Single Payer Health Care

So much of the health care debate is focused on attacking the ideological underpinnings of proposals instead of on their efficacy. The ACA has been attacked as much for the movement toward socialism as for any operational flaws. It seems now that those flaws, if corrected, would lead to greater government involvement in delivering health care. To not correct the flaws would be to destroy the health care system and return to the unregulated insurance market, which was even more of a failure than the ACA. What would happen if we asked this simple question: “what works in other countries?”

Most Western industrialized nations have adopted a single payer system or hybrid version. All the Scandinavian countries have a single payer system, as do Canada and Taiwan. Great Britain, France, Spain and Australia have hybrid systems where the government reimburses private insurers. How are they working? By almost every criterion, they work far better than our market-based system. Measured by patient satisfaction, all of the these countries have higher approval rates. Measured by costs, all have lower health care costs. Measured by actual outcomes to treatment such as infant mortality, or life expectancy, all are doing better. So, if everyone is getting effective health care for less, what is the problem with adopting and adapting one of their systems?

One issue is that of taxes. The taxes required to provide the single payer system are high. Putting aside the fact that people in these countries are satisfied paying more taxes to get guaranteed health care, what would be the costs of (as an example) going to a “Medicare for all” model? The CBO estimates that taxes would have to increase by an average of $5,000 per person to make the system financially viable. This makes a lot of people a bit weak-kneed, until they consider the costs of purchasing private health care now. The average cost of health insurance for someone not getting their insurance via an employer is $3,400.00 for individuals and $8,700.00 for families per year, not including deductibles. Most American families would actually pass less for their health care!

The most potent arguments against a single payer system are rooted in fears, not in data. Many people fear that government will somehow “screw it up.” This is not necessarily an irrational fear, but with decades of trial and error in other countries, the actual mechanism of the systems is established. Political leadership could be a factor, especially in our system where big money interests control policy. What would be the safeguards we need to put into place? Maybe a Supreme Court or FBI type of appointment where the term of the people in charge would not be related to political regimes?  The most powerful fear is irrational: a single payer system would be an ideological surrender. It would be an acknowledgment that at least with regard to health insurance, socialism offers an advantage over the open market capitalism. Never mind that we already acknowledge as much already with our national defense, or Social Security.

Because the arguments for a single payer system are so logical and empirical, it should be adopted regardless of how ideologues react. Whatever works should be the only measure. However, solving the health care problem is not the issue, as the GOP has proven already with their failure to replace the ACA with anything remotely as effective. Health Care for Congress is a political issue used to get votes. There is a lot of money to be made in Health Care and that means a lot of money to influence the debate in the form of campaign contributions. Your health is just a collateral issue.

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