Single payer universal health care

2013

There are many Americans who long for the day the U.S. has a single payer health care system. They base their goal on the perception that a single payer plan will have very low administrative costs, will be cheaper and will cover all Americans with no exceptions. In other words the ultimate in affordable health care.

The basis for this point of view is Medicare and the health care systems in many other countries.

While it is true that a universal system would provide coverage to all Americans, that is where the fulfillment of expectations will end. Medicare does not have as low administrative costs as many people believe. How Medicare spends its money is quite different than for a younger population. Medicare is expensive. In 2012 Medicare cost $11,325.44 per beneficiary and keep in mind that Medicare does not cover all services, there is no out of pocket limit and most beneficiaries find it necessary to buy supplemental coverage.

All this means that any universal system would likely have substantial deductibles and coinsurance and substantial premium/new taxes. More important is that the systems in other countries are quite different than even Medicare. In other words, they set and manage budgets, they, out of necessity, limit coverage and what will be paid for. There are routinely waiting times for health care services, especially elective procedures. Physicians are paid quite differently and at a lower rate in the U.S.

This doesn’t mean these systems don’t work. In fact, every person I have talked to in Europe likes the system they have even while complaining about the cost in many cases.

So what’s the point? Well, the point is that Americans are not Englishmen or Germans or Frenchmen. American expectations for obtaining health care are inconsistent with a government run system, for limits and constraints or for waiting for much of anything. Look what happens when changes are recommended in the use of screenings that people have been told for years were essential, or simple things like using generic drugs. Listen to the fear mongering over the IPAB for Medicare and the possibility something may not be paid for. Even today the expectations that many people have for “affordable” health care delivered via Obamacare are unrealistic, even undefined.

The bottom line is there are tradeoffs. The most important tradeoff is between unrestricted access to all the health care you want (and think you need) and the cost of health care you are willing and able to pay for. That goes for individuals and for society. A single payer system does not change that.