Please, no straw men.
Conservatives, do you object to single payer health care, and if so why? I am running out of reasons to oppose it.
Thanks,
Rob
I’m not a conservative, but it’s the same argument for why we shouldn’t buy everyone a house, car, etc. Nothing is free. You’re taking someone else’s hard earned money and giving it to people who didn’t earn it. It’s not an argument that is hard to understand, and I figure it’s everyone’s first conclusion before being talked out of it by more sophisticated arguments.
Exactly. It’s largely the same argument many on the right use against welfare, social security, rent control, or the minimum wage.
I think you’re right that this is part of the argument. I’d say, in the big picture, it’s one of the two most common arguments. The other one is fear and distrust of government. In the minds of conservatives, especially on the fringes of libertarianism, it is a central article of faith that there is virtually no evil of which the government is not capable, and if they control health care funding they will cut back on services and eventually death panels will be coming for your grandma, and soon after that, for you.
But the counterarguments are not complex. They need not be sophisticated. They really come from simple observation of other nations, not through the filter of insurance industry propaganda or rancorous conservative media spin, but as they actually are. So let me reframe the question as some questions for conservatives.
What one finds, regarding the first argument – giving health care to people who “didn’t earn it” – is that the elimination of the exceedingly complex screening and adjudication systems and spreading the risk across the entire population lowers health care costs for everyone. So my question to conservatives then is, why do you object to having your health care costs cut in half, while getting unconditional coverage for life because claims are never denied and policies never canceled?
And regarding the second argument, one finds that in these countries with universal single-payer, grandmas and other elderly individuals are not only still around, with “death panels” nowhere to be found, but they actually enjoy a longer life and better quality of life on average than their American counterparts. So my other question to conservatives is, why do you object to living a longer and more comfortable life in your old age, free of financial worries about health care costs?
That’s not an argument against single payer healthcare, it is an argument against Medicaid. Since most will pay for a single payer plan through taxes, many if not most will not get something for nothing. If single player plans are more efficient, then most people will get more for what they pay.
A few months ago, we learned about a scandal in the Veterans Affairs health care system. Many veterans had died while waiting for medical services. Meanwhile, government employees had run an elaborate cover-up to conceal the facts about lengthy wait times and shoddy services.
Perhaps conservatives don’t like the prospect of having their healthcare controlled entirely by the same government that did that.
You do realize that “single-payer health care” is not defined as the government providing health care services, right? It’s defined as the government paying the bills.
In most systems, the British NHS being a notable exception, basically the same independent fee-for-service health provider system exists as in the US. The Canadian medical system, as a case in point, would be virtually indistinguishable to a typical American from the one he is used to at home. Except when it comes time to get the bill, no bill ever comes. Does that prospect scare you? 
It’s also an argument for federalism. Let the feds fund it, the states/provinces administer it, and private doctors deliver the services.
If the wellness rates in State/Province A consistently out-perform the wellness rates in State/province B, then that may be an indicator that the government in A has found better ways to do things. Or, it may be that the government in B is corrupt or inept in some ways. By having the delivery done by the states/provinces, it takes advantages of one of the strengths of federalism, which in the long run helps to identify best practices for other states/provinces to follow, and bad practices to avoid.
More precisely, such a system lowers the total health care costs for the entire population at the expense of raising the individual health care costs for many by taxing those healthier persons who previously came out ahead personally by paying out of pocket. Health care does not become “free” just because it is paid through a single payer system run by the government.
A conservative point of view might advocate that a single payer system thus deprives an individual of the liberty to choose how to manage health care expenses.
However some who oppose single payer system note longer wait times for non-urgent medical procedures as opposed to the current system in the US.
While they are waiting for care, the Royal College of Surgeons found that some elderly in the UK are being denied the best standard of care through the NHS. In some areas of the UK there were no procedures to excise cancer from breast cancer patients over age 75. None. The RCS suspects age discrimination.
Just go home. But it’s not a death panel.
Did veterans actually get worse service than the uninsured and under-insured though? Longer waits? Did more people die waiting for treatment than the number who die being denied coverage?
I suspect even with the VA scandal, the VA provides better odds than the average, if you include the uninsured and under-insured in that average.
There are four fundamental models of health care delivery. Beveridge, which is the NHS one. Also used in Spain and Scandinavia. National Insurance, which is the Canadian or Japanese type, Bismarck which is insurance, often through employers. Germany, Switzerland and the Nederland uses this. And out of pocket, seem in rural third-world areas mainly.
Not completely accurate. Adjusted for population, most single payer systems cost less per person to cover 100 % of the population than the amount of tax money the US is currently spending on government health care. Covering 28 % of the population.
That something is a problem in the notoriously underfunded NHS does not actually mean that it is a problem with all UHC systems.
To illustrate, the yearly costs of the NHS to the UK is about 2900 per citizen. People in the UK spends an additional 500 privately. The yearly costs of US healthcare is about 8600 per citizen. 4200 of that is government spending, from tax money.
As for waits, when compared to UHC systems in general, the US is about average. I am unsure if that actually counts the uninsured in there though.
Private insurance companies can attempt to deny claims due to costs as well, or throw people off of coverage if they switch jobs pre ACA where the practice was stopped. But I suppose those were not death panels, because it was committed by a private system, and not the directly touched by government. So no harm no foul.
There are undoubtedly some tradeoffs in switching to single payer from our current system. Wait times might indeed go up, but the question is whether on net the system would provide better care for more people at cheaper prices… or not. This is an empirical question, and focusing on tiny slivers of the relative inferiority of a single payer system in specific areas is akin to making an argument in bad faith. An argument unconcerned with the more general question about whether it’s a better system or not, and more interested in scoring as many points against government paid healthcare as possible.
My point is that those who promote government run single payer systems tend to talk about lowering the total health care costs across a broad (nationwide?) group of people.
The counter-argument arises from an individual view - yeah, that’s nice but what is it costing me out of my pocket? I don’t care what the nation as a whole is spending on health care, just what I have to spend on my own health care.
The relatively young and healthy may not care if the administrative costs of the current system are a total abomination. They are opting out of insurance altogether and not going to the doctor because they don’t get sick much. They get to act as a free rider and come out ahead solely in terms of what they must pay out of pocket, particular given our abhorrence at the idea of leaving someone out in the cold for inability to pay for life saving treatment. Government funded single payer funded by tax revenue puts and end to that free rider issue.
And the reality is that even though any individual of that young and healthy group could be hit by the figurative bus tomorrow, the vast majority won’t. The majority of those individuals in the under age 30 group who opt to go without insurance would pay less, total, out of pocket by forgoing costly insurance premiums and paying out of pocket on a fee for service basis for what care they do need. Great plan, so longer as you are not the one who gets hit by a bus.
So the typical 23 year old individual with minimal health care costs would pay less than even the $3400 being spent per capita in the UK system (per Grim Render’s $2900 public + $500 private) by forgoing insurance and paying out of pocket for care as needed.
Insurance inevitably takes from the many to pay for those who make claims. Such is the nature of insurance.
Changing health insurers is possible in a free market. Changing government is harder.
Suing health insurers is possible in a free market. There is a reason for the phrase “Don’t fight City Hall.” Suing government can be nigh on impossible. In many instances an individual must ask permission from the state in order to sue them. The state can just say no.
And you credit something to the ACA that is better credited to HIPAA passed under the Clinton administration in 1996. HIPAA put an end to losing coverage for pre-existing conditions due to changing jobs so long as a continuous period of coverage was maintained. That built upon COBRA passed under the Reagan administration in 1985 that guaranteed the right to continue coverage under a group plan after a lay off with the person paying premiums through their former employer.
And again, the conservative individually minded argument may be that better care overall is not his goal if it means not better for me in the ways that matter to me.
Presumably he is paying taxes though. So under the current system he would be paying 4200 in taxes towards healthcare, and then paying out of pocket when he actually needs health care. Whereas his exact twin in the UK would be paying 2900 in taxes and noting out of pocket.
Nothing stops you changing health insurers in a UHC system. Or having insurance. In fact, some countries use private health insurers to deliver UHC. Thats how Bismarck type UHCs work.
Good posts, Grim Render
Of course, one party’s “notoriously underfunded NHS” is anothers ‘extraordinary good value’. Fwiw, for me it is certainly the former.
As has been pointed out many times, the NHS is not the model the US need concern itself with. It serves only to illustrate the most extreme position from where the US has been.
Yes, waiting times are all about funding, and funding is all about austerity measures and political choices. We have a general election in May and funding of the NHS is, a Guardian poll found this week, is by far the single most important electoral issue.
I would encourage you to look at UHC through a different perspective, a timeline even.
Were your grandparents working class or working poor, how were your parents born - who paid those bills? Did your grandmother get all the painkillers she needed, all the pre and post-natal care? What about your nephews and neices, what about their grandchildren - the ones not yet born: will they be able to pay their bills?
It’s not ALL about you at this moment in time in your life.
Fwiw, I know pretty well exactly the level of care everyone I have ever cared for or loved has had and will ever get, and I know all they have to do is show up. That’s a society I want to be part of.
With acknowledgment of some of the excellent responses already provided, and some further comments by you, I’d like to provide a few of my own as briefly as I can.
First of all, we should be rational and rule out the wonderfully cost-effective option of not having health insurance. That’s about as smart and realistic as not having car insurance, or buying a house and not having fire insurance. The fact that anyone would even consider taking such a risk with their life and financial future (and yes, I’m aware of EMTALA and also aware of its severe limitations and consequences) is part of the sordid and incriminating history of private health insurance. The fact that people who are responsible enough to carry health insurance might STILL wind up in personal bankruptcy and possibly lose their homes is another part of the sordid story (health care cost is the single largest major cause of personal bankruptcies in the US).
So putting that aside, who are these healthy insured people who are better off not being part of the general population pool? Here are some costs from Canada. In Ontario those making up to $72K would pay $60/mo for their health care premium; maximum for those making over $200,600 would be $75/mo. BC is the most expensive, charging a $57/mo per individual, $102/mo for a family of two, $114/mo for a family of three or more, with subsidies for low-income families. Per the Canada Health Act, there are no out-of-pocket costs whatsoever, no deductibles or co-pays, no payout limits, no preapprovals, no denials. You cannot buy a policy like that from private insurance at ANY cost. I challenge you to find me a comparable private insurance policy from a US provider, no matter how healthy you are. Of course there are tax subsidies that also go into the system from general revenues, but personal income tax rates in Canada are comparable to those in the US, and corporate tax rates are substantially lower. So who’s really the loser here? (Ref)
Yes, well conservatives and libertarians whine about their “individual liberties” whenever any social program is proposed, including the very existence of government itself. Let’s move on…
This is probably true. The key here is “non-urgent” – i.e.- elective procedures, and that urgent cases are triaged and handled appropriate to their urgency. The only way that you can NOT have wait times for routine procedures is to have expensive facilities, equipment, and staff sitting around idle waiting for you. This is basic queuing theory. And the US system has this because provider fees are so outrageously high and profits so astronomical that the market, at present, can still manage to support all that idle surplus. But if you look at where US health care costs are compared to the rest of the world and the rate at which they’re increasing, it’s clearly not sustainable. Insurance companies don’t care because they’re just a cashflow pass-through, taking their cut off the top while contributing nothing productive. But patients who want to continue to have accessible health care, assuming they have it even now, certainly ought to care.
There are many dimensions to this, some of which have already been mentioned. Nor is this an area in which I have any particular expertise. But a few comments.
First of all the Telegraph is a right-wing rag not exactly known for a fair presentation of anything. In fact just to the right of that article tonight was a link to an article on climate change, something that I do have some knowledge about, with the title “fiddling with temperature data is the biggest science scandal ever”, by a fellow named Christopher Booker, a mendacious climate change denying lunatic who should be committed to an asylum before he hurts himself. But I digress. The point is, a more balanced view of that study is provided directly by the Royal College of Surgeons which authored it:
This isn’t about surgeons slamming the theatre door on older people. In fact it is alarming to think that the treatment a patient receives may be influenced by their age. There are multiple factors that affect treatment decisions and often valid explanations as to why older people either opt out of surgery - or are recommended non-surgical treatment alternatives. The key is that it is a decision based on the patient rather than how old they are that matters."
The report outlines that not everyone will benefit from surgery and there are legitimate reasons why older people may decide with their clinician not to go ahead with a procedure.
It sounds to me like they’re identifying some shortcomings and procedural issues and trying to correct them, rather than the all-out war against the elderly that the Telegraph makes it out to be.
It’s also important to note, again, that single-payer doesn’t imply a government-run system. Canada, for instance, has a largely free-market health care provider system, but with single-payer funding. So whatever problems the NHS may or may not have – and my impressions of the NHS are largely very positive – it’s not inherent in the single-payer model.
Some years ago, for instance, my mother, then in her mid-90s, was hospitalized here in Canada for a variety of things. I was really impressed with the quality of care she received, and when a pacemaker was recommended as a precaution, she was transported from the original hospital to a research hospital that specialized in pacemaker implants, and was given what I later found out was one of the most advanced units then available. She continued to live at home with the assistance of a significant amount of home care support, including nursing, personal care, a dietician, and special medical equipment including a portable high-tech oxygen unit so she could continue to be mobile and go out shopping. All of it paid for by the health care system.
And a final note on this is that the elderly can struggle in the US, too; it’s not just the NHS. I wish I could find a paper I read once with stats on how the elderly in Canada don’t just live longer but have a higher quality of life than their average US counterparts (the above, I suppose, could be considered an anecdotal example). But the big problem under the private insurance system, regardless of Medicare, is cost – the amount of cash a person should really have saved away for health care costs before they retire, and the sometimes daunting ongoing costs:
After crunching the numbers, the report found that during that time period, more than 75 percent of Medicare-eligible households spent at least $10,000 out of pocket on health care. Spending for all participants during those last five years averaged $38,688, and for the remaining 25 percent the average expense was even greater: they spent a whopping $101,791 out of pocket. A quarter of participants also spent “more than their total household assets on healthcare,” according to the report. (Ref)
I believe the Swedish healthcare system preserves a lot of what you want. You still have choice, but the government pays most of the bills for healthcare costs financed through taxes.
Outcomes are superior overall. % of total gdp spent on healthcare is around 9.6 percent (compared to around 17-18% in the US). Wait times are increased, that seems to be the primary negative, although reforms in Stockholm seem to lessen those issues. But honestly, for nearly half the cost we could probably add more money to expand the doctor pool and get those wait times down.
But that last point you made can be a non starter. What some people are really clamoring for is to have a self centered view of healthcare policy. If it’s better for me personally, then who cares if we’re spending double our gdp on healthcare while covering fewer people and getting worse outcomes. So long as MY specific specific case is better off, that’s all that really matters.
The first class boards first on a plane model of healthcare. If that’s the core hangup, then we simply need to beat these people and have them sidelined in positions of power. There is an enormous element of hubris in that attitude, it’s essentially saying, “MY” life is more special than others with less means. If it means that the entire nation has to spend double the cost for service while tens of millions have little to no healthcare at all, that’s a fine price to pay so “I” have less wait time. Because as was already said, I am more precious and special than others. This is not an attitude worthy respecting and it simply needs to be overruled. Listening to conservatives as I often do I don’t think most of them will be convinced, the change in attitude will have to occur the old fashioned way, one funeral at a time. A slow process, but that’s one way to allow the ideas to wither away and not be replaced in the same numbers.
When it comes to actual life and death, about the worth of a human beings life, I actually want to care less about how big your bank account is. Boarding first as first class on a plane is more superficial, having that type of model for healthcare causes actual harm, harm far outweighed by the harms resulting for the losers in a single payer system.
Iggy, your link leads to a British web-page which analyses wait times under the NHS. However, it doesn’t have any comparative information for wait times in the US. Is there data for wait times in the US for all Americans, not just those with private health insurance?
Because if we’re comparing wait times in the US to the UK, we have to use the same populations: 100% of Britons are covered by NHS, so the wait times apply to all.
For a fair comparison, we need to know what average wait times are for all Americans, not just those with health insurance.
Single payer is not magic, it just changes who pays the bill. If the US changed to single payer over the weekend, on Monday the doctors and nurses would still want to be paid, the drugs would still cost the same amount, and patients would still want the same quality of care. The only possible savings would be that the bureaucrats administering the system would be in the government instead of the insurance companies. This savings, if it ever occurred, would be minuscule.
The way other countries have ended up with cheaper systems was to slow the growth rate in the 1980s and early nineties. This is not an option for the US. As has already been pointed out the US government spends as much to cover half its population as Canada does to cover all of its population. In order to believe that single payer will reduce the cost of healthcare to something like Canada’s cost, you have to believe that the US can add 150 million people to the Government’s health care system for free.
By changing the funding mechanism to taxation you add in dead weight loss to issue. Any efficiencies generated by centralization would have to be greater than the dead weight loss caused by the increase in taxation. Since the US has one of the most progressive income tax burdens in the world, dead weight loss in the US would be larger than in most other countries.
We have experience with government healthcare in the US and it is mostly not good. Medicare is inexorably taking up more and more of the federal budget with no end in sight. The VA is a national scandal, and people who are on Medicaid are more likely to die than those with no insurance at all. Doubling the number of people who depend on government for health care while promising cost savings does not seem to be a good way to improve the system.
There is a much better way than single payer. Legalize catastrophic health insurance, make medical prices transparent, and provide tax free health savings accounts for citizens. This way health care decisions are left to patients and competition works to keep prices low for everyone. Singapore has this system and it is the most efficient system in the world. Why should we copy the awful British and Canadian systems when we have proof that a better system works?