Monday, June 05, 2006

No Single-Payer in Our Time

More than thirty years ago, I noted that private enterprise economies, of which the U.S. is one, adopt public schemes for financing social services when the private sector proves unable to fund those services at a satisfactory level.

Since the private sector of health care in the U.S. was then more than adequately funded, I concluded that we didn't have the problem and so we wouldn't get the solution. In other words, no national health insurance.

We don’t talk about national health insurance anymore. Now we call it single-payer. But other than that, the situation seems to me to be unchanged.

Adequate funding leaves single-payer without a political constituency. In the U.S., the aged and the poor are already insured in the public sector by Medicare and Medicaid. Much of the employed population gets its health insurance through employee benefit plans.

There are, of course, the uninsured. While they are large in numbers (reportedly over 40 million) and a public embarrassment, they are neither visibly suffering nor politically active. They clearly would be better off if they were insured and they undoubtedly would like to be, but they are not marching in the streets.

Hospitals complain continually about inadequate reimbursement, as one might expect, but are in fact flush with money, as shown by their profit margins and their ambitious construction programs. Doctors are being squeezed, but still live well. Pharmaceutical and other health-related businesses are prospering.

If there are any that are “visibly suffering,” it would be the governments and employers that are bearing the high and rising cost of health insurance.

Single-payer would expand the health insurance role of government and, therefore, increase its “suffering” accordingly.

Employers complain about the burden of funding employee health benefits. But they show few signs of wanting government to take it off their hands. No doubt they realize that government would have to get the money by means of some kind of assessment (not even the most enthusiastic borrow-and-spend Republican denies that) and there is no assurance that the amount would be less than what employers are now paying for private coverage.

Conceptually, there may be a number of good arguments to be made in favor of single-payer. But if it isn’t going to happen, we need to forget about it and put our minds to devising other solutions for the problems of our health care system.

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