Single Payer Sequel


The Oakland Tribune reports on a doctors' confab in California in favor of single-payer health care, which is, as Reason's own Ron Bailey predicted, emerging again as a hot political issue just in time for the 2004 presidential race. (Btw, Bailey's legitimate concern that libertarians and defenders of free enterprise are "failing to articulate a credible alternative, market-based vision of health care" will be addressed by a forthcoming story in Reason.)

Supporters of single-payer may be chastened to learn that the latest test of this failed miserably at the polls. Check out this Fraser Institute study of how health care in Canada, the favored model for reformers, stacks up to other developed countries.

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  1. One problem with single payer health care is that it makes it harder to argue in favor of things like legalizing drugs, allowing people to eat as much McDonalds as they want, etc. Just think how powerful public health arguements against those things will be when people can say that your lifestyle choices raise my taxes.

  2. There must be atleast 7,000 loser doctors in the country (those that have supported the nationalization of healthcare, similar to Canada). What sort of a professional would want the Federal govt to fix his rates and workload? (See the Jesse Walker post above about British dental care). May be it is for the good of our “children”

  3. “What sort of a professional would want the Federal govt to fix his rates and workload?” Haven’t had much contact with HMO’s, have you?

  4. Madog-

    I realized a few years back that single-payer would make my eating habits somebody else’s business when I heard somebody justify a campus regulation on cigarrette sales on the grounds that smokers’ medical bills are paid by everyone (Medicare). Although not entirely accurate (many smokers have private insurance), it sunk in. It was one of the things that led me to start voting Libertarian.

    After hearing that I suggested that the University grant itself off-campus jurisdiction over the supermarket (it had already granted itself off-campus jurisdiction over student conduct in privately owned apartments, but that’s an issue for another time). I pointed out that one of the student government officers at the meeting works at the local grocery store and has hurt my efforts to win the battle of the bulge by selling me ice cream.

    Of course, my argument was drowned out by somebody who started crying because her father died of lung cancer. She said that all the libertarian arguments in the world won’t bring her father back to life (she used the L-word, not me). Her emotional response is understandable (nobody thinks straight when a relative dies) but we can’t go around making policy based on it.

  5. Actually Lefty,

    I don’t think that Canada has any private insurances. They are very against the two-teir model of health care there. Britain does allow private insurance and those people typically wait much less time than those on the government only plans for their health care needs.

  6. Go to this site to meet all your Canadian insurance needs.

  7. Mark: Canada does so have private insurance. I am looking at the latest guidebook from ManuLife financial right now. Covers my drugs, upgrades at the hospital, everything out of country, transportation to the emergency room… plus a bunch of cool stuff like massages and free eyewear and dental. Covers my girlfriend too, because I chose to sign her up. My parents are retired and they bought huge coverage so they can travel and continue to live recklessly at home and abroad.
    Do I have the choice to opt out? Not at this job. Does it let me jump the line? I have some colleagues who have used it that way, I fortunately haven’t had to try. Doesn’t make our health system any better, but if you are earning a few bucks, you definitely have choice and advantages over the average slob with only provincial insurance.

  8. Canada’s private insurance does not cover “basic” services, just things the National Health Plan doesn’t cover.

    In contrast, I believe you can purchase completely comprehensive private insurance in the U.K. and bypass the National Health System altogether. Canadians can only do that by paying cash on the barrel.

  9. Canada et al would be even bigger disasters if it weren’t for the US where nearly all progress in medicine takes place. The recent argle-bargle over re-importing pharmaceuticals highlights how they’ve been sponging off us. There are many other ways in which the expense for health care in other countries is paid here in the US.

    The current system of health care in the US bears little resemblance to a free market and suffers greatly for that. Suggesting that a single payer system would improve things, is like suggesting a single publisher would improve literacy.

  10. Russ, I had a job filing insurance claims. The private insurance companies were by far the easiest to deal with. If I didn’t have money in around 21 days, there was a problem somewhere in the system. It didn’t happen very often. When billing Medicare/aid or any of the other state run fiascos, 45 days was closer to the payment schedule with a bollicks rate around 10 times higher. I once had close to $500,000 in back claims tied up because Medicare changed its processing program and would not under any circumstance accept the codes for service. Took close to three months to clear up, and never was able to match dollar for dollar what we were owed and paid. Gave up and wrote the difference off to save the hassle. It isn’t so much the lower pay-outs from state run insurance programs. It’s the combination of the DMV’s competence and customer service levels with the lower pay-outs that make people want to avoid the hassle.

    Did anyone check out the wait times in Canada. Over a 2 week treatment wait for urgent cardiovascular surgery? People ain’t dying in the steets, they’re dying in the waiting room.

  11. The problem with single-payer insurance is that it keeps the basic structure of the existing system (a concentrated drug industry, patents, the medical licensing system, and all the other aspects of the hegemony of the white coat priesthood and Big Pharma), and then just federalizes it.

    If we ever have an affordable and responsive health care system, it won’t be by centralizing this whited sepulchre even further. It will be by decentralizing it and rebuilding it from the ground up, under the control of patients.

    Such a libertarian health care system will probably look like a fusion of the Ithaca Health Fund (do a Google search, you’ll be glad you did) and the Berkeley Cooperative Clinic, with a little of the barefoot doctor system thrown in. It will rely a lot more heavily on things like CoQ-10 for congestive heart failure, and other relatively cheap treatments emphasizing herbal medicine or nutritional supplements. The med school curriculum will look like it was designed by Andrew Weil.

    Nationalizing the health care industry, like any other industry, won’t change it’s top-down, bureacratic character. It will be just as shitty, but even less directly responsive to the consumer.

  12. Unsaid is the fact that the poor health corporations, enjoying double digit price increases, spent over a million dollars to defeat the measure while proponents raised only $37,000 from individuals to present their side.

  13. Lefty,

    Your “argument” suffers from the ad hominem fallacy and fails to make any point whatsoever.

  14. My point, Phil, is that single payer health care took a professional hit in Oregon. Twisted facts were repeated over and over in expensive TV and radio ads to support the health care industry’s desire to continue fucking the public and their employer.

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