The problem with single payer

This is another in my series of posts on health care reform. Eventually, I’ll get to my thoughts on what reform should look like. So far, I have mostly written about the history of health care and the basic problems that must be addressed. Here, I want to discuss a weakness of the single payer concept.

Kevin Drum, a leftist blogger with excellent reporting skills, states one of the problems clearly. A single payer system will be dominated by administrators whose focus will on “the greatest good for the greatest number.” This will inevitably determine an emphasis on public health and general “good health” measures like stopping smoking, obesity and changing behavior. Those are important issues but should not be part of a health plan. Most “preventive health” activities cannot be shown to be effective, often because they are politically driven. Exceptions are mammography and immunization but, even here, political considerations, such as the mythical link to autism, influence these factors.

…patterns of health service utilization in developed countries suggest that the marginal dollar of health care spending — money used to purchase high tech equipment or specialist services — is less progressively spent than the average dollar.

“Less progressively spent.” What does that mean ?

Maybe this: “Finally, a review of the literature across the OECD suggests that the progressivity of financing of the health insurance system has limited implications for overall income inequality, particularly over time.”

There is where the politics comes in and it is clearly socialist.

But I’d certainly agree that a publicly financed system ought to be careful about making any of it part of a basic healthcare package until it’s well proven in the field. As progressives, our goal shouldn’t be to provide gold-plated care to every person in the country, nor should it be to restrict the ability of the rich to get better service if they want to pay for it. Our goal should be to provide decent care to everyone, with the market free to operate on top of that.

Here, I agree with Kevin completely. A public funded health care system should provide a basic program that makes available the standard care that everyone living in the country should have access to. The problem is that many single payer activists, who might have considerable influence in an Obama administration for example, are adamantly opposed to allowing a market system to exist in conjunction with a publicly funded single payer system.

Kevin’s post comes from this analysis of another report on health care systems in other countries. It is available only for a fee.

Here is a comparison (actually a summary of a study available only for a fee) of Canadian and US health care.

The conclusion is interesting.

The authors conclude that while it is commonly supposed that a single-payer, publicly-funded system would deliver better health out-comes and distribute health resources more fairly than a multi-payer system with a large private component, their study does not provide support for this view. They suggest that further comparisons of the U.S. and Canadian health care systems would be useful, for example to explore whether the higher expenditures in the U.S. yield benefits that are worth their cost.

I believe that the Canadian system has a fatal flaw in that it banned all private care. That is the major issue that we must consider when examining the prospects for a US national health plan. Here, Kevin Drum and I may be close.

More to come.

3 Responses to “The problem with single payer”

  1. cassandra says:

    What I dread are the inevitable professional groups who will lobby to be included in coverage. Will chiropractic be covered? Those people are all over it at our legislature. What about holistic, acupuncture, naturopathy?

    Then there’s dentistry psychiatry. I think we all have similar ideas of what constitutes “decent care for everyone” but then people start splitting hairs over what it means in practice.

    BTW, can you tell me what the relative status is of osteopaths to MDs? I was surprised to be treated by a DO the last time I went to our walkin clinic.

  2. The California legislature has, once again, responded to lobbying by mandating acupuncture for workers comp cases. This is a major problem for political health care systems. Canada banned private care because politicians decided it was elitist. It was a disaster. Had there been private care, many of the scandals of the Canadian system would not have happened. There would have been a safety valve plus the competition would have shown up the drones in the government system. The British allowed private patients again after a scandal when a Labour health minister had a hysterectomy by a private MD in Belgium.

  3. Great blog! Loved the article. Thanks