The Case for Single Payer


That is, the case for single payer that some libertarians could also support—and that's because it's also the case for radical deregulation of the health care sector. The trick, as Arnold Kling argues, is to do both:

I would like to see more experiments and more variety. Instead of having a big national contest over what health care system, why not try single-payer in one part of the country and radical deregulation in another? Switzerland, which is about the size of Maryland, has different health care systems in each of its 20-odd cantons, which are about the size of Maryland counties. Surely it must be possible to try different health care approaches in Texas and Massachusetts.

I'm obviously wary of socializing medical payment, even at the state or local level. But given the opportunity to see single payer compete against a genuinely deregulated market, I'm pretty sure I'd bite. And I suspect a lot of single payer supporters would too. But that sort of political competition isn't in the cards. Instead we're stuck with a broken, compromised system in which neither side gets what they want: On one hand, the government controls nearly half of all medical spending, but failures get blamed on the free market. On the other hand, those who want to sweep away the current system and socialize medical insurance get stuck with messy legislative compromises larded with handouts for special interests. You could make the Beltway centrist's case that this is a good thing—that political systems shouldn't cater to extremes. But in this instance, we've got a system that's catering to almost no one. And in the meantime, we're stifling innovation and experimentation on both ends of the political spectrum.

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  1. One outcome to such a competition that I can see is that when the socialized program fails, the socialists will blame the neighboring free market state for the failure. It’s the sort of thing they do, for instance, to “explain” why D.C. gun laws don’t work. “Well they really do work it’s just those darn gun nuts in Virginia blah blah blah.”

    1. Please. It’s anti-government people who never need evidence for their outlandish proposals, because well, uh, we haven’t achieved libertopia yet, so it’s not really a free market. Just because every move toward deregulation causes more problems doesn’t mean it won’t work once we achieve absolute market purity.

      1. Every move toward deregulation causes problems?

        1. Yes, didn’t you realize that Tony curses those radical rightists Jimmy Carter and Ted Kennedy for deregulating trucking and airlines?

      2. Right Tony, because there isn’t an enormous mountain of evidence world-wide that more freedom = more prosperity. Are you blind or just really, really stupid?

        1. Oh Sean. All the arguing u and I have done over this topic.

          Don’t u wish there was actually a side-by-side comparison ??

          Even if I’m wrong and u r right, I’d love 2 c it.

          1. Learn TO WRITE GODDAMMIT

            1. Why does IM notation bother u so much?

        2. Exactly! We should definitely be moving in the direction of Haiti and other countries that have no “socialized payment of elementary education”, for example. Because not providing basic social infrastructure like health and education is the definition of freedom, and freedom is prosperity, and prosperity is illiteracy, and illiteracy is ignorance, and ignorance is strength, which is freedom, not to mention prosperity.

          1. Cool false dichotomy, bro.

      3. Unfortunately the free market does work that way: it’s either free or it isn’t. That’s why partial deregulation can indeed cause problems: for instance, maintaining strict price controls at the retail level while removing them at the supply level. That’s why libertarians reject the notion that one can just intervene in the economy a little: the intervention doesn’t work, which leads to further interventions, on and on.

        To go back to the gun control example, look at the Brady Bill. When it was passed it was hailed as the dawn of a new era. But before the ink was dry antigunners were yammering about having to “close loopholes” which they are doing to the present day. Of course the Brady Bill has accomplished nothing of any value.

        So for this little experiment to be useful, the free market areas will have to be genuinely free. If they’re single-payer lite they’ll end up as single-payer. And the single-payer areas will not be allowed to whine that the free market areas are “stealing” all of the “good” patients.

    2. Then let’s try this: Hawaii gets single payer, Alaska gets deregulated.

  2. Dont make it by geographic region. Single payer and/or deregulated and everyone ops in to one or the other (single payers have to pay the taxes to support single payer, no money from gen fund or the non-single-payers). Of course, the disaster that the single payer would be in that case is obvious.

    1. It’s called the public option. Maybe you’ve heard of it? The rightwing vehemently opposed it because it would stop the illness profiteers who fund their campaigns from making a killing off of dying.

  3. Not necessary. We already have Canada and some other countries showing how much single payer sucks at delivering quality care at a reasonable cost.

    1. Speaking as a Canadian I call shenanigans on your post. Waiting 6 weeks for an MRI gives me ample oppurtunity to think about the choices I’ve made in life that led to me getting an MRI, which builds character! And you know what character cures? Not a whole lot, but I got a lot of it.

      1. Six week?? When did you guys cut the wait time in half?

      2. If you were a dog you could get an MRI in 24 hours.

      3. Speaking as a Canadian I call Ellie Light on your post. The word shenanigans is never used by Canadians. Everyone knows we call mischief “Americanisms”

        1. You forgot to say “eh?”

  4. Does anybody believe Congress will loosen their grip on the throat of commerce?

  5. why not try single-payer in one part of the country and radical deregulation in another?

    Yeah; and then the single-payer states can set up checkpoints at their borders to examine people for fresh stitches, or other signs of contraband medical treatments.

  6. And I suspect a lot of single payer supporters would too.

    A lot of them would like to fake it so they can yell “market failure” at you. They don’t do unrigged games. Their damn platform is Rig the game.

  7. That is, the case for single payer that some libertarians could also support-If they weren’t chicken.

    1. “pluck, pluck, pluck? Have any of you people ever heard a chicken before?”

      1. The Poulty dialect does not pronounce the “P”. And they are neither clean nor articulate.

        1. Sugarfree & bagoh20, sorry for my lack of knowledge in making a chicken cluck. I guess you have a ton of experiences with farm animals. 😉

  8. Single payer health care for some, tiny Gadsden flags for others!

    1. Don’t blame me, I voted for Kodos!

  9. I’ve always been a staunch advocate of single-payer. You go to the doctor and you pay. Just seeing the confusion on the doctor’s face is worth it.

    1. Can we pay with a chicken? There’s one running around up-post.

      1. I don’t think you are going to be able to pay with a cock.

        1. I got one for sale though.

        2. Your expertise is required on the ban the dic. post

  10. Single payer will hide its problems by people crossing county/state lines for free market healthcare.

  11. I hate to say this, but, believe it or not, a lot of people in places with single payer healthcare actually like it. And defend it. Granted, there has never really been a deregulated market for healthcare, so the basis for comparison is not too good.

    So I propose a more scientific approach. Let’s try both and see which is really better. First, remove all regulations on healthcare for 10 years. Then, if people are still largely unhappy, try a full on single payer system for 10 years and see how that goes.
    This is really the only way to settle this.

    1. Great idea, or Zeb’s could work too.

      I think the elephant in the room though, is that most healthcare costs come from two places.

      1. Chronic diseases that are often preventable (ie related to obesity or smoking).

      2. Last ditch end of life care, where tens or hundreds of thousands are spent in the last 6 months of life trying to stop the inveitable by a couple more days.

      If we address those issues the problems would pretty much be solved.

      1. Man up and die, people. Man up and die.

        1. If people want to spend hundreds of thousands of dollars of their own money for an extra month or two of life, I of course fully support their decision.

          But when they want to spend that much of other people (my) money, then IMO, that’s a problem.

          1. Kroneborge,most disease is genetic but you do have a point with end of life care. Honest dialogue could alleviate some of that needless suffering.

          2. That’s really my point. But I would counsel folks not to waste their own money too. It’s really just an unnecessary emotion-based transfer of wealth.

            1. Agreed, I would counsel them to do so as well, but I would never stop them from wasting their own money.


              Yes genetics does play a part, but the way our society is currently structured also does. Because people don’t pay for the consequneces of their own actions (or if they do it’s WAY down in the future) people discount those actions.

              For example, if a family was offered $400 a month to stay fit, how much motivation would that be to do so?

              Of course the actual amounts would be based on the cost savings of being fit.

              But especially for lower income people, it makes more sense to pay them to be fit, than to pay for their chronic diseases.

              1. Is this a libertarian idea?

                1. yes and no. I think it’s the most libertarian idea that is even “close” to being likely to pass.

                  Things to think about.

                  1. All ER care in mandatory,
                  2. While Medicare and Medicaid might be reformed, they will probably never be elimated.

                  Thus, to make the best out of a bad situation, I think it makes sense for policies to be in place that encourage (but not require) users of those services to use them as little as possible.

                  1. I wonder about the nature of poverty and if you can successfully incentivize the poor/working poor to avoid costly healthcare.

    2. I have an ex-girlfriend with split US/Canadian citizenship, who spent much of her adult life in Canada. While making $700-1000/day (no benefits) as a video editor for a big TV show, she would complain about how expensive healthcare is in the US, and how she wanted to move back to Canada. (By comparison, as a PhD engineering project manager, I made half as much in a far crappier work environment, but had benefits.) In the next sentence, she would comment on how long her Canadian friends had to wait for doctors, late diagnoses of cancer, etc. She has recently moved back to Canada and gave birth to twins, so I’m curious to hear how everything pans out…

    3. People like getting free shit.

      It just takes time for them to realize the effect it has on the countries budget. Then the cutbacks start. Then the rationing. Then quality goes down. They they start realizing that it’s become the DMV of healthcare.

      Canada is clearly in the declining quality/DMV phase. Doctors and nurses go on strike every few years because their salaries are crap compared to the US. The best ones leave. Replacements are imported from third world nations.

  12. Hey, here’s another deal, for all those wealthy states that keep electing Democrats yet complain about their “donor state” status:

    1) Vote for federal tax cuts;
    2) Raise your own state taxes to make up the difference.

  13. The problem with socialized medicine is that we allow it to leech off such market driven medicine as there exists. All we have to do is allow drug re-importation and this whole single payer fantasy will come toppling down. Prescription drug consumers in the US fund a significant amount of the rest of the worlds health care. If we simply insist that they pay for what they use, they’ll go broke inside six months.

  14. Breaking news: Apple unveils iPad. Profusely thanks government competition and innovation. Jobs says government can do the same for health care!!!!!!!!!!!!!!!!

  15. Since I’ve moved to Seattle, my favorite example of gov’t vs. free market is the metro bus system online support. Looking up bus trips on metro.kingcounty.gov (kinda sucks) compared to maps.google.com (bus routes overlaid on real maps; whoda thunk it?) pretty much says it all…

    A long-time-resident friend said that the best way to learn the busses around here is to just ride them, and ask the drivers. At least THEY know where they’re going… Even LA has better bus maps!

    1. “Even LA has better bus maps!”

      That’s really… really sad. I’ve only ridden the bus up from Tacoma to downtown, so that was at least easy enough.

  16. We already have the test proposed up and running. Look at The Commonwealth of Massachusetts’s fully functioning program compared to one of say, Oklahoma.

    Even under the strict regulation we have now, Oklahoma’s health care is much cheaper for most of the populace. Granted, they cover a lot of people, but for the middle class, those often told they’re going to be helped, quality hasn’t improved but costs have skyrocketed.

    What we don’t have, the one variable we’re not testing, is the unregulated free market. We’ve got states with strict government control, and states with despotic control over their health care.

  17. I’m usually a big advocate for federalism, but if we’re going to attempt a single-payer approach, it has to be on a federal level. people shouldn’t be limited from signing up for this horrible idea just because they live in the wrong state. Conversely, I don’t want to be stuck in a particular option just because I happen to live in a particular place (I wonder which way CA will go?).

    I think we ought to have a Federal public option, along with some serious reform of the standing laws constricting the market. Fer instance:

    1) Allow insurers to sell across state lines.
    2) Don’t require insurers to take all comers regardless of health condition.
    3) Eliminate the tax incentives for employers to offer insurance, and for employers not to shop around for it.

    Have the two systems running concurrently. That way people can choose the one that best fits their lifestyle and values, and we’ll see which one provides better. Also, don’t require doctors and hospitals to take either private or public insurance. Let them decide who they want as patients.

    1. The problem is the government cheats. For example Medicare/Medicaid reimuburse below actual cost. thus insurance rates go up on the rest to make up for it.

      1. That’s the reason to drop the acceptance requirement. If healthcare providers don’t accept Medicare/Medicaid, they don’t have to juggle like that.

    2. I cant believe no one suggested that earlier, like at, say 12:29.

      You did flesh it out better.

      1. I also don’t think that they will be able to get away with keeping the fund segregated the way you suggest. I’d love to see it, but on the other hand, I already fund a number of gov’t trainwrecks, one more won’t matter as long as I get to keep my private plan.

  18. Single payer will hide its problems by people crossing county/state lines for free market healthcare.

    Not if the single-payer has to pay for services provided in other states.

  19. I want to know why none of the talking heads in the MSM or in Washington have ever mentioned the McCarran- Ferguson Act. Repeal the M-FA, which would cost nothing, And see what happens.

    1. Because in 21st century America, you can’t pass or repeal a law without adding a tax. It’s in the Living Constitution somewhere.

  20. Nothing…AND I MEAN NOTHING…would make me happier than to see a FAIR side-by-side comparison between single payor, the free market, and TRUE LIBERTARIAN WILL: no-payer (patients pay their own way…no insurance company and no government).

    I think the ONLY WAY to reduce costs is the NO-PAYER simply because people would have to pay out of their pocket. And, as a result, a doctor visit will not be $200 as people won’t pay it.

  21. If you really really really wanna lower cost…you’re gonna have 2 pay less for something. That is:

    – less for Doctors
    – less for medicine
    – less for health services

  22. Uh, am I totally mistaken or do we not already have some states such as the aforementioned Massachusetts (as well as Oregon and a few others) that basically have socialized medicine as it is? Granted, we don’t officially have a free market system in place pretty much anywhere you go yet due to state regs etc.

  23. But given the opportunity to see single payer compete against a genuinely deregulated market, I’m pretty sure I’d bite.

    We’ve already got the single-payer model in Cuba, so let’s deregulate Florida.

  24. Why can’t some group come up with a healthcare insurance cooperative and compete?

  25. Federalism is a means to protect liberty by creating competition between the states. However, as single payer means, by definition, that attempting to pay for health care outside the single payer would be illegal. I don’t see how any libertarian leaning person could support such a scheme even on a federal model.

    1. I nominate whatever state Suderman has residence in be the “single payer” experiment.

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