# What are the conservative arguments against single payer health care? **URL:** \ **Category:** Great Debates\ **Created:** [February 18, 2015, 3:59am UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974 "2015-02-18T03:59:49Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [February 18, 2015, 8:37pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/61 "2015-02-18T20:37:46Z")
> [@ElvisL1ves](#): > > While today, and for the last few years while ACA was in Congress, there were no lobbyists from Big Pharma anywhere to be seen in DC. 😉 > > Comparing a proposed real system to an ideal is non-productive, and just what those profiting from the status quo want you to do since that’s what it leads you to support. You need to compare the proposed real system to the \*existing \*real system, and to other proposed real systems. Why go to a system that makes the problem worse? If we use Singapore’s system then there is no one to lobby for money. The way to get money is to compete with other providers for customers. Any system the US implements are not going to be run by Sweden’s technocrats but by the US congress. Therefore the less politics, the better and single payer is all politics. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [February 18, 2015, 8:41pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/62 "2015-02-18T20:41:15Z")
> [@puddleglum](#): > > Why go to a system that makes the problem worse? Does it? Again, Medicare runs a 2 percent overhead even with an elderly, high-care customer base. > [@](#): > > Any system the US implements are not going to be run by Sweden’s technocrats but by the US congress. If Congress leaves the technocrats alone, as it generally does with Medicare, sure it can. > [@](#): > > Therefore the less politics, the better and single payer is all politics. The implementation is, sure, like any major change. There is no case to be made that operation of it is anywhere close to being as politicized as the postwar US system, or could be. ---
**Author:** ![davidm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidm/32/225_2.png) [@davidm](https://boards.straightdope.com/u/davidm)\ **Post date:** [February 18, 2015, 8:48pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/63 "2015-02-18T20:48:54Z")
Medicare is run by the US government, and Americans seem to be happy with it. My mother does well by it. I have to give kudos to **puddleglum** for a novel argument. America isn’t capable of doing what other countries do. That’s giving in to the people who are intentionally sabotaging our politics. “We shouldn’t try to do anything new or useful because Congress will intentionally fuck it up”. How about, instead of thinking like that, we try to change Congress? ---
**Author:** ![Claverhouse](https://avatars.discourse-cdn.com/v4/letter/c/13edae/32.png) [@Claverhouse](https://boards.straightdope.com/u/Claverhouse)\ **Post date:** [February 18, 2015, 8:52pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/64 "2015-02-18T20:52:53Z")
There were terrible scams going on at the inception of the NHS. My favourite example, and I lost the link, was a shocking example of thievery, and possibly mopery, witnessed by an American writer who declared it was common for people now in receipt of false teeth and free spectacles and free wigs for the first time in their lives to make a bee-line for the local pub — _Brits love their boozers so, and gather around joannas and sing honky-tonk songs and music-hall melodies whilst puffing gaspers and raising their pints to the queen, gawd bless 'er_ — and sell off these freely acquired trinkets to anyone who wanted a pair of false teeth fitted for another in exchange for a drink. ## This was in a 1940s/50s pamphlet produced by an American ‘Liberty for Doctors’ type thing foundation who seemed pretty outraged at socialized medicine. Almost to a comical effect. As to Grim Render’s point: _To Europeans , that fear is like being afraid of Goblins. Its not something you worry about in the modern age. In these discussions, the people who fear not getting healthcare are always American_, as a Brit I can say I’ve virtually never _thought_ about healthcare in my life, nor needed it much ( apart from dentistry, and since I had little income at the time, this too was free ). ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [February 18, 2015, 8:57pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/65 "2015-02-18T20:57:47Z")
Reagan eased his way into politics by way of [shilling for the AMA](http://en.wikipedia.org/wiki/Ronald_Reagan_Speaks_Out_Against_Socialized_Medicine), which opposed Medicare: > [@](#): > > “They say once the Forand bill is passed this nation will be provided with a mechanism for socialized medicine capable of indefinite expansion in every direction until it includes the entire population. Now we can’t say we haven’t been warned.” > … > Reagan warns that if his listeners do not stop the proposed medical program, “behind it will come other government programs that will invade every area of freedom as we have known it in this country until one day as Norman Thomas said we will wake to find that we have socialism.” Under this scenario, Reagan says, “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.” How’s that workin’ out for ya, Ronny? Oh, and, showing that some things never change: > [@](#): > > “When I opposed Medicare, there was another piece of legislation meeting the same problem before Congress. I happened to favor the other piece of legislation and thought it would be better for the senior citizens. … I was not opposing the principle of providing care for them…” Carter’s campaign accused Reagan of “rewriting history”, saying that there was no such alternative legislation. There wasn’t, of course. There isn’t now and never will be, either. ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [February 18, 2015, 9:00pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/66 "2015-02-18T21:00:49Z")
I would favor single payer in America if there were a corresponding cutback in taxes elsewhere to ensure that the overall tax burden remains largely unchanged. ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [February 18, 2015, 9:02pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/67 "2015-02-18T21:02:31Z")
[QUOTE=davidm] I have to give kudos to puddleglum for a novel argument. America isn’t capable of doing what other countries do. [/QUOTE] Nothing novel about it…nor is it as ridiculous an argument as some of you who are handwaving it away seem to think. It’s a fundamental structural change for us to get from where we are today to some ill defined ‘let’s do it like the Europeans’ goal, and I’ve yet to see a good way to do it except to gradually move people from the current system to Medicare somehow, which means we will have two systems we will be supporting for some ill defined number of years through a transition that will cost some ill defined amount of money and have some ill defined amount of disruption. Because other countries have UHC or single payer systems doesn’t mean that the US can just do the same thing because they did. You can’t handwave away all of the political ramifications, nor the entrenched corporate and health care provider issues, no even the issues that Americans know the system we have and would need to be convinced that the pain of moving from where we are to some ill defined final goal will be worth it in the end, especially since no one can really say what we will get to in the end, considering that it will probably be a compromise system and probably won’t end up what it started out as, considering that there will most likely be several administrations and changes in Congressional majorities between the theoretical start and finish. These are issues that other countries didn’t have to deal with in getting from where ever they started to where they are today because no one else is structured like we are politically and socially. When one of you becomes god Emperor of the US and can simply do whatever you want by fiat, then come back. Until then handwaving away reality is really just mental masturbation and doesn’t do anything constructive to the real issues. It would be like me saying that we should build hundreds of nuclear power plants because that would be the best thing we can do for global warming and that we could do this because France already has over 70% of their power generation via nuclear…why can’t the US do that too if France can?? Well, we can’t because we aren’t France. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [February 18, 2015, 9:11pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/68 "2015-02-18T21:11:41Z")
His claim wasn’t that the existing system is too heavily entrenched, but that Americans are somehow inherently more prone to game systems than are people elsewhere. And even if it were, obstacles exist so they can be overcome. Giving in to despair over the prospect is surrendering before the war even starts. ---
**Author:** ![OldGuy](https://avatars.discourse-cdn.com/v4/letter/o/3bc359/32.png) [@OldGuy](https://boards.straightdope.com/u/OldGuy)\ **Post date:** [February 18, 2015, 9:17pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/69 "2015-02-18T21:17:00Z")
> [@Velocity](#): > > I would favor single payer in America if there were a corresponding cutback in taxes elsewhere to ensure that the overall tax burden remains largely unchanged. Do you favor that the money most corporations pay to provide health care for their workers become profits to them, or increased compensation for employees, or lower prices … or perhaps that via taxes could finance the health care. In the US in 2013, 2.9 trillion was spent on health care. In fiscal year 2014, the federal government collected $3.02 trillion in taxes. If the federal government pays for all our health care with no increase in total taxes, there’s not going to be a whole lot else they can do. Interest on the debt alone is over $400 billion so even that could not be paid. ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [February 18, 2015, 9:17pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/70 "2015-02-18T21:17:41Z")
> [@ElvisL1ves](#): > > His claim wasn’t that the existing system is too heavily entrenched, but that Americans are somehow inherently more prone to game systems than are people elsewhere. > > And even if it were, obstacles exist so they can be overcome. Giving in to despair over the prospect is surrendering before the war even starts. Oh. Well, my apologies then. I think it’s a worthy goal, and I’m for it if the details can be nailed down. I think it’s obvious to everyone that we have to do something. Even my dad, one of the more conservative people I know, agrees that things have to change. But getting from where we are to where we want to be (assuming that is ever even nailed down) is going to be VERY difficult, and saying that the Europeans or Japanese or Canadians have done it really is meaningless in the context of the US, since in order for us to do it is going to mean buy in not just from the voters (like herding cats) but from both political parties, and business both small and large, plus the medical service companies and organizations. One party is never going to be able to do it. Really and realistically from where we are at it would be better to start at the state level and build it there. If it can be made to work at that level in just a few states then you could use that success (assuming you got success) to build consensus as people could see and understand the example and put it in a context of their own experience and how it would work for them. But in the end I have no more idea how to actually do it than I do in convincing my fellow citizens that this global warming thingy is important and that we should be building nuclear power plants like mad. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [February 18, 2015, 9:22pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/71 "2015-02-18T21:22:02Z")
Absolutely, it has to be done in stages, and absolutely, one party can’t do it alone, especially with the other in auto-obstruct mode. But we have the basis for a national system already in place and working well, with essentially no complaints or organized opposition. Rather than depend on state governments, with all the same institutional resistance to overcome but less ability to combat it, why not just phase in expanded eligibility of the fine system _we already have_? Opposition would have a much harder time coalescing, and the final result would be pretty much optimal. ---
**Author:** ![BobLibDem](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/boblibdem/32/3149_2.png) [@BobLibDem](https://boards.straightdope.com/u/BobLibDem)\ **Post date:** [February 18, 2015, 9:23pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/72 "2015-02-18T21:23:15Z")
> [@Velocity](#): > > I would favor single payer in America if there were a corresponding cutback in taxes elsewhere to ensure that the overall tax burden remains largely unchanged. That’s preposterous. You’re currently paying insurance on one hand and taxes on the other. So you’re in favor of having the government take the burden of your insurance off your back but only if you don’t have to pay a nickel for it? ---
**Author:** ![BOOM](https://avatars.discourse-cdn.com/v4/letter/b/c4cdca/32.png) [@BOOM](https://boards.straightdope.com/u/BOOM)\ **Post date:** [February 18, 2015, 9:25pm UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/73 "2015-02-18T21:25:31Z")
Maybe once you begin to lose the obstructive white noise of lobbyists and special interests change can happen quickly, especially with moden technology and the option of learning from the mistakes of other systems. Already people up thread are saying they want Singapore and not this or that. The biggest issue will surely be changing the mindset. ---
**Author:** ![Salvor](https://avatars.discourse-cdn.com/v4/letter/s/b5e925/32.png) [@Salvor](https://boards.straightdope.com/u/Salvor)\ **Post date:** [February 19, 2015, 4:04am UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/74 "2015-02-19T04:04:44Z")
> [@puddleglum](#): > > 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](http://www.ncbi.nlm.nih.gov/pubmed/7979836) 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? The Singaporean health savings accounts were discussed here (it picks up in two places to keep watching) [![](https://img.youtube.com/vi/Pz3OoKrRnGI/hqdefault.jpg "WonkTalk: Avik Roy and Ezra Klein Debate Obamacare Rate Shock and the GOP Health Care Agenda") ](https://www.youtube.com/watch?v=Pz3OoKrRnGI) But what you left out of that diatribe is the fact that Singapore mandates a garnishment of wages to put into those healthcare savings accounts (oh no government MANDATES !!!), they also dictate the prices for drugs and how much doctors and hospitals can pay for more things (again, oh no GOVERNMENT MANDATES !!!). I don’t know how easy a system like that would be to set up here, but the big hurdle will still be to the remove the white foam from conservative mouths while trying to get them to acknowledge that the better systems involve different government policy and constraints. Case in point. [![](https://img.youtube.com/vi/ZGwLhyfJvDA/hqdefault.jpg "Ben Carson: I'm Against Obamacare Even If It Works") ](https://www.youtube.com/watch?v=ZGwLhyfJvDA) This is why I made such a big deal about finding a way to break through these sorts of axiomatic beliefs about the way things should be, beliefs impervious to practical results and more focused on an almost aesthetic preference about the way things ought to be. But these beliefs have consequences and need to be ground to dust. It is not enough to let them stand because a bunch of people with thick skulls believe them. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [February 19, 2015, 4:32am UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/75 "2015-02-19T04:32:17Z")
> [@ElvisL1ves](#): > > Does it? Again, Medicare runs a 2 percent overhead even with an elderly, high-care customer base. The Medicare 2% overhead myth is achieved by comparing apples to oranges. Try taking all things into account: [http://www.manhattan-institute.org/html/mpr\_05.htm](http://www.manhattan-institute.org/html/mpr_05.htm) ---
**Author:** ![Salvor](https://avatars.discourse-cdn.com/v4/letter/s/b5e925/32.png) [@Salvor](https://boards.straightdope.com/u/Salvor)\ **Post date:** [February 19, 2015, 5:08am UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/76 "2015-02-19T05:08:50Z")
> [@Terr](#): > > The Medicare 2% overhead myth is achieved by comparing apples to oranges. Try taking all things into account: > > [http://www.manhattan-institute.org/html/mpr\_05.htm](http://www.manhattan-institute.org/html/mpr_05.htm) He decries price controls, but that single fact seems to be one of the largest factors in why Americans spend so much more on health care costs. I don’t think healthcare functions like a normal market because the product is human life and its quality. There is virtually no premium people would not be willing to pay if they are able. This is why it’s one of the largest causes of bankruptcies. You parent needs care, or your child needs care that is not covered by insurance? What are you going to do? Let them die? Especially in the case of children, parents often take out mortgages on their own property to pay for medical service. This is not like skipping out on the latest high end retina mac, this is about life and death, and the premiums people are impelled to pay for their own lives and the lives of their families is much higher. For these reasons among others, we need other ways to check the costs of healthcare. That guy mentioned cross subsidies as if they were a bad thing. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [February 19, 2015, 5:14am UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/77 "2015-02-19T05:14:13Z")
> [@Salvor](#): > > He decries price controls, but that single fact seems to be one of the largest factors in why Americans spend so much more on health care costs. I didn’t cite the paper for his criticism of price controls. I cited it for his analysis of what the true administrative costs of Medicare are. Hint: they are a lot higher than 2%. ---
**Author:** ![BOOM](https://avatars.discourse-cdn.com/v4/letter/b/c4cdca/32.png) [@BOOM](https://boards.straightdope.com/u/BOOM)\ **Post date:** [February 19, 2015, 6:01am UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/78 "2015-02-19T06:01:25Z")
> [@Terr](#): > > I didn’t cite the paper for his criticism of price controls. I cited it for his analysis of what the true administrative costs of Medicare are. Hint: they are a lot higher than 2%. It’s great debates so “hint” isn’t really carrying too much weight. How about a cite? > [@](#): > > The latest NHEA, also prepared by OACT, is for 2010. According to it, Medicare’s overhead totaled $31 billion that year, far more than the $7 billion reported by the trustees for 2010. That $31 billion constituted 6 percent of total Medicare spending in 20102 — much higher than the 1 percent rate reported for that year by the trustees. \*\*The difference between the trustees’ measure of overhead and the NHEA measure is \*\*due almost entirely to the fact that the NHEA defines Medicare’s overhead to include not only the $7 billion in administrative expenditures reported by the trustees for 2010 but also the $24 billion in administrative expenditures incurred by the insurance companies that participate in Parts C and D. So that source is saying Medicare does its side of the admin for 1%, the private insurers side adds 5% - which is kind of the whole ball game in a single number. > **[Important: What are Medicare's true administrative costs? - PNHP](https://pnhp.org/news/important-what-are-medicares-true-administrative-costs/)** > > How to Think Clearly about Medicare Administrative Costs: Data Sources and MeasurementBy Kip Sullivan Journal of Health Politics, Policy and Law, February 15, 2013AbstractIn his article, Kip Sullivan has finally laid to rest the distortions and... ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [February 19, 2015, 6:07am UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/79 "2015-02-19T06:07:41Z")
> [@wolfpup](#): > > The point is, a more balanced view of that study is provided directly by the [Royal College of Surgeons](https://www.rcseng.ac.uk/news/age-should-not-close-the-door-to-surgery-warns-rcs-and-age-uk#.VORrMCfFJ8F) 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." My grandmother is 101. Her blood tests are A-OK. She’s got minor mobility problems and some arthrosis (uses a walker, or a cane she waves like Charlot and a person to hold onto; needs help with blouses). High hearing loss. Eyesight ridiculously good, thank you. Sometimes she presents fecal blood. Medication: an OTC painkiller, as needed. Doctors and family agree that at her age, the most likely CoD without an autopsy will be “old age”, excuse me, “cardiorespiratory arrest”. The procedures to find out where the blood is coming from would be invasive. She hates being in bed. She hates not being allowed to move around. She has been asked “Mom, you know sometimes you shit black?” “Oh yeah.” “You know what that means?” “I shit blood! Do you think I’m stupid, woman?” “No, Mom, I don’t think you’re stupid. I think a lot of nasty things about you but I’ve never thought you were stupid. The doctors say we can maybe take you to the hospital, see if they can find out where that blood comes from. Do you want to do that?” “No, I don’t want to go to the hospital!” What, should we bundle her up into an ambulance, grunting her negative impression of everybody under the sun, because maybe we can find out where she’s got an ulcer or something? ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [February 19, 2015, 6:51am UTC](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974/80 "2015-02-19T06:51:06Z")
> [@BOOM](#): > > It’s great debates so “hint” isn’t really carrying too much weight. How about a cite? I cited the paper. It’s in there. For the private market, non-benefit costs are about 11-14 percent of total premiums, while the direct administrative costs reported for Medicare are about 3 percent of Medicare outlays. A reasonable allocation of a share of outlays for general government functions and for the administration of justice increase direct and indirect administrative—that is, non-benefit—outlays as reported in the federal budget to about 6 percent of Medicare outlays. … Because the federal tax system is an institution necessary for financing all federal programs, including Medicare, the unmeasured costs borne by the economy as a result of the tax system are a real cost of federal spending, and the lowest plausible assumption about the magnitude of that excess burden has the effect of raising **the non-benefit costs of Medicare to about 24-25 percent of Medicare outlays** , or about double the net cost of private health insurance. A more realistic assumption raises the **true cost of delivering Medicare benefits to about 52 percent of Medicare outlays** , or about four to five times the net cost of private health insurance. See bolded. [Previous page](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974.md?page=3) [Next page](https://boards.straightdope.com/t/what-are-the-conservative-arguments-against-single-payer-health-care/712974.md?page=5)