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Medicare is essentially single-payer for old people, yet it's identified in the article as part of the problem. Like other government programs, it's so much bet
by gojomo 13y ago
Medicare is essentially single-payer for old people, yet it's identified in the article as part of the problem. Like other government programs, it's so much better at measuring inputs (amount spent and procedures performed) than outputs, that there's an institutional bias in favor of overspending and overlooking corruption. ("Oh, no, that's not 10% more fraud and inefficiency this year, it's reaching 10% more of the needy.")
There's only one other sector of the US economy that's "single-payer": military procurement. And that's not known for its spending efficiency, either.
So it's not simply "single-payer" that magically saves money, but the specifics of the incentive system that's set up, and the other precedents from American federal governance are not positive.
Thank you for acknowledging that the main mechanism that a federal medical buyer monopsony (aka nationalization/single-payer) could use for cost-control is, essentially, "death panels" who say no to many treatments currently performed.
But can the American political system embrace that step, or will it wind up with single-payer without cost-controls? We wind up with the kinds of giant federal programs that can make it through the political system, and get implemented by the bureaucracy... not the kinds of idealized programs existing only in advocates' minds.
Finally, in single-payer systems, getting "whatever you want" done "at your own expense" is often effectively prohibited. For example, when the official system has particular limits (like price controls, limited participating providers, or waiting lists) for a covered procedure, it has often been illegal, in US Medicare or Canada's programs [1], to purchase that same procedure out-of-pocket/out-of-system for a negotiated price. Once you've nationalized, there's even a certain logic to such prohibitions: the system is straining under budget caps, and you can't risk the wealthy siphoning off capacity/copayments that could help support the common base.
[1] http://www.cato.org/publications/policy-analysis/freedom- http://www.cato.org/publications/policy-analysis/freedom-
- drzaiusapelord 13y agoA cato link isn't convincing. Its an extremely biased source. Cato can't stand that the single payer works in the rest of the world.
- gojomo 13y agoYour glib bias-accusation is unimpressive and unresponsive: Cato cites verifiable details about the particular point I was making, that single-payer systems often do "prevent any doctor and patient from doing whatever they wanted, at their own expense". Similar to the claim that under ACA, no one would lose a plan they liked [1], the claim that single-payer will still allow full freedom to work outside the system is a pre-implementation falsehood used to build support. Hell, it's even in the name: "single-payer". You have to crack down on competing payers, or your price leverage slips away, and voters stuck in the single-payer system get angry that they're facing the political cost-benefit rationing that others aren't. None of the other-country "single-payer"-ish systems cover even 1/4th the population size of the US. If single-payer can work so well for cost-control in the US political reality, why doesn't it work for Medicare, and the Defense Department? [1] http://networkedblogs.com/Qy7JI http://networkedblogs.com/Qy7JI
- drzaiusapelord 13y ago>None of the other-country "single-payer"-ish systems cover even 1/4th the population size of the US. That is 100% meaningless. Cost per patient is the only metric that matters. Its the same old right-wing canards that get pulled around here by the same ultra-conservative libertarains. I am so glad you are on the losing side of history. Imagine if I said "Whoa whoa, you can't open a giant factory in the US! No one has ever made one so big!" and you said "But my cost per item and cost per worker works out." Its madness that this kind of thinking is artificially applied to healthcare, like its some special industry immune to all the rules and can never, ever be regulated or be made in single payer like the Europeans have been doing for decades.
- gojomo 13y agoA nationalized service industry does not benefit from the same economies of scale as a factory. Also, health care isn't primarily delivered as standardized mass-produced widgets. If what you say about the ease of running an efficient nationwide federal program were true, Medicare and the DoD would be known for their cost-controls. Instead, they're known for the opposite.