Two states have put forth “single payer” proposals as a means to reduce health care costs. Both have been rejected by the voters. Why? Supposedly they would have saved money by eliminating the “overhead” of private health insurance which supposedly costs more than having a government agency doing the same thing. So why did the voters reject them?
The majority of people obtain their health insurance through their employer who likely pays most of the cost leaving only co-pays and deductibles for the individual to pay. Thus, they are very likely viewing the issue considerably differently from someone who is paying the full cost of their health care insurance. Someone who is writing a check every month to the insurance company. So most people don’t understand what the true cost of health care is.
There is another issue that isn’t often considered. A US doctor probably pays more for his or her education than do doctors in the rest of the developed world. Student loans can run in the hundreds of thousand dollars. Imagine what the interest alone is on a quarter million dollar loan? The US also is the major developer of new drugs and new medical technology. Being “first” is expensive. Additionally American doctors face malpractice law suits far more often than do doctors in the rest of the developed world where filing such lawsuits is far less common. Having more lawyers per capita than any other developed country is one of the reasons for this. Another is that a bad outcome can leave a person crippled in a society where there is less of a “social safety net” than is common in the rest of the developed world. This too likely encourages lawsuits that wouldn’t be filed in other first world nations.
Back in the early 1960’s it cost me $8 to see a doctor. Today the cost is almost 20 times that. True, the value of the dollar has fallen, but only a bit less than half can be considered here. The other portion is due to “government regulation” and the greatly increased use of health insurance which considerably complicates the issue as to “who pays the bill”. That doctor back in 1960 had an “office nurse” as an employee. Today’s doctor however will have the “office nurse” along with people to do insurance verification, billing, along with compliance with all the government regulations that exist today, but were unknown back there in 1960. Anyone who runs their own business today will be well aware of the costs involved here in dealing with all the government rules and regulations both state and federal. All of this is a part of the driving force that has driven US health care costs to the level they now are today.
So what effect would “single payer” have on this? Replacing the private insurance industry with a state or federal government agency won’t make that big a difference if any. Both Medicare and Medicaid have “fraud” problems. As does private insurance, although not to the same level as the two “government” programs do. The VA for example is an example of a health care service that is run completely by the federal government. There are “access” problems that the VA seems to have trouble resolving. The VA does have the advantage that it can negotiate drug prices (as can Medicaid) while Medicare is legally prohibited from doing this. And none of the private insurance companies are large enough to do very much about “prices” of drugs and other medical equipment. So unless the proposed “single payer system” has the authority as the VA does to negotiate prices, there won’t be much savings there. We might also consider that private insurance companies pay taxes, something that government agencies of course don’t have to do. So any comparison should take this into consideration… Looks to me like we’re comparing apples to oranges (2 different things)!
Looking at single payer systems in use in the rest of the developed world, they cut costs by paying doctors considerably less. Something they can do because the doctor’s education (in many cases) was paid by the government. (where is that cost figured in?) They also wait to purchase advanced medical technologies until the prices drop as they do after a few years. Then less equipment in total is purchased, so the cost is less although patients have to wait longer to get their MRI’s, CAT scans, etc., than their US counterparts do. This of course does “lower” the cost of health care. The popular term for doing this is called “rationing”…
There is a much simpler way to reduce US health care costs. I’ve covered this again and again in this blog. SIMPLY REDUCE THE AMOUNT OF GOVERNMENT INVOLVEMENT IN HEALTH CARE! Repeal prescription laws. Allow people to take care of their own health (without involving a doctor) to the limits of their abilities. Hey, we used to do this! Prior to 1938, you were free to go to your local drugstore and buy the medical drug of your choice. The druggist would assist you if you needed any help. Today there is so much more available information (Internet and books) that any reasonable competent person should be able to handle health issues like high blood pressure, high cholesterol, high blood sugar, arthritis without ever seeing a doctor. That’s probably at least HALF of all visits to primary care physicians today. And the cost of dealing with these common health issues shouldn’t cost you more than $200 for a year even if you have all four of them to deal with! Even somewhat more complex issues, if they are treatable by taking a “pill” may well be within a person’s abilities to deal with. We can also expect that software companies will soon create a “doctor on a disc” program to assist you in taking charge of your own health. Even issues such as insulin dependent diabetes are not all that difficult to deal with if you’d done sufficient study to understand what the disease is and how to balance carbohydrate intake with the amount of insulin you are taking. As long as you are cautious and pay attention to what precautions you should be considering, keep up with your studies, you’ll be surprised at what you can do to take care of your own health. The more you know, the better for you! You do need to be aware of possible side effects, which affect different people in different ways.
There will of course be strong opposition to repeal. Doctors have gotten dependent upon their legal monopoly and the power over their patients that these laws give them. The AMA will doubtlessly do everything it can to prevent repeal from taking place. Remember that the US health care industry is a THREE TRILLION DOLLAR industry today. It has gotten that way because the industry relies more and more upon the government for its assured profits.
It would help if we repeal all the drug laws at the same time, but that’s another chapter in this blog and my attempts to prove how much better off we are with a far smaller government.