Monday, July 20, 2009

Barack Obama on Single Payer

The shame is that we have a president who understands the need for a basic health care plan for all, but has settled for the completely disjointed morass that is coming out of the sausage maker in Washington. While health care reform is necessary, passing an inferior bill would be the only thing worse than doing nothing.

Sure, political considerations will always take precedence, but the current bill, in all it's thousand page glory, does not achieve the goals as outlined by President Obama: 1) universal care, 2) paid for within the budget, 3) containing quality standards. None of these three goals are met in the current bill.

Which plan could fit all these criteria? Answer: Medicare for all. This is a program that has been around for two generations with a bureaucracy already in place which has high standards that have been tested and revised, and can be implemented over the entire population fairly easily... certainly more easily than a brand new 'system' made from the existing mish-mash of private insurers with all the various models.


Anonymous said...

You have a point about Medicare. The only complaint I've ever heard about it concerned funding, not about its being overly bureaucratic/inefficient.
How many people are currently served by Medicare, and what would it take to ramp it up to serve the additional clientele?

Tony said...

Today, about 43 million Americans and permanent residents are covered by Medicare, making it one of the largest single-payer programs in the world.

The difference between Medicare and other single-payer systems is that Medicare covers only the elderly and disabled, so the per capita costs are obviously going to be higher than, say, Canada or UK systems that include younger healthier people.

Funding would be accomplished with either payroll, income or consumption taxes, or some combination of the three. This would be fairly easy to do with the revenue currently transferred to private insurance companies.

The biggest advantage of Medicare-for-ll would be the economies of scale, but other benefits would be the larger risk pool, the ability to maintain standards of care, and the savings by utilizing disease prevention protocols.

The realpolitik, however, is much more complicated. Insurance and pharmaceutical industry advocacy groups will not acquiesce easily since their profits are dependent on the status quo. Other opponents in Congress also truly believe that govt bureaucracy is universally evil.

The fact is that we had this same debate in 1993, and universal care lost. Now we are 16 years on and US costs have skyrocketed, so something will be done now... let's hope it's the correct reform.

Hilary said...

Fascinating blog. It appeared in the search results when I was looking for information about a meeting at the Kalamazoo Library this evening. How fortuitous, because I have enjoyed it thus far, and will make it a point to return. I have been espousing a single-payer, private-delivery health care system for much of my adult life. An organization I was active in until last year held several public information meetings for health care at which I was present. The general ignorance and fear of such a system made me, literaly, want to bash my head against the wall. Telling people, "it would be like Medicare, but for everyone" did not work, I don't care what you followed it up with. I imagine most in attendance enjoyed third-party insurance coverage, though I never had the audacity to conduct a poll. Thanks for the blog!