A universal single-payer health system is inevitable

2014

Ok, I said it. I didn’t say it was the best system or that it will control costs, but it’s coming in any case and here are the main reasons.

⬛️ Obamacare will not control costs and the pressure will build for something new

⬛️ Physicians are being squeezed on their fees, by insurance companies, by regulations and by Medicare. Many are ready to give up private practice. According to the American Medical Association, about 60 percent of family doctors and pediatricians, 50 percent of surgeons and 25 percent of surgical subspecialists are employees rather than independent, and the number is growing. Once the majority of physicians are salaried, opposition to a single-payer system evaporates.

⬛️ Two fundamental problems of our system are the lack of coordination of patient care and the financial incentives to provide more care. It’s hard to see how the current fractured delivery system can address those issues

⬛️ Americans don’t want to deal with health care costs directly and they don’t accept the rationale behind premiums. It’s like retirement. Americans don’t think much about Social Security and Medicare taxes, but they do a poor job of thinking about and putting their own money away for retirement

✔️ Now consider this back of the envelope estimate. Total non-government health care spending (everything except Medicare, Medicaid, CHIPs) is estimated to be $1,141 trillion in 2016. Using the estimated payroll base for Medicare taxes of $7,093,103,448,275 a payroll tax of about 16% would cover health care spending. Assume an employee share of 8% (remember, Obamacare considers 9.5% of household income affordable). I’m thinking many people would consider that a good deal to have what would amount to an under 65 Medicare like program. As far as employers go, 8% is not much more than they are paying now.

From an Employee Benefit Research Institute publication

⬛️ Whether it is premiums and out-of-pocket costs in a Obamacare exchange plan, employer plan or private coverage, these costs are creating a significant financial burden for all but the lowest income Americans. This is not sustainable

⬛️ Employers have had it with health care benefits. The value of benefits they do provide is shrinking rapidly and an increasing number are shifting most of the responsibility to private exchanges. I’m guessing many employers would welcome a new payroll tax that gets them 100% out of the business.

Don’t get me wrong, universal health care is no panacea. Costs will still go up, some forms of rationing, at least by American standards, will be necessary and then there is the bureaucracy. But you see, at some point the frustration level with our current system will make all that irrelevant.

So when will all this occur? Your guess is as good as mine, but within ten years discussions will get serious.