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> Single-payer essentially nationalizes more than fifteen percent of the US economy (by dollars). It would more or less make every doctor, nurse, and technician

> Single-payer essentially nationalizes more than fifteen percent of the US economy (by dollars). It would more or less make every doctor, nurse, and technician an employee of the US government. But much more importantly than that, it would remove broad market price discovery from allocation of medical services. Instead of prices rising or falling to match demand from actual consumers, things would cost what a system of bureaucracies would say they cost Eh? Universal healthcare doesn't mean price regulation. The price signals are still there but you now have a very large public buyer able to negotiate prices with very big private suppliers. How is that not better than the current system where large numbers of citizens cannot afford adequate healthcare and big companies can extort whatever price they want out of those seeking access to life-saving drugs? > They also have a valid concern that single-payer would distort and degrade the health care system. Degrade how? Universal healthcare can still work with e.g. privately-run hospitals and clinics. You don't need the government to hire all the medical practitioners; just pay for the cost of treatment.

tptacek 12y ago
If there's a single federal buyer paying for 90+% of the market (look how much of the market for seniors Medicare covers), it's hard to see how the price signals continue to work the same way. The (slow, error-prone) political process is engaged in every buying decision. Already you can see that changes in the way Medicare reimburses and measures outcomes have impacts on the way services are delivered today, and Medicare is just a fraction of the overall market for health care in the US. The federal government doesn't hire all the practitioners. They just fix all the prices. At any rate, there's a difference between disagreeing with an argument and pretending that it doesn't exist, as other comments on this thread did. (I am in part assuming the mantel of the GOP argument against single-payer here; I prefer the Swiss system to the NHS, but unlike most Republicans I strongly believed that a national solution was needed for health insurance and financing.)
- gradstudent 12y ago
  > If there's a single federal buyer paying for 90+% of the market (look how much of the market for seniors Medicare covers), it's hard to see how the price signals continue to work the same way. I'm not sure I follow. Price signals are based on demand. The same demand is still there in the sense that customers still interact with private health providers. The only thing that changes is payment is now handled by a single government system. Uncle Sam guarantees you access and his guys sort out the payment with the private provider, later. > The (slow, error-prone) political process is engaged in every buying decision. I'm not sure I agree with your premise for a start (i.e. publicly ran organisations are necessarily slow and error prone) but setting that aside, why is bulk billing between government financiers and the private health providers not an option? The government knows how much demand they have for XYZ product or service so they can negotiate based on volume. Have I missed something?
  - dlss 12y ago
    > Price signals are based on demand. The same demand is still there in the sense that customers still interact with private health providers. Price signals require both a supply side and a demand side. Government funded healthcare likely increases demand, since it reduces cost on an elastic good. However, it also reduces supply, since it reduces payment. (There's a good discussion of this at http://www.cato.org/blog/price-controls-rise-latin-america http://www.cato.org/blog/price-controls-rise-latin-america) To put it another way... if we passed a law saying that all programmers could charge at most $30/hr [edit: which is a good wage compared to other non-degree requiring jobs] we would have increased programmer demand (since now more businesses can afford programmers) and would also have less total programmers since many would switch careers to meet their financial needs. Something similar would happen in the medical industry with a single large federal buyer. > The government knows how much demand they have for XYZ product or service so they can negotiate based on volume. Have I missed something? This is also missing the supply side. When you take money from one group and give it to another it is very very important to look at what happens to the group you've taken from in addition to the group you've given to. The real value in healthcare hasn't been created yet. It's in the drugs of the future. Changing the incentive structure for health startups changes how many people found healthcare startups. A system with basically a single buyer is a reverse monopoly (ie http://en.wikipedia.org/wiki/Monopsony http://en.wikipedia.org/wiki/Monopsony). If you find you're building a product for essentially a single customer... you should probably found a different company. They're not going to voluntarily pay you anywhere near what you'd make in a real market.
    - gradstudent 12y ago
      > Price signals require both a supply side and a demand side. Government funded healthcare likely increases demand, since it reduces cost on an elastic good. However, it also reduces supply, since it reduces payment. I'm not arguing for the government to fix the cost of drugs or health services. I'm arguing for the government to guarantee access to a minimum set of healthcare products and services and then negotiate price with the providers based on uptake. From a consumer perspective, this is much better. Far better than buying said products and services directly from a monolithic private entity. From a supplier perspective, this is less good and there may be some incentive to artificially limit supply. But that's why we have governments in the first place: to take over in cases where the market is unable or unwilling to function in a way that is beneficial to society as a whole. If private hospitals decide to limit the number of e.g. heart procedures per year then government needs to step in and either regulate or take other measures to ensure the delivery of essential services.
- trevelyan 12y ago
  Public and private spending in most single-payer countries is far, far lower than what it is in the United States. The bloat is a product of market inefficiencies: http://data.worldbank.org/indicator/SH.XPD.PCAP http://data.worldbank.org/indicator/SH.XPD.PCAP What you are suggesting is essentially that market failures have made private health care "too big to fail." Not a reasonable argument when public health is at stake.
  - tptacek 12y ago
    First, be careful with the word "you". As I've been at pains to point out in both comments on this thread: this isn't my position. Second, "lack of single-payer insurance" isn't why Americans overpay for health insurance. We have collusion between cartels of buyers and sellers (hospital chains and insurance companies) with secret price lists, funded by HR managers several hops away from the actual demand for services. It is probably enough to decouple insurance from employment. The Swiss, for instance, don't have a single-payer system, and they also pay far less than the US on health care. (That latter argument, unlike the ones I've written about previously on this thread, actually does represent some of what I believe).
  - baddox 12y ago
    What makes you think that the bloat in the US is a product of market inefficiencies and not government inefficiencies?

tptacek 12y ago

If there's a single federal buyer paying for 90+% of the market (look how much of the market for seniors Medicare covers), it's hard to see how the price signals continue to work the same way. The (slow, error-prone) political process is engaged in every buying decision. Already you can see that changes in the way Medicare reimburses and measures outcomes have impacts on the way services are delivered today, and Medicare is just a fraction of the overall market for health care in the US. The federal government doesn't hire all the practitioners. They just fix all the prices. At any rate, there's a difference between disagreeing with an argument and pretending that it doesn't exist, as other comments on this thread did. (I am in part assuming the mantel of the GOP argument against single-payer here; I prefer the Swiss system to the NHS, but unlike most Republicans I strongly believed that a national solution was needed for health insurance and financing.)

gradstudent 12y ago
> If there's a single federal buyer paying for 90+% of the market (look how much of the market for seniors Medicare covers), it's hard to see how the price signals continue to work the same way. I'm not sure I follow. Price signals are based on demand. The same demand is still there in the sense that customers still interact with private health providers. The only thing that changes is payment is now handled by a single government system. Uncle Sam guarantees you access and his guys sort out the payment with the private provider, later. > The (slow, error-prone) political process is engaged in every buying decision. I'm not sure I agree with your premise for a start (i.e. publicly ran organisations are necessarily slow and error prone) but setting that aside, why is bulk billing between government financiers and the private health providers not an option? The government knows how much demand they have for XYZ product or service so they can negotiate based on volume. Have I missed something?
- dlss 12y ago
  > Price signals are based on demand. The same demand is still there in the sense that customers still interact with private health providers. Price signals require both a supply side and a demand side. Government funded healthcare likely increases demand, since it reduces cost on an elastic good. However, it also reduces supply, since it reduces payment. (There's a good discussion of this at http://www.cato.org/blog/price-controls-rise-latin-america http://www.cato.org/blog/price-controls-rise-latin-america) To put it another way... if we passed a law saying that all programmers could charge at most $30/hr [edit: which is a good wage compared to other non-degree requiring jobs] we would have increased programmer demand (since now more businesses can afford programmers) and would also have less total programmers since many would switch careers to meet their financial needs. Something similar would happen in the medical industry with a single large federal buyer. > The government knows how much demand they have for XYZ product or service so they can negotiate based on volume. Have I missed something? This is also missing the supply side. When you take money from one group and give it to another it is very very important to look at what happens to the group you've taken from in addition to the group you've given to. The real value in healthcare hasn't been created yet. It's in the drugs of the future. Changing the incentive structure for health startups changes how many people found healthcare startups. A system with basically a single buyer is a reverse monopoly (ie http://en.wikipedia.org/wiki/Monopsony http://en.wikipedia.org/wiki/Monopsony). If you find you're building a product for essentially a single customer... you should probably found a different company. They're not going to voluntarily pay you anywhere near what you'd make in a real market.
  - gradstudent 12y ago
    > Price signals require both a supply side and a demand side. Government funded healthcare likely increases demand, since it reduces cost on an elastic good. However, it also reduces supply, since it reduces payment. I'm not arguing for the government to fix the cost of drugs or health services. I'm arguing for the government to guarantee access to a minimum set of healthcare products and services and then negotiate price with the providers based on uptake. From a consumer perspective, this is much better. Far better than buying said products and services directly from a monolithic private entity. From a supplier perspective, this is less good and there may be some incentive to artificially limit supply. But that's why we have governments in the first place: to take over in cases where the market is unable or unwilling to function in a way that is beneficial to society as a whole. If private hospitals decide to limit the number of e.g. heart procedures per year then government needs to step in and either regulate or take other measures to ensure the delivery of essential services.
trevelyan 12y ago
Public and private spending in most single-payer countries is far, far lower than what it is in the United States. The bloat is a product of market inefficiencies: http://data.worldbank.org/indicator/SH.XPD.PCAP http://data.worldbank.org/indicator/SH.XPD.PCAP What you are suggesting is essentially that market failures have made private health care "too big to fail." Not a reasonable argument when public health is at stake.
- tptacek 12y ago
  First, be careful with the word "you". As I've been at pains to point out in both comments on this thread: this isn't my position. Second, "lack of single-payer insurance" isn't why Americans overpay for health insurance. We have collusion between cartels of buyers and sellers (hospital chains and insurance companies) with secret price lists, funded by HR managers several hops away from the actual demand for services. It is probably enough to decouple insurance from employment. The Swiss, for instance, don't have a single-payer system, and they also pay far less than the US on health care. (That latter argument, unlike the ones I've written about previously on this thread, actually does represent some of what I believe).
- baddox 12y ago
  What makes you think that the bloat in the US is a product of market inefficiencies and not government inefficiencies?