our borders, particularly our southern border.
- The will to constrain costs emerges.
but, since those are vanishingly unlikely, I seriously doubt that will happen. My own view is that the reason that healthcare is so expensive in the United States is not because we’re not all covered under the same system but that prices are too darned high and no one has the incentives to cut costs. Getting private insurance out of the picture might help a little but in the absence of real will to control costs it would only be a litte.
Let me explain just one of those. I don’t mention closing the border out of any prejudice against migrants. Will this single-payer system cover everyone in the United States or just some of the people in the United States and what percentage of the people need to be covered by it before the economies kick in?
Consider Illinois. In Illinois something between 5% and 15% of the population consists of illegal immigrants. Will they be covered under this single-payer system? If they are not, everyone in the country will not be covered by a single system. If they are it seems to me that the costs will be significantly higher than has been estimated (and the estimates are high as it is) plus is will add yet another “pull” force to attract illegal immigration.
It’s not just Illinois. California, Oregon, Washington, Colorado, and New York have large populations of illegal migrants as well. That may be part of the explanation for why those states’ Medicaid systems support illegal migrants.
“…no one has the incentives to cut costs.”
Its a maintenance system, not an insurance system. If consumers view it as “free” and all covering. If providers view it as the insurance companies problem, but they still get paid. And if the consumers just impotently rail at insurers, but enjoy the all inclusive coverage, refusing to “economize” ………..there is no hope. There are no incentives.
I’d ask of anyone. You have auto insurance to cover primarily collision and liability. If that scheme was suddenly changed to a plan that covered, windshield wipers, filters, new tires, tune ups, car washes, brakes, bulbs, etc etc. Would premiums go up, down or stay the same. Would consumers use covered services more, less or the same? Would providers recommend use of services more, less or the same?
I’m always told health care is “different.” Bull. Economics are economics. Incentives are incentives.
Always gives me chuckle when the nurse’s unions advocate for universal healthcare while also better insurance and higher wages.
walt:
“Rich” means richer than me.
With respect to immigrants, all states are required to provide healthcare through Medicaid and CHIP, at least for amnesty seekers. Texas reports these costs in their immigration lawsuits. I think Illinois goes further in having more generous programs than other states (or at least Texas) while also extending coverage to illegal immigrants not required to be covered by federal law.
Don’t most European countries exclude immigrants from non-emergency healthcare? I would assume a single-payor system would not cover immigrants as a matter of political reality. Illegal immigrants can’t access the Obamacare markets. Obamacare excluded coverage for abortion. I think moving (relatively) from more marketplace to more statist control will reveal things that voters want more of, as well as things they want less of.
That provides more evidence that any single-payer would cover everybody. How such a plan could ever be affordable eludes me.
Too lazy to look up the exact numbers but I will be close. 50% of people account for about 4% of all health costs. IOW, when you do the stuff that is the equivalent of changing your wiper blades it doesnt cost much. Also, a lot of the cheap stuff is preventive care. The literature is mixed but at least in some cases if people have to spend out of pocket for preventive care they wont and we spend more in the long run.
You ought to have data if you want to talk about the effects of illegal immigrants. Granted, it’s hard to find reliable info since they are illegal. Since they largely cant have federal health insurance, unless they are asylum seekers, we are mostly talking about emergent care. So to use one estimate let’s use the estimate generated by the (GOP) congress in 2024. They guesstimate we spent $7 billion. I would think given the provenance here, YMMV, that is the high end estimate. Other guesstimate lower. Regardless, total US health care spending was about $5 trillion in 2023. That’s about 1/7th of 1% of our health care budget. Need I say more? (Glad to be corrected on this if someone has better numbers.) As a double check you can look to see if there are higher hospital failure rates in areas with lots of immigrants and that is not happening.
https://budget.house.gov/imo/media/doc/the_cost_of_illegal_immigration_to_taxpayers.pdf
Steve
There is no such thing as a reliable statistic on this. They don’t keep track of immigration status.
That’s not limited to healthcare and it’s not just about immigrants. The things they don’t keep statistics on for political reasons are legion.
Crime has become that way. Don’t look at the crime statistics because they are phony. Police reports don’t jibe with the victim reports or the 911 statistics. Look at the daily reports of crime and the number of people voting with their feet.