Saturday, February 07, 2004
The Single Payer Concept – Both Futile and Pernicious
It is probably about forty years ago that I first predicted that we would not in our lifetime see a single payer system for financing health care (then more plainly called national health insurance).
My reason was simple enough. Public financing of a social service always has the purpose – or, at least, the consequence – of increasing the amount of money devoted to the support of that service. But a central problem with the American system of health care is that we spend too much money on it already. So spending even more would make that problem even worse.
That consideration helps to explain the fate of the Clinton Health Care Reform proposals of the early 1990’s. Many reasons have been given, but the possibility I find most convincing is that the Congress was not willing to vote the funds needed to fund the Clinton plan. Apparently the logic of reducing cost by spending more money was not persuasive.
So the single payer concept has so far proved to be futile. But it has also been pernicious in the sense that too many people – including leaders and intellectuals in the field - have been fixated on it to the exclusion of the alternatives.
I was reminded of this recently when I undertook to search for a thoughtful critique of the provisions of the recently enacted Medicare Prescription Drug act that are directed towards reducing cost by creating competition between Medicare and private health plans. I have made inquiries in a number of directions and so far have come up with nothing. Competition being a private sector solution, the leading minds of health care seem not to think it worth their attention.
If we are going to make progress in addressing the problems that face health care, we need the help of progressive thinkers in the intellectual community and in industry leadership. They need to apply their minds to possibilities other than single payer, which, it seems all but certain, is simply not going to happen.
It is probably about forty years ago that I first predicted that we would not in our lifetime see a single payer system for financing health care (then more plainly called national health insurance).
My reason was simple enough. Public financing of a social service always has the purpose – or, at least, the consequence – of increasing the amount of money devoted to the support of that service. But a central problem with the American system of health care is that we spend too much money on it already. So spending even more would make that problem even worse.
That consideration helps to explain the fate of the Clinton Health Care Reform proposals of the early 1990’s. Many reasons have been given, but the possibility I find most convincing is that the Congress was not willing to vote the funds needed to fund the Clinton plan. Apparently the logic of reducing cost by spending more money was not persuasive.
So the single payer concept has so far proved to be futile. But it has also been pernicious in the sense that too many people – including leaders and intellectuals in the field - have been fixated on it to the exclusion of the alternatives.
I was reminded of this recently when I undertook to search for a thoughtful critique of the provisions of the recently enacted Medicare Prescription Drug act that are directed towards reducing cost by creating competition between Medicare and private health plans. I have made inquiries in a number of directions and so far have come up with nothing. Competition being a private sector solution, the leading minds of health care seem not to think it worth their attention.
If we are going to make progress in addressing the problems that face health care, we need the help of progressive thinkers in the intellectual community and in industry leadership. They need to apply their minds to possibilities other than single payer, which, it seems all but certain, is simply not going to happen.
