Republican Party

Republicans Learn to Love Single-Payer Health Care

Almost half of the GOP now backs Medicare-for-all.


Liberal Party (U.K.)

Who wants a Medicare-for-all system? A plurality of Republicans, apparently. A new Economist/YouGov survey shows 46 percent of the party in favor of "expanding Medicare to provide health insurance to every American." Just 38 percent are opposed. This comes on the heels of a January Pew poll where 30 percent of Republicans agreed that the government has a responsibility "to make sure all Americans have health coverage." That looked like a pretty high number at the time, but these new results make it seem small.

If you were alert, you could see this sentiment building for a while. About a year ago, a Gallup poll suggested that 41 percent of the GOP liked the idea of replacing ObamaCare with federally funded universal health care. That number was probably inflated by people willing to endorse anything framed as an alternative to ObamaCare, but you can't say that about this year's results.

Meanwhile, you don't see New York Post headlines like this every day:

New York Post

That's F.H. Buckley, the chief author of Donald Trump Jr.'s speech at last year's Republican convention; he's making the case for "universal health care, on the Canadian model." Buckley's been for single-payer for years, so the news here isn't that he feels this way. It's that this seemed an opportune time to publish his arguments in The New York Post. That and the reminder that such sentiments can be found in the president's orbit as well as the president's voting pool.

For an extra little thrill, Vox has this:


The article below that headline jumps somewhat haphazardly from the alt-right to mainstream (or at least semi-mainstream) conservatives, so that center-right figures like Buckley and Christopher Ruddy appear alongside the likes of Richard Spencer. But it makes its case: A lot of people under that broad "alternative right" umbrella, from Spencer to Mike Cernovich to Mencius Moldbug, have either signalled that they're open to a single-payer system or endorsed it outright.

All of this is striking, but none of it should be shocking. Rank-and-file Republicans may love to grumble about big government, but most of them made their peace with entitlements long ago; if they can handle that tension, they can probably handle another one. And if enough Republican voters decide that this is what they want, there will be Republican politicians who are willing to oblige them. The last time Mitt Romney ran for president, he attacked Barack Obama for allegedly cutting Medicare. It's not hard to imagine a future GOP nominee warning the electorate that those dastardly Democrats are plotting to roll back Berniecare.

Right-wing intellectuals might have a trickier time making the switch, but they have at least two paths open to them. Many nationalists are already on the road toward embracing a herrenvolk welfare state that bestows its services on the designated in-group while excluding outsiders. The alt-rightists may be inclined to frame this in purely racial terms, but that's not actually necessary—many on the right embrace a sort of rainbow nationalism that isn't limited to white people. At any rate, there will be a broad agreement on the fact of the boundary even if there's some disagreement about where it should be drawn.

American Medical Association

This is not really new. Way back in 2006, while marking the anniversary of Bill Clinton's welfare overhaul, I called immigration

the one area where welfare still has an impact on the culture wars. In the old days, you could rile up red-meat conservatives by arguing the relief rolls were filled with shiftless, undeserving bums living high on the taxpayers' dime. Today, the immigration debate centers not on services meant for the desperate but on services meant for everyone: schools, hospitals, public amenities. Immigrants aren't accused of pretending to be poor or pretending to look for a job. They're accused of pretending to be Americans, of taking goods that rightfully belong to all us citizens regardless of class.

Those old culture-war complaints about the underclass came roaring back with the financial crisis. But the nationalist argument didn't exactly go away, and it's not hard to see it adjusting itself to make room for health insurance among those benefits guaranteed to the in-group.

So that's one path. The Vox piece discusses it in some detail, with an eye on how it resembles the positions taken by populist parties in Europe. The other approach has a much briefer cameo in Vox's story:

[John Derbyshire] laments the fact that Americans are unwilling to accept a true free market in health care—but argues that single-payer makes more sense than the current hodgepodge of insurance subsidies and regulations and tax breaks. "Citizens of modern states will accept no other kind of health care but the socialized or mostly socialized kind," he said on a 2012 episode of his podcast, Radio Derb. "This being the case, however regrettably, the most efficient option is to make the socialization as rational as possible." Single-payer, he concludes, would involve "less socialism, and more private choice," than "what we now have."

This is an argument you sometimes encounter on the left end of the libertarian movement: that single-payer might actually be less statist than the current corporate-state setup. The only novelty here is hearing it from Derbyshire, who is neither left nor libertarian.

There is a basic truth underlying this idea, even if the argument eventually goes off the rails. In the wake of World War II, as other western nations developed expansive welfare states in which the government provides benefits directly, the American welfare state sometimes took a more indirect form—a public-private partnership in which the government sets the parameters and businesses deliver the goods. This wasn't deliberately designed so much as it gradually grew from policies developed on the fly, such as the tax incentives that made employer-provided plans the primary means of receiving health insurance (and made insurance the primary means of paying for health care). The result was a dysfunctional, bureaucratic system that's pretty easy to criticize from a free-market perspective, and indeed free-marketeers have been hammering away at it for several decades now. People like Derbyshire borrow the libertarian critique, but instead of proposing radical reform they use it as a handwave: Sure, what I'm suggesting isn't a free-market setup, but neither is what we have now, so whaddaya gonna do?

Now, it's possible to imagine a system that expands government coverage in some ways while at the same time becoming more market-oriented. Singapore has universal health insurance, but it also has a competitive market largely driven by out-of-pocket payments; if a proposal like that were on the table, a lot of libertarians might back it as a step in the right direction. A Canadian-style system would have a harder time finding libertarian takers.

But we are not speaking of libertarians here. We are speaking of the Republican Party. Between the nationalists and the hand-wavers, the GOP won't have much trouble accomodating voters interested in expanding the entitlement state. I wouldn't bet my money that Trump will sign any big overhaul of the health care system, but if he does, don't be surprised if it looks more like this than like anything the Freedom Caucus wants.

NEXT: Media: Openly Using a Bill Clinton/Harry Reid Law = 'Stealth Assault on U.S. Regulations'

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150 responses to “Republicans Learn to Love Single-Payer Health Care

  1. Christ, what assholes.

        1. Why does reverse centaur have six limbs? What a freak!

          1. What about a mantaur?

  2. Yes, but the Republicans are still better than Democrats, because Democrats are worse.

    1. Cool story bro.

    2. Democrats like immigrants too much. Those immigrants who are going to bring their socialism with them.

  3. Maybe is would not be as popular if people would stop calling it "single payer" and call it taxpayer payer. There is no really rich guy who is going to pay for this, just the millions of taxpayers.

    1. Or (most likely) debt funded health care.

      1. all funding is in the net only driven by debt which is itself by legal tender statute a credit, ergo 'current money'. you might as well say "money funded health care". ok duh

    2. just the millions of taxpayers, paying for each other's care. the math totes checks out.

      smdhfacepalmwtffbbq, also, fried chicken.

      1. Sorry citizen, only healthy, pre-approved meat and meat-like preparations can be charged to your benefits card.

    3. I'm all in favor of designating a single payer. 0bama can be the single payer, until he is homeless in the gutter. Then Feinstein can be the single payer. Then Bernie...

      1. This is the best health care plan I've read yet.

    4. how's that? there are not any NET taxpayers, or very few. most "taxpayers' already get most of the spending right back for their benefit. the entire system runs on deficits which means 'printing money'.

  4. Because if we try hard enough, maybe medicaid could lose enough money to fraud to rival the GDP of half the world's nations.

  5. Succumbing to the undeniable reality: promising to give out free shit earns votes.

    And it's guaranteed to work because, somehow, there is always a majority of Americans who believe that they are in the minority of Americans who will benefit from these government programs. In their mind, the government can just keep milking the super-rich and will find an inexhaustible supply of funds to give free shit to all the little people.

  6. Re the Vox article: never forget, fellow commenters, that the author of the article, Dylan Mathews, looks like this. And yes, that means that I don't believe anything he writes about, even though in this case it's probably true.

    1. ^This^

      'Even the Alt-Right is on board with single-payer!' smells an awful lot like 'Consensus!'

      1. I agree with your statement, however, I do think that a lot of those people on the alt right care far more about whatever group they feel they are a part of than they do about individualism, which I think is the case for most Republicans, too, so it wouldn't surprise me if Republicans/Conservatives, etc, could talk themselves into a single-payer healthcare system using the same logic as Derbyshire.

        1. Herd logic ultimately leads to herd solutions.

          1. I herd that.

          2. You didn't have to one-up me with your pithiness.

          3. "We have to adopt single-payer. Otherwise the Left will win!"

        2. I talked myself into it yrs. ago. Considering how overwhelmingly the entire rest of the world has gone for socialized medicine, no matter how shitty the results, it's a wonder the USA has resisted it for this long?& wouldn't've resisted even this long if it hadn't been slowly introducing it piecemeal & ad hoc. Seriously, if the pressure hadn't been taken off periodically by increments like Medicare Part D?don't blame the Bush Republicans; they had to make such a concession?as a kind of relief valve, the boiler would've blown long ago. I think the best we could do is slow it down as much as possible, & meanwhile free up the rest of the economy enough so we'll be rich enough to make it a relatively small burden.

          1. it really is "single payer" already, just filtered through layers of corporate chaff.

            single payer with a single name: The Federal Reserve System

    2. Oh god that dude. I don't even remember the idiocy that brought him to our attention last time - I just remember that face.

      1. likewise.

        What I don't understand is, how do you get through life looking like that without getting the smug beat out of you on a regular basis? It's unnatural for someone so dorky and ugly to be allowed to feel that superior at the same time.

    3. I gotta say, that's the most punchable face I've seen all week.

    4. Isn't he the Caveman in the GEICO commercials?

  7. We should draft everyone and have the VA handle it. That will teach people to love government healthcare.

    1. As a veteran who uses VA care, that would send most Americans screaming back to free market health insurance and medical care.

      I always try and explain how government nurses who get paid no matter and cannot get into private practice are not who you want caring for you when your life depends on it.

  8. The one good thing about this (presumably Medicare-for-all) if it happens. When we do finally face bankruptcy or the imminent need for dramatic systemic reform - the overwhelming majority of Americans will be on the same side of 'austerity' and 'health care rationing'. That is likely to produce a far better outcome than all the current nonsense of the last 25 years or so on this issue. And I doubt this would accelerate that day by more than a year or two.

    1. Dude: remember the reaction in Greece over their austerity program?
      Multiply that by 30, because that's how many times our population is, than theirs.
      Then throw in our "diversity".

      1. Greece spends $2,000 per person (8% of GDP) on health care.
        US spends $10,000 per person (18% of GDP) on health care.

        Any 'austerity' in the US is in a different universe than Greece. We're more like the 600 lb man who will have to pay for his second cow at dinner himself. Except that right now - we have no clue how much we weigh and no idea how much the cow costs and no clue how much we eat.

  9. So, a year ago, according to the links provided, 55% of republicans were opposed to--

    "Replacing the ACA with a federally funded healthcare program
    providing insurance for all Americans"

    And this year 54% are opposed? Ouch.

    1. No -
      46% are in favor, 38% are opposed, and 17% are undecided.
      So according to this poll, a plurality of Republicans favor "Medicare for all".

      Looks like Obama won after all. Here we come, single-payer!

      1. No- according to media polls that give skewed polling numbers to back up their nonsense....

        [all of the rest of the BS you said].

  10. Yeah, it's not surprising, but the hypocrisy in this place would be so much less revolting if some of the fake libertarian shitbags who work here weren't constantly shilling so hard for taxpayer-funded abortion on demand.

    I mean, it's not exactly as if a fetus is the same thing as a malignant tumor or Lou Gehrig's Disease or something.

    1. That's a hell of a non-sequitur, Simple Mikey.

      1. Listen, cuckaschmuck, Reason has to start living up to Mikey's expectations, because if they do not, his head movies are going to keep making his eyes rain, and that just isn't right.

        1. And quit talking to yourself in two different screen names, you total fucking loser.

          1. And quit talking to yourself in two different screen names, you total fucking loser.

            Do you think it's impossible for more than one person to find you disagreeable? That may be stupider than your Weigel theory.

            1. I would accuse Mikey of actually being Trump, but his grammar is too good.

        2. Quit arguing with yourself, by which i mean me, scumbag!

      2. Now sure how it's a non-sequitur to point out that liars like you are demanding your own preferred free shit.

        1. Your absolute stupidity is breathtaking. And you're the second person I've ever said that about.

        2. Simple Mikey does not know what "non-sequitur" means. Sad!

          Please continue to share your cartoonish delusions with us, though. Your stunted mind is a bizarre, fascinating place.

          1. From the "nuclear option" thread: Scalia was murdered by Democrats. Probably by Yomomma's friends from the hood.

            1. Specifically, Scalia was murdered by ALL of the Democrats, together.

              1. On the Orient Express?

              2. In his sleeping compartment on the Orient Express?

    2. It's either taking a shit or killing a baby.

  11. When it comes down to it, supporters of single-payer are just betting they'll be poorer than the average taxpayer.

    It's a pessimistic, self-loathing, race-to-the-bottom, loser's mentality.

    And it's winning.

    1. It's been winning for the last sixty years, so there's that.

    2. All morons just want everyone to be miserable with them.

      Its because they are too stupid to figure out how to become successful so the natural default is misery for all. That is the appeal of marxism.

      Hopefully necessity for innovation and market function will eventually win out and capitalism as the mother of all necessity will one day lift enough people out of misery to quash retarded Marxist thought.

      1. I think it's the appeal of what we are currently living through to opioid-addled rednecks who spend all of their waking lives blaming their shit lives on other people.

        1. And black people always complaining and wimpy leftists always crying about some ginned up injustice.

          These are time tested relics of the masses. Politicians are capable of getting all the retards to be mad at something other than them.

    3. I don't think that's quite right. Most single-payer supporters believe it would eventually cause a drastic reduction in the cost of healthcare compared to the current system, such that the average taxpayer would pay a meaningfully smaller portion of their income for healthcare than they do now.

      1. One of the saner comments here.

    4. I support single payer and earn a decent living- I don't feel pessimistic or self-loathing at all. I'm just fed up with seeing friends and family members get screwed by the system. I'm sick of paying premiums to pad the profits and salaries of insurance companies, and I'm sick of paying inflated prices to hospitals- 8 dollars for one aspirin tablet in the hospital. Both are completely lacking in transparency.

      I want to pay a tax and know that the people I care about will be taken care of. That's it. There's nothing self- loathing or pessimistic about it.

      That's your own projection- and I won't pretend to understand it or analyze it. But I wanted to let you know that your characterization doesn't reflect any of my thoughts about the matter, or anyone that I know who supports a public system.

  12. Just 38 percent are opposed.

    Honestly, it surprises me that so many are opposed. I have never had a debate about healthcare without an attempt to make me into someone who wants to drown sick orphans and grandmothers to appease the free market Gods (like that even works...everyone knows they prefer handicapped minorities)

  13. everyone knows they prefer handicapped minorities

    Bonus favors from the Gods if the sacrificial victims are lesbian vegans.

  14. So now a slumbering Gorsuch rises from his watery tomb to destroy downtown Tokyo, right? Or do we get a 300-ft. tall former Chief Justice Vinson and Gorsuch dons his power suit to fight him?

  15. Republicans agreed that the government has a responsibility "to make sure all Americans have health coverage." That looked like a pretty high number at the time, but these new results make it seem small.

    That's because the debate is over. No one wants to see people suffer without healthcare. Since the debate has been successfully framed that way, there's only one option: make sure everyone gets healthcare, no matter the cost.

    We're just haggling over price at this point.

    1. Well, "middle class" was fun while it lasted.

  16. Singapore has universal health insurance, but it also has a competitive market largely driven by out-of-pocket payments; if a proposal like that were on the table, a lot of libertarians might back it as a step in the right direction. I absolutely back this type of system, but it'll never fly here.

    Americans driven by a mostly Democratic-operated media have been led to believe that any out-of-pocket expense for your healthcare is fundamentally unfair/racist/anti-poor/cruel.

    When the media speaks on single-payer-ish systems around the world, the any discussion of the out-of-pocket expenses in that system are given short-shrift, and the free-ness and universal access-ness of it is is given long paeans to fairness and egalitarianism.

    As a result, the American psyche doesn't seem to want to accept any cost burden in the maintenance of their own healthcare.

    1. If Americans, who routinely have to shell out ungodly amounts of money for medical care that people in other countries get for free, can't accept it, then what hope is there?

      1. You just won the 100 yard dash to miss the point. And the point you did make, you're wrong.

        1. His trolling is much less subtle lately.

          1. He's a confused sad sole.
            But at least he wont get a gun and go a shootin because he sounds like a complete proggie douche.

            1. You're right. I live in a nice house in a nice neighborhood around people who've read a book or two in their lives and can tell the difference between someone appropriate to take on a date and their cousin. We sit on furniture, not tire rims, and we eat food, not roadkill.

              We proggie douches are measurably and objectively better than you redneck fucks in every way.

              1. Ahh there it is. The seething hatred for that entire middle portion of the country that won Hillary the election and has helped the Dems to dominate every branch of government since 2010

                1. It's not seething hatred, it's pity and frustration.

                  Contrast to every single day on every single rightwing message board where you'll find calls to Hitler the fuck out of "proggies" and our obsequious minority poodle races, and they're not joking either.

                  1. It's seething hatred for me. At least it is NOW.
                    I've been called a "race traitor" by some alt-right douche at least twice in the past month.

                    Fuck every last one of those fucks. They can all die in fires.

                    1. How is the in-group preference of the alt-right much different than Tony's clear in-group preference for people who always vote Democratic and don't follow NASCAR? They both prefer their own kind and demonize everyone who disagrees with them as a cuck or cousin-fucker, and to varying degrees want the government to do something about the people who have the "wrong" values

                      Other than the fact that Tony is fairly representative of the mainstream progressive, and the alt-right isn't much more than 200 autistic virgins posting frog memes online

                    2. And a chief adviser to the president of the United States. But nothing mainstream about that.

                    3. Tony, it's remarkable that you still feel entitled to hide behind your facade of compassion, when your recent posts clearly establish that you are motivated by nothing more than pure, tribalistic hate.

                      Which makes you possibly the most spectacularly unadulterated manifestation of psychological projection I've yet encountered.

        2. You said the American psyche was predisposed against paying for healthcare, even though we're the only ones in the civilized world who already do.

          There's a reason why when your European friends come visit not a single one of them wants to trade healthcare systems.

          1. They sure like to get to the Mayo Clinic for cancer treatments though...

            1. And Harvard is the best university in the world, NASA the best space agency, and the Grand Canyon the grandest of canyons. You're not making a point relevant to the discussion, but you probably know that.

              1. The point is that Europeans come to the United States for quality care--if they can afford it.

                It means the quality of care middle class America enjoys may be much higher than what government systems elsewhere can offer.

                You know it means this. You're just being willfully obtuse.

                1. You said the American psyche was predisposed against paying for healthcare, even though we're the only ones in the civilized world who already do.

                  I'm sure the European taxpayer would be surprised to hear they're "not paying" for health care. Why are you responding to this willful trolling?

              2. The point is that that level of innovation will undoubtedly go away as soon as single payer becomes a thing. But if you would like 2017 medicine delivered with the same efficiency as the VA for the next 50-years, knock yourself out.

                1. Maybe that's true, in which case there is a choice to make. Do we prioritize universal coverage or innovation? It's not like your answer is the automatically ethically superior one.

                  I have a little more faith in human ingenuity than you do, apparently, which is odd since you're the libertarians. You want innovation in healthcare (or anything else)? Throw government money at it. That's how we got to the moon and invented the internet. But you're against that too, so I guess it's "die if you're poor" from here to eternity. The only ethical option!

                  1. '''....every time we object to a thing being done by government, the socialists conclude that we object to its being done at all. We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain."

                    ? Fr?d?ric Bastiat, The Law

                    True 150 years ago and still true today.

                    1. A strawman then, a strawman now. Sorry you base your political philosophy on inane horseshit.

                2. I've never understood the "innovation" argument against single payer. Why does shifting redundant, dead weight paper pushing by doctors and insurance companies equate to the death of innovation?

                  When Taiwan implemented its single payer system in the 90's (modeled after Medicare after looking around the world for the most efficient method of delivery) people were afraid the increase in demand would result in horrible rationing, etc.- but the opposite happened, the increase in demand spurred exponential growth in the healthcare sector- as well as incredible innovation.

            2. And the Mayo clinic wants to prioritize private pay patients over those on Medicaid.


            3. "Mayo reported a sharp increase in the amount of unreimbursed costs related to Medicaid patients, from $321 million in 2012 to $548 million in 2016. The figures include its campuses in Arizona and Florida. Mayo nonetheless remained profitable in 2016, with income of $475 million."

              From link above

              So, they lose money on their Medicaid patients and make up for it by gouging private insurance to cover their losses on treating Medicaid patients.

              . . . even the Mayo Clinic does this!

              Hospitals that can't attract paying customers from all over the world and suffer from high Medicaid populations just close if they can't attract enough private pay patients to gouge.

              1. you should rephrase slightly to say even the Mayo Clinic HAS ALWAYS done this!

                pre-ACA they did this too, just like many other medical institutions. Instead of charity care they are being reimbursed some through Medicaid now.

                The question is: is the person who is now on Medicaid ok with waiting behind the private insurance person at this specific institution for care? The article takes great pains to identify this as being a very rare occasion and for non-life threatening situations only. The Medicaid recipient is also free to choose another medical institution to receive care from if they would like. My guess is that they'd much prefer waiting the month or going to a different hospital than nothing at all.

                1. All hospitals that take Medicaid patients either have to gouge or go out of business, and they've been doing this for as long as Medicaid has been only reimbursing providers for a fraction of the cost of care.

                  The ACA made it worse because the ACA was in its essence an expansion of Medicaid.

                  I suppose some medicaid patients have some choice, but less than you might think. There are very few hospitals left in high percentage medicaid areas. Hospitals are like retailers in that they serve a local population in a 1, 3, 5, and 10 mile radius, and the demographics in those concentric circles have a certain income level. Retailers place their physical locations in circles where more people have more in the way of discretionary income. It's all about demographics.

                  Hospitals are the same way. It's a battle for insured patients. When you see stories (here and elsewhere) about some hospital rent seeking to keep a competitor out, this is what that's usually about. Siphon off some of the privately insured in their 10 mile radius (or whatever) and they don't have to wait to see what will happen to their bottom line over time. Take away a significant slice of the privately insured demographic in their territory, and they'll go broke providing for local Medicaid patients.

                  The ACA made all that worse by expanding the eligibility for Medicaid.

                  1. Honestly you're really making the case AGAINST insurance which is really what single payer is - no insurance for most medical interactions.

                    Medicaid has been around for HOW LONG? These individuals have been supported through the system by the largess of private policies which support somewhere around 110 million people ish? Over half of every dollar currently spent comes from Medicare/Medicaid. So OUR modern healthcare system was BUILT on backs of this subsidization which was in a slow death spiral ANYWAYS due to this relationship. Need more money? Gouge the private insurance! Except now there isn't enough private insurance to support the weight. So either you cut people off ( I presume you would find that morally untenable) or you vastly change the relationship because the economics are no longer viable.

                    BTW - Mayo doesn't pay it's staff the way most healthcare facitilites do (assuming you know that) and they are still PROFITABLE inspite of their challenges. You might be hard pressed to say that the situation couldn't be fixed with minor tweaking as opposed to a major reshuffle.

                    1. Mayo is still profitable because of their brand name. They've moved into areas where there are large populations of wealthy patients (in Arizona and Florida), and they attract paying customers from all over the world.

                      That's why Mayo can't take a $548 million loss on Medicaid patients in one year and still be profitable. The average community hospital can't do that.

                    2. they are profitable because they are efficient and they compensate their staff differently to encourage that efficiency.

                      AZ and FL are filled with retirees. For every "wealthy" patient you suggest is walking in the door, I guarantee there are 10's in not hundreds on Medicare (lower reimbursement) and medicaid. Obviously the local hospital can't take a 548 million dollar loss which was why there were large scale consolidation efforts throughout the industry prior to the ACA, and they were accelerated by the ACA - because of the death spiral. Mayo article references that people need to go to the appropriate facility to be seen for their particular condition. People don't know how to interact with the healthcare system because they AND the healthcare system were living on the largess which has come to an end. Time to rework.

                    3. Mayo Clinic is a nonprofit, so I don't think it's quite accurate to say they are "profitable" or to cite the Mayo as evidence of the superiority of a "free market" system.

                      The excellence of the Mayo Clinic derives from the fact that its core values are "To inspire hope, and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research."

                      Because it is a nonprofit, it can pursue these goals with fewer conflicts of interest than the growing number for for profit hospitals consolidating around the country.

                      I never hear this mentioned in the healthcare debate- everything is framed in terms of "government" or "market." But for most of American history, hospitals were neither government nor "market" enterprises, they were charities set up by religious and philanthropic groups.

                      Why there isn't more of a movement to restore hospitals (and insurance companies) to the nonprofit sector where they originated, is something I do not understand.

                    4. Also, I'm not making the case against private insurance.

                      I'm making the case against Medicaid.

                      We need to start by cutting Medicaid eligibility. Rolling back the ACA Medicaid expansion was a good, honest start. The Ryan plan did that. Too bad it died.

                    5. On the contrary, you are making the case against insurance because you think you can push for a healthcare system that relegates 100 million people to the sidelines (more or less), I think you are in for a rude surprise. Couple that with what I assume you would push for in chopping Medicare (since their reimbursement rates are also below market) and you have most of the U.S. scrambling. And all this without asking anything from the medical community or fellow citizens? I don't think you're quite hearing what you're saying.

          2. If by European friends, you mean "my mother" then you're wrong. She traded up the NHS faster than you can say 'Death Panels'.

            The Europeans get their news from the same sources you do, which has people believing that if you go to the doctor, you get a $30,000 bill and there's a severe looking woman following you around the hospital tapping her foot, waiting for payment. (God I remember that movie and how awful it was).

            No one I know pays for healthcare- beyond their employer-provided insurance. And about 100% of my friends are well on the lower half of the income spectrum. And depending on how one counts it, probably the lower third.

            I worked in healthcare for almost 30 years, and very few uninsured poor people paid for their healthcare either. But I'm not going to digress into a 500 word essay on the economics of hidden costs.

            My point, which you missed was, as a libertarian, I'd LOVE to have one of those foreign systems where there's a basic national insurance program, but you pay out of pocket for many of the ancillary healthcare costs. Modern Americans wouldn't have it, because you'd have NPR doing a 12 part series on the cruel inhumanity of a woman forced to pay $22 for her birth control by the American Taliban.

            Shorter: Whatever single-payer system Americans eventually end up with, it will be more free and more comprehensive than any foreign system on the planet.

            1. And that's bad, right?

              1. Well, I guess if the government subsidized iPhones and the cost of an iPhone went to $12,000, there are those that would continue to blame the free market. But as long as it's covered by your tax dollars... what's the big dillyo?

            2. There is a way out of the employer-based system.

              Make it tax neutral to purchase your own individual policy vs. the employer-based one. Step back and wait for employers to allow opt-outs. The relatively young and healthy will start opting out of employer-based policies into the individual market. Although this might take a generation to work itself, out eventually it will kill the employer based system and put people back into the individual market. Then they will see the full cost of their insurance up front, and will start moving toward HDHPs, with HSAs to cover the deductible. And that, in turn will drive cost transparency and restore price signals.

              1. 1) Get government out of health care and health insurance.

                2) Cut taxes.

                3) Change the Emergency Medical Treatment and Active Labor Act (EMTALA), so all an ER has to do is stabilize you and then they show you the door or drop you off at home in an ambulance.

                1. As far as I know EMTALA only compels stabilization.


              2. I'm not against individual policies, but you're still ignoring the ultimate cause of the problem.

                According to the story I linked above, the Mayo Clinic alone lost $548 million treating Medicaid patients in 2016 (not including Medicare). They made a profit anyway--by gouging private insurance companies to make up for the difference.

                What difference will it make whether your insurance company is selling you an individual policy or a policy to your employer if the insurance company is still being gouged for a nationwide average of around 150% of the cost of care?

                Is this not clicking for you yet?

                Even if the insurers could justify taking their profit margins all the way down to less than 1% in order to compete for more individual policy holders, the insurers' costs would still be artificially inflated by some 150% by providers.

                That means the insurers' profits would represent one percentage on top of the 50% they get charged by providers above cost.

                There are lots of things we could do to improve the healthcare system and make it more free-market capitalist, but the solutions that don't include slashing Medicaid eligibility will have an insignificant impact so long as Medicaid and Medicare continue to reimburse providers at a fraction of the cost of care.


                1. let's start with open pricing

                  1. You can't have open pricing when Medicare and Medicaid are only covering a fraction of the cost of care and the providers need to gouge private insurers to make up the difference.

                    You can't have open pricing when the hospital on the wrong side of the tracks has twice as large a medicaid population and, hence, has to gouge insurers for more to make up for more losses.

                    You can't have open pricing when different states are compensating Medicaid differently in an attempt to keep hospitals open in poor neighborhoods with large Medicaid populations.

                    You can't have open pricing and Medicaid. Again, when hospitals can't arbitrarily gouge insurers to make up for the money they lose on Medicaid patients, they go out of business. 16 hospitals have closed in New York City in recent years for precisely that reason.


                    Open pricing won't do a thing to change the fact that providers need to gouge insurers to make up for the losses they take treating Medicaid patients.

                    1. honestly, that's the only thing that prevents gouging. It's funny to me that the first thing the libertarians point to when it comes to how healthcare should be run is the hospital in Oklahoma. What's the first thing you see on their website before contacting them? - how much it will cost. What they don't accept - insurance.


                    2. "Prevents gouging"?!

                      What universe are you living in?

                      Do you see this link?


                      Look at it. Feel it in your bones. What does it show?

                      Do you see what happens to costs of private payers circa 2012?

                      Did you see the quote from The Mayo Clinic story?

                      "Mayo reported a sharp increase in the amount of unreimbursed costs related to Medicaid patients, from $321 million in 2012 to $548 million in 2016. The figures include its campuses in Arizona and Florida. Mayo nonetheless remained profitable in 2016, with income of $475 million."

                      Those new, extra losses are from the ACA Medicaid expansion.

                      They gouged private payers for $548 million just to make up for Medicaid losses alone--not including what they lose caring for Medicare patients.

                      That's gouging. You think gouging is being "prevented" by something?

                      Medicaid makes gouging absolutely necessary.

                      Did you just wake up or something? What do you think we've been talking about?

                    3. right Medicaid didn't exist before 2012 then yes? Oh...wait.

                      So what I see when I look at that chart is a relatively STABLE line from the Medicaid line with actually a DIP that is coming back up slowly after 2012 and a huge spike from the private side. So some things can be drawn from that chart a) the "subsidization" has always been there b) private vs. Medicaid actually starts to diverge significantly in '02-'03 - recession years and in fact never recovers. Why it's like a huge number of people lost jobs during that period that paid for their health insurance and got shuffled to government programs because of what?

                      So gouging was already occurring, it got worse entering the post 9/11 recession continuing to diverge and then the ACA hits in stages throwing the market out of whack for a couple of years. Boy it'd be great if instead of employers squeezing wages and paying out huge comp and benefits packages and huge share buy backs (which they are completely entitled to do) which inspires the huddled masses to want to tax them to pay for government entitlement spending - what if they just paid their workers better so they didn't have to apply for Medicaid/TANF to get by?

                      Oh, the chart doesn't address what I said about price transparency preventing gouging so maybe you could "feel that in YOUR bones"?

                    4. Yes, gouging existed before 2012--and guess what? We had the same problems in our healthcare system before 2012 because of gouging.

                      These problems were exacerbated by expanding the eligibility for Medicaid, and our problems will not get better until we roll back the ACA Medicaid expansion.

                      Yes, before the ACA Medicaid expansion, insurance premiums were significantly higher than they should have been relative to the cost of care--because private payers were being gouged to cover Medicaid costs back then, too.

                      However, the problem wasn't as bad when there were fewer people on Medicaid.

                      The baby boomers continuing to hit their Medicare eligibility years didn't help any either, but that's too politically sensitive to get rid of at this point.

                      In regards to transparency, again, even if transparency didn't drive significantly more community hospitals in low income neighborhoods to close, what would transparency do about the fact that providers have to charge private payers a national average of about 150% of cost?

                      The correct answer is "nothing".

                      P.S. Back of the napkin calculation suggests bringing Medicare and Medicaid up to paying 100% of costs might add some $300 billion to the federal budget annually. And that assumes Medicare enrollment is static.

                    5. Do you not understand that when there aren't enough patients with private insurance to gouge, the hospitals simply disappear?

                      In recent years, 16 hospitals have closed in the low income neighborhoods of New York City alone.

                      Go ahead and read this article.


                      It's written by and for progressives. It's all about how and why those 16 hospitals in low income neighborhoods closed--and it's all about Medicaid not paying enough to cover costs. The state of New York was dolling out Medicaid reimbursement to try to keep more of those hospitals afloat, but Medicaid's reimbursement rates are so low, it was too expensive for the state to keep doing that. Cuomo vetoed the bill to continue it!

                      Not some libertarian.

                      Not some Republican.


                      The Medicaid expansion is crushing the system for the poor. Why don't you understand that there can't be transparent pricing when hospitals in different neighborhoods need to gouge private payers in order to compensate for all the money they lose treating Medicaid patients?

                      Poorer neighborhoods with more Medicaid patients need to gouge more than other hospitals in the same city to stay open. Transparent pricing would bankrupt those already non-profit providers--not because of anything they have control over, but because they're treating Medicaid patients.

                    6. Some people have a hard time believing that socialism fails for the same reasons it's always failed in the past.

                      Have you been following what's going on in Venezuela? The big boss threatened to throw bakers in jail for not baking bread--but they can't afford or find the ingredients!

                      So the shopping market shelves are bare.

                      It's Russia circa 1989 all over again.

                      Who knew that would happen in Venezuela?

                      Well, everybody who knows anything about what happened in Russia and why circa 1989.

                      It's the same thing with Medicaid. You expand eligibility, leave providers to gouge insurers for Medicaid losses, try to force young, healthy people to buy insurance they won't use to help the insurers cope with the gouging, and when that doesn't work, the progressives wonder why?

                      Or, I guess you blame it on a lack of transparency?

                      I guess that's better than blaming it on corporations, the Koch brothers, fake news, or Vladimir Putin.

                    7. My comment appears to not have posted, yet again so I'm going to type the abbreviated version.

                      You are again not addressing the issue.

                      To review:
                      1) Always has been gouging always will be. Nothing you're proposing will end that.
                      2) Yes local hospitals are closing. That's been the trend pre-ACA and has accelerated post. You make no mention on total capacity in a given area since most networks are consolidating into regional monopolies to achieve scale.

                    8. My comment appears to not have posted, yet again so I'm going to type the abbreviated version.

                      You are again not addressing the issue.

                      To review:
                      1) Always has been gouging always will be. Nothing you're proposing will end that.
                      2) Yes local hospitals are closing. That's been the trend pre-ACA and has accelerated post. You make no mention on total capacity in a given area since most networks are consolidating into regional monopolies to achieve scale.
                      3) Over 1/2 of every dollar spent is already coming from the government programs which reimburse at a supposedly below market rate. Nothing you've stated will reverse that trend. Your only answer, that I can tell, is to role back enrollment numbers. Those people don't go away. They can't pay for private insurance. You're putting them back into the system on charity care, or not at all. You're not preventing gouging.
                      4) Open pricing, especially as people actually have to pay for standard medical procedures through deductible, should be encouraged as much as possible so that individuals can shop for standard procedures and medicines. Empower consumers to save their healthcare dollars and they will.

                    9. 5) HMOs PPOs HSAs and all other efforts to reorganize the system have failed to increase coverage or bend the cost curve back. Your hyperbole about Venezuela or Russia, neither applicable to our current predicament, is irrelevant to the market gouging you're complaining about because a) no one is suggesting we change our ENTIRE economy to central planning, and in fact we continue to try and preserve FM principles wherever possible even in markets that don't lend themselves well to their use and b) hybrid systems work fairly well all over the world. Communism fails because there are no checks and balances to the system which we clearly have.

                      None of the things you've brought up would reverse the trends or reduce "gouging". I find it interesting that you protest even the thought of open pricing to help consumers make better choices in purchasing their own healthcare.

                    10. ***Communism fails for many other additional reasons too, of which don't really need to be spelled out here.

                    11. However, if the insurance companies don't exist- a doctor won't need 3-4 medical assistants to handle billing, coding, chasing unpaid claims, waiting on hold for pre-authorizations etc. So, the standard reimbursements for Medicare-for-All could afford to be raised.

                      That's the theory anyway.

                      But I agree with the assessment of Medicaid driving up the cost to private insurance. It's a similar dynamic as college tuitions, I think.

      2. Except they do not get it for free. Taxes are high, queues to be treated are long, medicines are rationed and certain treatments are not available. The government is the customer, the patuenr is at vest a child, at worst, livestock.

      3. Lets just satify all parties by giving all Americans FREE healthcare and college, and go to war with anyone that refuses to pay for it all for us.

        I call this new platform NeoProgressivism.

    2. A lot of this is framing,

      I want every American to have an awesome motorcycle. Ask whether you think everyone should have a sports car, and a lot of people are for it.

      Frame the question differently, and the answer changes.

      How much are you willing to pay to ensure that everyone has health insurance?

      The responses will flood in to the "zero to less than zero" category.

      1. I was just doing some side research and I found two competing arguments:

        Free birth control is singularly responsible for a massive drop in abortion rates, which is why conservatives should support free birth control.

        Abortion rate drops are a direct result of GOP meddling and abortion restrictions passed in many states, causing abortion access to be more difficult for teens and poor minorities.

        El Oh El.

        1. Why can't men get free condoms if women can get free birth control?

          NO free birth control for men or women.

        2. I don't know where my comment went on this either, but this was a really weird thing to stick into this thread.

          The first argument is a proactive step to bring about a very positive outcome for pro life individuals through some small economic pain.

          The second is using the power of the government to interfere with a legal right. Since "meddling" isn't defined - it's tough to pin down what this means. Whether it's making a determination on viability or shutting a clinic's doors because their hallways aren't wide enough, there's a pretty wide array of options. Offering free BC vs. pay BC would likely affect a small amount of women, but my assumption is that pro choice individuals expect that pro life individuals would assume ANY improvement is worth it since even one abortion is too many. They are likely talking past each other to a large extent.

          THe only problem with those statements coexisting really, is the word singularly. In truth, people are just having less babies and the whole trend is heading downward and has been for a while.

      2. Everyone needs to be reminded that America pays out about $8,000, for every man, woman and child, on medical care, each year.
        Currently, there are about 120 million of the 322 million population on Medicare and Medicaid. So, about one third of that $8,000 per person is already factored into government costs of medical care, though the low reimbursement rate needs to be factored in.
        That means the government will have to come up with an amount in the neighborhood of $5,200 for everyone, for a grand total of $1.674 TRILLION.
        That will have to be paid, either through taxes, or debt, for there to be a public medical system.
        When only half of the people are actually paying any income taxes, that amount will be double for taxpayers.
        So, "single payer" will result in adding about 50% to the government's annual budget.
        And how many are good with that?

        1. My premiums are $8400 a year- so $5200 sounds like a bargain.

  17. Secret Meeting of Progressive Masterminds circa 2014:

    Cabalist #1: "How can we get working class white guys to vote for socialism?"
    Cabalist #2: "I have an idea. If we can just make socialism racist enough maybe they will join us!"
    Cabalist #3: "Eureka!"

    And the rest is history.

    1. I can't tell if you're joking because... that's kind of how it actually worked... historically speaking.

      1. Just read it with a lot of irony and pain.

    2. Replace socialism with parasitic capitalism and you've described the last 40 years of Republican politics.

      1. I presume you used the term "parasitic capitalism" to distinguish it from actual capitalism. Welcome to the fold.

    3. The flaw in your secret meeting is that working class majority voted against socialism this election by electing Trump.

      buh bye ObamaCare.

      1. Cabalist #4: "But we have to tell them it's not really socialism. They're too stupid to know the difference so as long as we call it something like the 'Not Block Insane Yomamma Health Care Act' they'll believe whatever we tell them".

      2. Right, Trump ran on 'making sure everyone is covered, keeping the pre-existing condition coverage, making it a fraction of the cost and BETTER care'.

        He ran on that as the President that would bring that about i.e. government initiated. The problem will come when the AHCA passes with the Freedom Caucus getting their way and all of those conditions he ran on aren't included.

        There is a simpler way to solve this, just like SS and the other problems - pay people more. Unfortunately the mechanisms to compel that have shorted out thanks to globalization and automation.

        1. Pay people more from where? With what? In exchange for what?

          1. I don't know where my reply went. The problem is cultural. I posted the link to what happened when WalMart took the initiative to pay people more so maybe the did have to apply for Medicaid/TANF and look what they found:


            The problem is how do you get businesses to bite off on it without compelling them through government intervention? They should see the wisdom in paying their people more, rather than inching up a dividend payment to their shareholders without the government stepping in. The shareholder should see that maybe they don't get that extra penny this quarter, but Medicaid?TANF costs go down and the U.S. Government outlays go down. Maybe they could see a tax break from that since now those people don't require government benefits to live. Or, we could just cut the benefits and wait for all those people to leave those jobs until Walmart and company start paying more. In the interim, a great deal of pain would be had by all.

            I would hope we could progress to a more cooperative relationship in capitalism ala a more German model.


            1. The trouble with the "WalMart took the initiative to pay people more" story is that while they probably did get cleaner stores and tidier shelf space etc, it was probably not due to the current low paid employees suddenly taking an interest in these things because they got a raise but more likely because Walmart HR started getting a better class of applicants who got hired to replace the current workers who got laid off.

              1. There is NO mention of that taking place. In fact, there are extensive references to the new training put in place to help adjust employees opinions about their prospects and work in addition to their increases in pay. Made all the difference in the world. While it's a higher turnover industry there is no mention of massive new hiring to replace all the terrible workers you're implying were biding their time there. I could just as easily say that these workers saw more respect for their work so their productivity picked up and their pride showed through because they were valued.

                Doesn't really matter because it only really matters about the end result - better results for the employer, better results for employee.

            2. Sqrlz et muh comment

          2. I don't know where my reply went. The problem is cultural. I posted the link to what happened when WalMart took the initiative to pay people more so maybe the did have to apply for Medicaid/TANF and look what they found:

            look up WAlmart pays people more in the NY Times

            The problem is how do you get businesses to bite off on it without compelling them through government intervention? They should see the wisdom in paying their people more, rather than inching up a dividend payment to their shareholders without the government stepping in. The shareholder should see that maybe they don't get that extra penny this quarter, but Medicaid?TANF costs go down and the U.S. Government outlays go down. Maybe they could see a tax break from that since now those people don't require government benefits to live. Or, we could just cut the benefits and wait for all those people to leave those jobs until Walmart and company start paying more. In the interim, a great deal of pain would be had by all.

            I would hope we could progress to a more cooperative relationship in capitalism ala a more German model.

            see VW in Tennessee

  18. No kidding! Politicians want to control and ration your access to healthcare? Every election now has a guaranteed winning issue: Those Dems will be spending your money on abortion. Those Repubs will be kicking your granny out of the hospital. Those Libertarians will let doctors compete for your money and ADVERTISE on TV, FFS.
    Yeah, I think a few politicians might like that idea.

  19. What world have I woken up in? Have I woken up?

  20. HSA, Direct Primary Care, publish prices for drugs, procedures and hospital rooms. No more first dollar coverage. You pay out of an HSA.

    True catastrophic insurance to cover the unforeseen.

    These are important ingredients to reducing costs and keeping the government's grimy paws out of our medicine.

  21. I know that only a system of free choice, a market of volition can properly work for the best advantage of the people.
    That said, we are going into a system of national health care (socialized medicine) because the American people are so poorly educated (NEA) as to choose the worst possible plan, and their leaders are so corrupt.

  22. So they've infiltrated Reason now too?

    What must be done - A manifesto of the 'isms.'

    Conservatives ? Creating their Own Worst Enemy?

  23. Well, that's it for the republic then. If lawmakers can't resist meddling in affairs not authorize by the constitution, what then becomes their lodestar? Either those who pay them graft to elect them for favors or the mob enraged by it. It's civil war. All that's needed is a casus belli. It ain't bathrooms so it'll be a few years yet.

  24. John Derbyshire grew up with NHS in UK, which at its best is Frankenstein's monster. France, Germany, and Japan, require everyone to have healthcare, but NONE have single player insurance. UK citizens either criticze NHS, or make excuses for its scandals, lack of funds, and incompetence. Many envy the 5% who have private healthcare, belonging to strong unions, or have money to pay for it. Most are frustrated their healthcare care isn't as good as France or Germany. They are also frustrated many UK doctors leave for Europe, Australia, or the US, for a better salary. In US, many doctors refuse to take Medicare, unless they have co-insurance. Medicade run by state for the poor pays even less. Both need systems engineering need reform. Wellness clinics, urgent care, and cheap meds can be run efficiently at deep cost savings. Problems begin when unreasonable services are required. Services like invetro fertilization, and sex reassignment are too costly to be covered. Many people with fantastic healthcare from their employer pay for it themselves.

  25. Is your goal improving the quality of and access to healthcare for human beings? Or is it proving yourself right about a philosophy of government?

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