Getting Clear about Single Payer

May 31, 2007 -- Francine Hardaway writes a fascinating and often brilliant blog in which the topics are sometimes medical:

Rarely do I disagree with her, but I did when she wrote:

I don't think we will accept a single payer system, because that's just another way to say "rationing health care."
Here's my reply.

What does "single payer" really mean? The significance of the number of payers is that when there is more than one, the incentive structure changes. The rewards no longer go to those who provide prevention and care. They go to those who stick the other guy with the bill.

We already do have rationing, Francine. Every country and every system has rationing; it has to. There's always a gatekeeper (as it's called in the UK, where health care is provided primarily by public funding.) Why ration? Because resources are finite.

Many people are frightened by the idea of gatekeeping by governmental agencies. Consider, though, that the activities of government are subject to the scrutiny of we who elect them; they don't have the impunity of corporations that operate behind closed doors. Corporations are beholden primarily to stockholders. To them, doing a good job means increasing the dividend each quarter. Over corporate officers and management the public has even less control than they do over governmental officials. As long as we have a democracy, I prefer that gatekeeping be done by government, thank you.

The problem with our system is that with multiple payers, we have an additional, unproductive layer of bureaucracy -- all those insurance company claims adjusters who do their jobs "best" when they deny treatments, drugs, and care. They're not evil people but what they do is evil because the incentives are wrong.

Insurance companies add 15-25% (depending on whose numbers you use) to the cost of our healthcare. Yes, there must be rationing. But the rationing process needn't be so expensive.

Eliminating these middlemen is unlikely, alas. They command huge resources and their lobbies are powerful. To protect their bottom line, they run vast disinformation campaigns and promote myths such as the one Francine has voiced. And their job is to ration.

But don't take my word for it... Here is an op-ed piece from the New York Times (3/28/2006): U.S. Should Implement Government-Sponsored, Single-Payer System and Physicians for a National Health Program: Health Care Reform in the United States: Arguments for a Single Payer System.

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