Single-Payer Wanted

by Pejman Yousefzadeh on August 4, 2009

Never think for a moment that single-payer is not the Obama Administration’s ultimate aim:

The White House claims that these clips are just cherry-picked. Whatever. When you hear Barack Obama endorse single-payer, that’s one heck of a cherry.

Quite frankly, if the Obama Administration wants to argue on behalf of single-payer, that’s a debate we can have. I just wish they would be honest about it.

  • http://www.donkeylicious.com/ NeilTheEthicalWerewolf

    I'm happy to agree with you that the public option smooths the road to single-payer. What I think Republicans might appreciate, however, is that the road goes directly through the market. Our strategy for getting to single payer depends on consumers choosing the public plan in a free market over private insurers. If you thing private insurance is better and believe in the market's ability to make the right choices, why not call our bluff?

    I have a post putting up these thoughts in longer form.

  • Pejman_Yousefzadeh

    Come now, Neil. We all know that “competition” between private insurers who have to make a profit and the public plan, which can operate at a loss and still get subsidized, is not any kind of competition at all.

  • http://www.donkeylicious.com/ NeilTheEthicalWerewolf

    Public insurers get the exact same subsidies as private insurers under this program. It's basically a voucher system.

  • Pejman_Yousefzadeh

    Private insurers don't get the luxury of operating at a loss.

  • http://www.donkeylicious.com/ NeilTheEthicalWerewolf

    Neither will the public plan, at least under Schumer's proposal.

  • CSBadeaux

    (1) I'm intrigued by the assumption underlying this response. Are you suggesting that the “Schumer proposal” is now the plan under which this little adventure in British health care will take place? If so, what happened to all the others? How do you have this inside knowledge?

    (2) Humor us all with a hypothetical: You do not have secret knowledge, and in fact, the “Schumer proposal” — which, last I'd checked, has changed since May, but I'm old and tend to miss a lot — will not be the vehicle by which a public option enters the system. The new public option is backed by the Full Faith and Credit of the United States. Same answer?

    (3) Following through on your guess, isn't Schumer's backed by the Full Faith and Credit Clause?

    (4) If it's not underwritten by the government — which, in its first three years, it would need to be, if only because it won't have premia from which to pay out claims — then what's the point? Why aren't private carriers good enough, especially if compelled and subsidized to provide the things the government thinks we need?

    (5) Are you actually suggesting that a Federal government plan would not leverage off its ability to regulate the health care industry as a way of negotiating prices and therefore keeping its premia artificially low?

    (6) Staying with your guess: Will the premium on this be taxed by the government as private insurance premia look to be? If not, won't you concede that this is an implicit subsidy?

    (7) Staying with your guess: Do you actually think a direct or indirect subsidy is, absent “market” forces, the only impetus for this drive to single payer? Off the top of my head, the ability to require insurance companies to provide things at costs they cannot afford (but which the government can negotiate down to Medicare + $.01) and fining employers and individuals for not taking on insurance just like the public option (which won't be available from for-profit companies, which is to say, anyone but the Federal government) seem like easy answers.

    I'm forced to question whether you're deliberately being obtuse, or accidentally being so.

  • http://www.donkeylicious.com/ NeilTheEthicalWerewolf

    1) Well, the Schumer proposal is basically in the middle of all the Democratic proposals, with Rockefeller to the left and Baucus to the right. So it's as good a guess as any to what we end up with. BTW, it's French health care, not British. I have no secret knowledge — just that I've been obsessively following the congressional sausage-making for a while.

    2) Yes, but I'm not seeing exactly how that impacts the situation.

    3) Yes, see 2.

    4) Because private carriers have produced an pretty terrible value. They haven't held costs down as well as Medicare, and we spend far more on health care than anybody else — 15% of our GDP — and that's for a system that leaves 47 million people uncovered. The empirical evidence is that modern societies need a government-run system to get a decent deal on health care. We're getting an abysmal deal right now, while France is getting universal coverage and no waiting lines for 11% of their (smaller per capita) GDP. You can also go the bare-bones UK way, but that's full-on socialized medicine, which is further away from single-payer than we are, in the other direction.

    5) It will leverage that ability to keep costs non-astronomical. Which means a better deal for you! There'll probably be more pharmaceutical innovation — rather than selling pills at a super-high margin to a smaller client base, pharmaceutical companies will be selling them at a not-so-high margin to a larger client base (because universal coverage means more people will be insured and able to buy the pills.) Best of all, the IMAC system Peter Orszag is pushing will enable us to evaluate medical technologies based on what actually works, rather than which pharmaceutical company hired the hottest cheerleaders to sweet-talk doctors into prescribing their overpriced copycat drug. I worked in a big pharma cancer research lab for a couple summers, and I remember all the biologists moaning about how we were a “second-to-market company” that would just copy other companies' drugs, have chemists modify them into things that weren't covered by the patents, and pump money into sales and marketing to win at the doctor's office. I'm all for the end of that.

    6) As far as I know, the tax situation is the same for premia on both public and private plans.

    7) I'm happy to endorse the government negotiating prices down as a big part of the reason why health care costs will go down.

  • http://www.donkeylicious.com/ NeilTheEthicalWerewolf

    1) Well, the Schumer proposal is basically in the middle of all the Democratic proposals, with Rockefeller to the left and Baucus to the right. So it's as good a guess as any to what we end up with. BTW, it's French health care, not British. I have no secret knowledge — just that I've been obsessively following the congressional sausage-making for a while.

    2) Yes, but I'm not seeing exactly how that impacts the situation.

    3) Yes, see 2.

    4) Because private carriers have produced an pretty terrible value. They haven't held costs down as well as Medicare, and we spend far more on health care than anybody else — 15% of our GDP — and that's for a system that leaves 47 million people uncovered. The empirical evidence is that modern societies need a government-run system to get a decent deal on health care. We're getting an abysmal deal right now, while France is getting universal coverage and no waiting lines for 11% of their (smaller per capita) GDP. You can also go the bare-bones UK way, but that's full-on socialized medicine, which is further away from single-payer than we are, in the other direction.

    5) It will leverage that ability to keep costs non-astronomical. Which means a better deal for you! There'll probably be more pharmaceutical innovation — rather than selling pills at a super-high margin to a smaller client base, pharmaceutical companies will be selling them at a not-so-high margin to a larger client base (because universal coverage means more people will be insured and able to buy the pills.) Best of all, the IMAC system Peter Orszag is pushing will enable us to evaluate medical technologies based on what actually works, rather than which pharmaceutical company hired the hottest cheerleaders to sweet-talk doctors into prescribing their overpriced copycat drug. I worked in a big pharma cancer research lab for a couple summers, and I remember all the biologists moaning about how we were a “second-to-market company” that would just copy other companies' drugs, have chemists modify them into things that weren't covered by the patents, and pump money into sales and marketing to win at the doctor's office. I'm all for the end of that.

    6) As far as I know, the tax situation is the same for premia on both public and private plans.

    7) I'm happy to endorse the government negotiating prices down as a big part of the reason why health care costs will go down.

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