Friday, February 26, 2010

No Single Payer in Our Time

Despite the determined persistence of its advocates, we are not likely to see a single payer program adopted in the United States in our time.

There are several reasons. Perhaps the most important is our high level of health care spending, which provides generously for those who have health insurance. The larger portion of premiums are being paid by the employer or by government and the insured are for the most part satisfied with the coverage they have.

With government budgets already strained by the high cost of health care, all of this makes it hard to convince the insured that they would benefit from nationalizing their health insurance and makes it relatively easy to make the case that single payer might well leave them worse off – if for no other reason than the taxes required to support universal health care.

That leaves the proponents with the need to justify their cause on moral grounds; i.e., that as a society we have an obligation to help those who cannot obtain health insurance or are unable to afford it. But that argument is weakened by government-supported safety-net hospitals and clinics in our larger cities and by the legal obligation of hospitals to treat all who appear in their emergency rooms, regardless of ability to pay. While the care provided by these facilities may not always measure up to that received by the insured, it is good enough to prevent the sort of heart-rending stories that might energize the public to support a more comprehensive public program.

Then there is the political ineffectiveness of the uninsured population. It is to a large extent a transient, politically inactive group, some of whom are uninsured by choice. One hears of people marching for this cause and that, but never for national health insurance.

And all this exists in the context of a political culture that includes a deep-seated distrust of government.

Adoption of single payer would be a political act. However, political conditions in the United States do not favor it and the chances of its happening are somewhere between slim and none.

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