Health Care

An op-ed: in today’s Times does a reasonably good job of summing up the state of American health care, but concludes with this somewhat unsubstantiated swipe at single-payer insurance:

Deep in their hearts, many liberals yearn for a single-payer system, sometimes called Medicare-for-all, that would have the federal government pay for all care and dictate prices. Such a system would let the government offset the price-setting strength of the medical and pharmaceutical industries, eliminate much of the waste due to a multiplicity of private insurance plans, and greatly cut administrative costs.

But a single-payer system is no panacea for the cost problem — witness Medicare’s own cost troubles — and the approach has limited political support. Private insurers could presumably eliminate some of the waste through uniform billing and payment procedures.

I’m not sure what they mean by medicare’s “cost troubles.” Medicare is an insurance company, and so it’s subject to many of the same forces that have led insurance premiums to increase across the private insurance plans. But Medicare is also very efficient, spending only a tiny fraction of its expenses on overhead, and very generous, rarely second-guessing doctors.

The currently-favored alternative to Medicare-for-all is individual mandates, where you force everyone to buy their own insurance. The result is almost the same, except it’s much less efficient. Instead of collecting a straightforward income or sales tax, you force everyone to buy their own plan and penalize them if they don’t. Much more complicated to enforce. Which is why, elsewhere in the Times we read that Massachusetts is having a hard time getting everyone to sign up for a plan. A tax would have guaranteed 100% enrollment, but the tax has the downside of being called a “tax,” which is a no-no in our bizarre political climate.

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