Repeat After Me: Single Payer Is Cheaper


Ah, Taylor Marsh, love her but I wish she wouldn't say things like "no one thinks it's affordable" when refering to single payer health care (care where the government pays the bills and you either never see them or pay a small amount). It may not be doable in political terms, but in the total amount of money spent it is actually the cheapest plan, it's just that money comes from the government and your taxes, rather than being paid to an insurance company. Does it matter if you pay a little more taxes and wind up with more money in your pocket at the end of the day because your overall health care costs have gone down? Personally, if I have to pay $500 more taxes a month, but don't have to send Aetna $1,000 a month, I'm feeling mighty far ahead.

Heck, for that matter most first world governments spend less per capita on health care than the US government does (in terms of spending just by the government). And they all have better health care than the US on almost every metric.

Mandates are an awful way to do insurance. It's the car insurance model. How many people are happy with their car insurance?

That said, if you want universal care and you won't do it the smart way (single payor), then you need mandates. So since American politicians are allergic to leading or cutting out special interests like insurers, I guess to get people insured it'll have to be done the wrong way.

So yeah, Edwards' and Clinton's health care plans are better than Obama's. But that ain't saying much.


Ian Welsh January 17, 2008 - 7:49pm
( categories: Miscellany | Analysis )

I don't have to own a car. And if I do (and own it directly), I don't have to have collision, only liability (which might well be better bought with each gallon of gas).

There is no equivalent to liability in health insurance. If there were, no airline would still be in business.

GordonMcMillan January 17, 2008 - 8:03pm

you MUST have insurance.

And in large parts of the country, you effectively MUST have a car if you want access to decent jobs. The US ain't Europe, good public transit is limited to a few cities.

Given that you are forced to buy it and given how useful a car is, it's a mandate and the analogy is close enough. The fact that they're different types of insurance is irrelevant to the point.

Agreed on buying it with gas. I believe one state tried that, and was sued by the insurers.

Ian Welsh January 17, 2008 - 8:14pm

If I cough in your face and you get sick, you can't do shit about it. There is no equivalent to liablity in health insurance. If I (or my bank) wants to protect my (their) investment in the car, then I buy collision, but that is not a mandate.

Driving is a privelege. Requiring liability is reasonable. Are you saying that living is a privelege?

They are opposite types of insurance, so the analogy fails.

GordonMcMillan January 17, 2008 - 8:59pm

The universe doesn't owe you anything... accept it.

Societies form to care for their sick because doing so makes the society stronger. If caring for the sick made a society weaker, then regimes like Sparta would conquer weaker regimes like Athens...

...hey wait a minute...

Seriously, tho... single payer has its downsides. I like the Singapore "single-payer" model best: everybody gets $1500 per year for health care from the government. More than that they have to pay out of pocket. In the event of major surgery, your medical account is drained first, then government subsidies kick in. But, if you're a hypochondriac who wants a CAT scan every month, guess what? You're paying, bud... You can also buy supplemental insurance, but its less common and much less expensive.

If you live a long healthy life, you'll have $100,000 in the bank to leave to your kids... but other than that, you can never touch that money. Ever ever ever.

--
http://bexhuff.com
Of COURSE you can trust the US Government! Just ask the Indians.

bex January 18, 2008 - 12:56pm

...that it takes no time to go through $1500 for legitimate reasons. Most of us pay a minimum of $2500 a year in premiums alone.

Steve 2.0 January 18, 2008 - 1:18pm

I believe Americans spend more per person on medical insurance paperwork than Canadians do for medical care.

Plus, that's $1500 per person, including your children. Most people would spend less than $500 per year, so by the time they hit 50 and might need an expensive surgery, they have $50k to play with.

--
http://bexhuff.com
Of COURSE you can trust the US Government! Just ask the Indians.

bex January 18, 2008 - 4:01pm

...than $1500 a year in monthly premiums for just myself and fifty is still quite a ways off for me. Healthcare is beaucoup expensive in the States, and that's kinda the way insurance companies want it.

Steve 2.0 January 18, 2008 - 4:15pm

Then so is liberty and the pursuit of happiness. Thanks, I was a little unclear on that point.

GordonMcMillan January 18, 2008 - 11:47pm

this one is a no brainer. but the numbers are consistently hidden, and the spectre of "socialized medicine", the dreaded "socialism" a dead beat's dream and libertarian horror story keep being pushed on an ignorant public.

however, many people are waking up from sheer, real, grab your guts pain. educated. middle-class. people.

any so-called conservative who looks at the numbers should be ashamed.

overhead costs for private insurance run 15%-45%.
and ~ 45 million not covered which is the most expensive thing imaginable, people not covered for health care costs which drains America of so much resources in human endeavor, not to mention the emergency room which is the most expensive of all, being used as an MD office. ERs CANNOT turn people away for inability pay.

Medicare [ a single payor, REALLY GOOD comparison] runs at about 3-4%.

like i said a no brainer.

the real question comes down to this; are we in a dog-eat-dog- world, everyone, in everything, for themselves,
or are we in this together, all of us, every one, in at least SOME things? like health care? like old age? like devastating disability?

America has taken rugged individualism to the level of pathological. it's time to have regard for one another, at the very least in the big things. it's the only thing that really makes sense.

Dennis Kucinich has said that he will pay for one payor universal health care by recinding the Bush tax cuts.

bernadene January 17, 2008 - 8:40pm

Socialism. The most hated word in the US. It reminds everyone of the USSR. It reminds them of the Cold War.
It reminds the big corporations of loss of control.
Capitalism has become a mantra.
This is just like politics. "I am right, you are wrong."
All that is left out are the peoples views.
In the USSR they said that socialism helps the people. It helped the people in control.
In the US they said that democracy lets people chose their own way.
It helped the rich.
Who is right? The people in control or the rich. What is the difference?
They are still the same people.
The USSR fell by the wayside. Soon the US will too.
Everyone will realize that they are not important in the world view and they want a say in their future.
I hope it is sooner rather than later.

repressive governments mix administrative clumsiness & inefficiency with authoritarian tendencies.

kimmy January 17, 2008 - 9:27pm

a health care provider I can say it will happen sooner than later. People are fed up and will get over weird feelings about socialism, as long as it helps them. Enlightened self-interest rules.


"I beseech you in the bowels of christ think it possible you may be mistaken."

Scott M January 17, 2008 - 10:24pm

Why pay a health insurance salesman a big commission? Everyone wants insurance. Get rid of the insurance company. Go see what they do in Denmark, I have and they love it. Single payer is the way to go. The cheapest way too.

Bucksouth January 17, 2008 - 11:09pm

...are too proud to do anything the way they do it in "Commie Denmark."

I really think if we want a solution to this problem, we need to focus on what the people can stomach, like laws that restrict the conditions in which companies can deny claims. Breaking the AMA and allowing colleges to open new medical schools would help too.

Steve 2.0 January 17, 2008 - 11:40pm

...was kind of slow, but they're not really on the wrong side anymore. These days, they're lobbying against legislation that passed for their apparent benefit, but with no success. The benefit actually accrued to the HMOs and insurance companies. There's still a fight with "doctor-owned" hospitals (like Kaiser) and the AMA is losing clout among doctors as a result.

GordonMcMillan January 17, 2008 - 11:57pm

There is no other country. Only the USA. I think Canada is a state?

Forget it, Jake - it's AmnesiaTown

Tonsure Wimple January 19, 2008 - 2:57am

You obviously hate the word socialism.
Proving my point.

repressive governments mix administrative clumsiness & inefficiency with authoritarian tendencies.

kimmy January 17, 2008 - 11:52pm

...I would actually call myself a social democrat, and I'm quite anti-capitalist on some issues, but I accept the facts of American society, and the key fact is we are individualistic. For many of us, the ability to choose our own doctor is a more basic right than the surety of coverage. It may not be what's best for us, but don't go around pretending the log-cabin mentality is an integral part of the American psyche.

Steve 2.0 January 18, 2008 - 1:34am

"the ability to choose our own doctor"

What makes you believe you loose this choice under, universal, single payer? I've been in two, UK & Belgium, and I chose my doctor, always. My wife lived in Canada for many years, and she chose her own doctor. In medicare you choose your own doctor.

I though of writing something stronger, instead I'm really curious from where you get this strange belief?

Synoia January 18, 2008 - 1:15pm

Another is that you'll spend half your lifetime waiting for authorization to perform a life-saving procedure. Or that waiting times in hospital emergency rooms will be interminable. Or that life-saving drugs won't be approved by "official" channels.

I have an alcoholic friend in Denmark whose doctor visits him at home. In the good old USA, he'd be uninsurable and probably dead.

Petronius January 18, 2008 - 1:23pm

...an HMO, like most Americans nowadays. To get any service whatsoever, you must go to your "gatekeeper" physician first, and they will decide--on the company's behalf-- whether you really need this service.

Sure, you can "choose" who this is: from a list of about a half a dozen doctors.

Steve 2.0 January 18, 2008 - 1:23pm

freedom to choose my doctor than many Americans. I can go to ANY doctor who's accepting new patients and he or she will take me. ANY doctor. Not just doctors who accept my insurance plan, or if I'm on an HMO, an HMO doctor.

This is a pure MYTH.

Ian Welsh January 18, 2008 - 1:50pm

...but I don't live in Canada like you. I know the American mood and mein. I have these conversations with conservative friends all the time. They won't hear any proposal that doesn't allow them to "own" their insurance. Anything that is percieved as limiting freedom--at least in economic terms--is DOA in the public square. All I said above is that any health care reform needs to contain elements that are politically palatable to the people who live in the country. Our values are different from the rest of ther industrialized world; there's no use hiding from reality. Universal coverage is not a near-off reality; we need to focus on what can actually get done.

The specter of losing choice under universal health insurance in America is almost palpable here. Telling people what it's really like in your country is not going to change that.

Steve 2.0 January 18, 2008 - 2:40pm

it is a FACT that you have more choice in physicians in Canada and almost every other single payer system. It's a FACT. If Americans are so brainwashed that they won't listen to FACTs then I don't know what to do, but I will say this: I'm not going to stop telling them the FACTs. Perhaps if more people told other Americans the FACTs, Americans would know the FACTs.

This is the key problem with US discourse--that Americans live in a fantasy world where Saddamn was behind 9/11, Iran has a nuclear program, single payer is more expensive, single payer has less choice, the US has more income mobility than other nations (it has the least of all western nations) and so on.

You can't make good decisions when you don't have the FACTs. So instead of saying "Americans won't ever believe the FACTs" we should concentrate on getting the facts out.

And full universal healthcare was very close a couple times in the US - both in the 30's and the early 70's.

When conservatives see a popular program they hate, they campaign against it till the public perception changes. In the 70's it would have been impossible to repeal Glass-Steagall, for example, by the 90's it was easy. Likewise if they want policies enacted that wouldn't be possible, they campaign for them.

Democrats and progressives, they just say "oh well, the polls are against us, so lets give up."

But even progressives are fooling themselves and believing myths, because polls aren't that against single payer, in fact some even show majority support for it some polls even show majority support for single payer.

- Question 50 shows 57% say they would support this program even "if it limited your own choice of doctors" (which doesn't necessarily have to be a side-effect of a single-payer system).

- Similarly, question 51 shows 62% say they would support this program even "if it meant there were waiting lists for some non-emergency treatments" (again, not necessarily a side-effect).

So, I simply don't agree with the choice BS. 1-you don't give up choice (even over what's covered, you can have top up insurance if you want) and b) there's some evidence that even if you did lose choice, Americans would still go for it.

Ian Welsh January 18, 2008 - 3:01pm

...in 1993, and I sure as shit remember the rhetoric. I also remember the 1994 elections. I'd like to think I know what the American people are willing to go for. I'm sorry that our comfort threshold is a little closer in than most modern countries. But let's face facts: we are a market-oriented, pro-business society, that deeply believes in personal responsibility and bootstrappism. We absolutely do not believe in providing for someone else's needs. at least not when their not our relatives. As self-destructive as this can be, this is who we are.

Facts are good but fears cancel facts. We, as a people, will not accept anything that increases the government's role in our lives, raises our taxes, is percieved as impinging on our liberty, and is seen as destructive to the traditional American notion of self-reliance.

Just as you can't force Jeffersonian democracy on the Muslim world in one generation, you can't force universal care on a country with American attitudes.

Steve 2.0 January 18, 2008 - 3:28pm

...machine have spent the last 35 years convincing us that's who we are. We wouldn't have national parks, social security, a highway system or medicare if that's who we actually were.

GordonMcMillan January 18, 2008 - 3:35pm

...national parks were created during the administration of Theodore Roosevelt, Social Security was enacted under FDR, and Medicare became law under LBJ. Each administration served in unusually progressive times; times that were--if you read history--quite an aberration in America. The Interstate Highway system--initiated under Eisenhower--was touted for its usefulness in aiding national security. This is the only matter where most Americans feel collective action is desireble.

Steve 2.0 January 18, 2008 - 3:44pm

....when we're not? There are some instances of American exceptionalism but this idea that Americans are somehow wired differently than the rest of the world is bs/propaganda.

Rojo January 18, 2008 - 4:48pm

...that there are simple exceptions to a general rule.

Steve 2.0 January 18, 2008 - 5:07pm

...established a way of funding public education. The first public school in this country started in 1643. Both VA and MA are Commonwealths, which might give you an idea about what was on peoples' minds.

I do read history, which is why I don't buy the Marlboro Man theory (an image, BTW, that better suits Teddy Roosevelt than Grover Norquist).

GordonMcMillan January 18, 2008 - 5:53pm

Umm..he's my customer (google Myron Natwick), and he's liberal.

Synoia January 19, 2008 - 1:18am

One is a guy who is an actor with a very long TV/movie resume. The other invented Betty Boop and recently died at 100.

Please continue on this topic. I am confused at the moment.

Forget it, Jake - it's AmnesiaTown

Tonsure Wimple January 19, 2008 - 3:06am

...there was a steady succession of Marlboro Men. I heard one drowned on a TV shoot in the '60's and another died of smoking related illnesses.

But that's all word-of-mouth.

Steve 2.0 January 19, 2008 - 2:43pm

Wikipedia:

Actor and author William Thourlby is said to have been the first Marlboro Man. The models who portrayed the Marlboro Man were New York Giants Quarterback Charley Conerly, New York Giants Defensive Back Jim Patton, Darrell Winfield, Dick Hammer, Brad Johnson, Bill Dutra, Dean Myers, Robert Norris, Wayne McLaren, David McLean, Buster Hobbs and Tom Mattox. Two of them, McLaren and McLean, died of lung cancer.

GordonMcMillan January 19, 2008 - 5:58pm

the majority in that poll wanted universal insurance. I really, really, really don't know what to say. I really don't.

Again--that poll showed majority support EVEN if it would lead to a reduction in choice. I have seen other polls in the high 40s and low 50s.

This fight isn't lost yet, in America. It's lost in the minds of progressives and liberals who have imbibed the beltway wisdom that the US is a fundamentally conservative country, when polling shows, consistently, that it isn't.

Ian Welsh January 18, 2008 - 7:05pm

Please don't go there.

repressive governments mix administrative clumsiness & inefficiency with authoritarian tendencies.

kimmy January 18, 2008 - 12:03am

...speaking for others, not myself.

Steve 2.0 January 18, 2008 - 1:35am

Anyways, I don't pay attention to any of those health care plans. They are all obviously DOA right now, and we need a few more years of middle class people discovering that their insurance...isn't to accrue the necessary determination to throw 100k people out of good paying jobs being murduring leeches.

Humans by nature do not suffer from enlightened self-interest.

shah8 January 18, 2008 - 1:01am

I live in the little Kingdom of Denmark. As a student, I'm in the lowest tax bracket, 42% after the first 4000kr tax free(aprox. 800US)per month. There is a 25% VAT on all retail goods, including groceries. Yet a minimum wage worker here has more purchasing power than in the US. Of course the state is paying for my education with a stipend and all health care is provided. My wife is just coming off a paid 1 year maternity leave. When I graduate this summer, and presumably start working full-time I'll move into the top tax bracket. I will loose none of the state benefits I currently enjoy, only a higher level of contribution into the system. Oh, the economy here is cruising and unemployment is only around 5%. I guess I'll vote libertarian when I start making the big bucks.

STN

stuart noble January 18, 2008 - 2:13am

...and he was forced to drop that one amid cries of "socialized medicine".

It'll happen again, just watch.

Petronius January 18, 2008 - 3:57am

Medicare parts A and B were the competing plans to get it started. Then Congress decided that rather than fight over which one to use, they'd just pass them both. It wasn't until the Reagan Devolution that single-payer became a dirty word (Reagan's entire campaign was "The 9 most feared words in the English language: I'm from the gov't and I'm here to help".)

GordonMcMillan January 18, 2008 - 12:04pm

Look at the shape and status of health of the american people; of all the developped countries, those people are probably the worst off, all because they let themselves be scared by one word: SOCIALISM.
What a bunch of idiotic people the yankees are, havin a SOCIAL program is NOT socialism, for chr..t sake even comunism was never socialism, the only places you find the real McCoy are in some Israeli kibbutz and some religious orders, where every and all ressources are pooled togetter for the common wealth and happiness of the community.
Socialised medicine is not socialism, it's the only way to go for the betterment of a society, where are your soldiers gonna come from if not from a healthy lower class, the republican party, YEAH.
Wake up america, cause if you wait too much you risk paying a hefty price and not even have a serum pole to be hooked to in case of emergency.

Jelco Cathlon January 18, 2008 - 6:21am

...says: social reform leads to socialism; socialism leads to communism; communism leads to Tiannamin(sp?) Square. So therefore, any government attemt to improve the lives of the average person leads to those same average people getting crushed by tanks.

Steve 2.0 January 18, 2008 - 2:57pm

called SOCIAL Security, and medicare. these are socialist programs, but were so demanded that the libertairians name call was not heard when instituted.

In much of modern Europe, a woman can stay home a year after giving birth and get her full pay. so she can then breast feed as well. what a great way to start off a life. most American woman have no idea this happens. not to do this is so short sighted.

i saw a great interview on C-Span with Grover Norquist [" want to drowned government in a bathtub"] as a "guest interviewer" of someone who wrote a book about the ills of capitalism, i think. i should look it up, if anyone already knows, let me know. This author tore up Norquist's libertarian spew limb from limb, and so adroitly, so calmly, so deftly that it made me laugh out loud. it was a beautiful thing to see. [i was watching C-span late night and didn't get the author, for which i am really sorry.]

pretty much the same conclusion, tho...are we dog-eat-dog or are we together? which do we want for what? it does not have to be all one way or the other.

bernadene January 18, 2008 - 12:10pm

Can watch it from this link.

Some wonderful stuff at booktv.org (and if you forget that name, you can get to it from cspan.org, too).

Not sure I'd recommend, say, Michael Gerson interviewed by Richard Viguerie, but, sometimes when you get them out of the yelling-over-the-token-liberal format used on "news" channels, conservatives can be quite amusing in a slapstick kind of way.

GordonMcMillan January 18, 2008 - 3:29pm

Sorry to take so long to reply, i needed to find time to watch it again. Thanks a lot. Interestingly, they began talking about Supply Side Economics,here's the "trailer"

[Jonathan Chait argues that regardless of what political party is in power the United States economic policy stands to the far right. In "The Big Con: The True Story of How Washington Got Hoodwinked and Hijacked by Crackpot Economics,"

Mr. Chait a senior editor at the New Republic contends that economic policy for the past three decades has been ill-conceived. Mr. Chait points to supply-side economics as an example of a what he deems a flawed policy that is championed by few. Jonathan Chait is interviewed by Grover Norquist, president of Americans for Tax Reform, an organization that is against higher taxes.]

and then they got into the philosophical distinctions between Libertarians and leftists and Chait did a beautiful job.

bernadene January 19, 2008 - 10:45pm

Lets analyze the numbers:

Step in the Chain GS&A, Profit, Costs(Payouts)
Insurance: 40% 30% 30%
HMS/Hospital 40% 30% 30%
Doctors 40% 30% 30% (maybe, not included)

GS&A = general, sales & admin. Typically of he 40% aboue 30% is for marketing (not necessary in a single payer system, or not for profit hospital).

Crude, but effective, the numbers need to be verified (I'll go the edgar and pull some annual reports, say for Aetna & Some Hospital group)

For every $1.00 spent in medical insurance, $0.30 flows to the medical providers. For every $1.00 the medical providers receive, they spend $0.30 on YOU.

In agggregate, for every $1.00 spend in insurance, $0.09 cents is spent on you, and there is still fat in the system - doctors own marketing expense.

In a single payer system the breakdown would be something like:

Step in the Chain GS&A, Profit, Costs(Payouts)
Insurance: 3% 0% 97%
HMS/Hospital 10% 0% 90%
Doctors 40% 30% 30% (maybe, not included)

For every $1.00 paid in medical insurance, $0.87 is spent on YOU. (The medicare story)

This is the foundation of the dirty litle secret not being told. There are multiple profit & marketing bites taken out of your medical insurance dollar before you get any benefit.

We need a mutual medical assurance system. Not a for profit medical insurance system.

Synoia January 18, 2008 - 12:58pm

many organizations understand the numbers, such as the National Nurses Organizing Committee of which i am a member. However, they are not getting out.
the best democracy money can buy. When the grass roots finds out the truth, change will come, i am sure.

Again, Dennis Kucinich is the only candidate proposing one payor, not for profit health care. his day will come.

bernadene January 18, 2008 - 3:14pm

Can't let this pass:

"I live in the little Kingdom of Denmark."

Dude, pull out a map of the world, look on the North Atlantic, in between North America and Northern Europe...notice a big piece land...almost a continent...it's called Greenland....Denmark owns it.

With the oil and ore deposits and global warming it could be a piece of prime real estate. I think makes Denmark the biggest country in Europe.

S Brennan January 18, 2008 - 1:24pm

...who wish that Greenland would declare independence. Supporting Greenland and the Faeroe Islands is a big drain on the Danish economy.

Petronius January 18, 2008 - 2:42pm

It's a little smaller when you view it in a correct projection :)
Say, on a globe.

The Mercator Projection was designed to make navigation by sail, pre-chronograph, trigonometrically simple.

Forget it, Jake - it's AmnesiaTown

Tonsure Wimple January 20, 2008 - 3:22am

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