Should the U.S. Have a Public Health Insurance Plan?

Yale’s Jacob Hacker and Sesame’s David Goldhill debate a government-run health insurance plan.

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Should the U.S. Have a Public Health Insurance Plan?

Jacob Hacker and David Goldhill debate the resolution: "The government should offer to all Americans a health insurance plan that would compete with private insurance plans."

Jacob Hacker is arguing for the affirmative. He's a professor of political science at Yale University and codirects the Ludwig Program in Public Sector Leadership at Yale Law School. He is a resident fellow at the Institution for Social and Policy Studies.

For the negative is David Goldhill, CEO and cofounder of Sesame, an online marketplace for discounted health services. He is also the author of Catastrophic Care: Why Everything We Think We Know About Health Care Is Wrong.

The debate is moderated by Soho Forum Director Gene Epstein.

Comments

[Uncle Jay]

"Should the U.S. Have a Public Health Insurance Plan?"

No.
Get your own damn health care plan.

[Sam Bankman-Fried]

Romney, the white you voted for in 2012, disagrees with you! Lololololol!!!

[TJJ2000]

Did you say the RINO disagrees?
Think McCain also qualified as a RINO after upholding Obumercare.

[Sam Bankman-Fried]

McStain didn’t uphold Obamacare…he helped Ryan get $300 billion more in tax cuts. You are thinking of the individual mandate which proved to be innocuous but the CBO still scored it as costing $300 billion which Ryan used for tax cuts during reconciliation.

[JesseAz (Prime Meanster of Sarcasia)]

No.

[Gaear Grimsrud]

No

[Longtobefree]

Hell no!

[Vernon Depner]

Whether we should or not, a single-payer national medical care system is inevitable.

[JFree]

No it isn't. A single payer system only exists in Canada which is not at all a model for any other system. Even the UK is not really a single payer system since they allow 'supplemental' insurance which many employers offer to employees. That is not a model for any other country either.

'Single payer' is a political meme intended to place all options into an electoral framework. Not an actual workable option. An option that would work in the US is a 50+ minimum payer system - where each state creates a risk pool for its residents and where the feds provide reinsurance for those states. Medicaid and Medicare and state university/research hospitals and VA hospitals and muni hospitals (and likely non-profit hospitals) could easily transfer their funding and facilities to those states to seed the risk pool with people who are already covered under public/govt plans.

Those states could easily expand their risk pool to cover more people. They could negotiate FAR more intelligently than the feds ever can for purely political purposes. The costs of that risk pool would not increase much at all to those new people because the existing pool already covers the old, the dying, the disabled, the destitute, children of the poor, etc. Those not covered are overwhelmingly - healthy and of working age. Those are VERY low risks and should therefore have very low costs. That would not prohibit any private coverage. Many employers would offer private in large part because a well run tax paid plan also rations care. For most people that's ok. For those who want to bypass lines/rationing, that is precisely what private plans do - but 'bypassing lines/rationing' is what private plans do NOT do here in the US (see the murder of insurance plan CEOs with a slogan about the rationing that they currently do).

[JFree]

As an aside - our existing 'public health insurance plans' do not eliminate one iota of what a private system would offer. They do not compete with - or subvert competition of - a hypothetical private system. No private system will pay for the elderly (whose end state of medical care is still dead no matter how heroic they want someone else to cover), the destitute, the disabled. Exclude those people however and you have the young and healthy - who don't spend money on health care in any rational world.

[Vernon Depner]

It doesn't matter what the arguments against are. It's coming.

[Sam Bankman-Fried]

You are still defending the UAW/New Deal Democrat designed health insurance system…the same one that ended up undermining American manufacturing in the 1980s!?! You are a useful idiot for the American health insurance industry.

[JFree]

Then you're not reading my comment. And you certainly don't understand history.

[Sam Bankman-Fried]

If you support the pre-Obamacare status quo then you support a health care system designed by the UAW and New Deal Democrats. Basically you want your boss to determine which doctor looks at your wife’s and daughter’s vagina! Sicko!!

[JFree]

Read the fucking comment you stupid partisan hack.

[charliehall]

Had the US enacted John Dingell Sr.'s National Health Insurance plan in 1933, US manufacturing would not have been undermined, and the US economy would not be draggee down by the high healthcare costs. Oh and we would he healthier and live longer.

[damikesc]

Because, going by the VA, nobody provides better service and outcomes than the government.

[Idaho-Bob]

Found the retard who thinks social security is the greatest thing ever.

[Sam Bankman-Fried]

We lost the jobs in the 1980s coming out of the Volcker recession…so it worked until it didn’t.

[InsaneTrollLogic (Muting Sarc like he mutes us)]

Did you happen to forget what occurred between 1968 and 1980?

[Sam Bankman-Fried]

A bunch of the companies that make up the Fortune 500 were created??? From a macro level the 1970s looked pretty good up until Volcker.

[Sevo, 5-30-24, embarrassment]

charliehall.
Is.
Full.
Of.
Shit.
Not one of his claims is other than imbecilic lefty bullshit.

[chemjeff radical individualist]

'Single payer' is a political meme intended to place all options into an electoral framework.

Oh come now. Every possible option can be assigned a label of either "capitalist" or "socialist", and Real Muricans reject the socialist label and pick the capitalist label. Especially the ones who cash their Social Security checks every month.

[InsaneTrollLogic (Muting Sarc like he mutes us)]

Your strawmen suck hard.

[Sam Bankman-Fried]

Vermont and Massachusetts could have a Medicare for All (M4A) program within 5 years. The federal government isn’t necessary to implement M4A because all of the revenue necessary to fund a M4A program is currently being spent on health care in states like Vermont and Massachusetts AND every state currently runs a health care program!! You simply start in year 1 by transferring state employees into the state run health care program and every year add another group like in year 2 everyone that works for a university is transferred into Green Mountain Care.

[Idaho-Bob]

Yeah, the socialized VA works so well for veterans.

My dad used to say "the VA is for the vets who can't afford insurance and need a place to die."

[Sam Bankman-Fried]

Trump fixed it. Now it works great. Remember Trump was already president and he released the Epstein Files and built the Wall and fixed the VA and ended wars for good.

[InsaneTrollLogic (Muting Sarc like he mutes us)]

I think you may need a doctor so he can extract your head from your ass.

[Social Justice is neither]

Because that's working so well with retirement funding, right? What are the total funded and unfunded liabilities now?

[Chumby]

Fuck no

And eliminate Medicare/Medicaid.

[Sam Bankman-Fried]

And increase tariffs. And where are you on invading foreign countries today?? Because you supported invading Iraq in 2003.

[InsaneTrollLogic (Muting Sarc like he mutes us)]

Cite?

[Sometimes a Great Notion]

Take it away Robin

https://youtu.be/haYV_KIX4BQ?si=HYsjYMhLhLbpIDbZ

[Gaear Grimsrud]

My health care plan is simple and cheap. Balancing my intake of cigarettes and beer to maintain optimal BMI. Also sex, drugs and rock and roll. Seven decades and I'm still here bitches!

[Longtobefree]

You died five years ago, but they forgot to tell you - - - - - - - -

[Gaear Grimsrud]

Yeah Covid took me out. I only haunt the material world because there's a very small chance Fauci will end up head first in a wood chipper and I'd like to be around for it.

[Moonrocks]

Of course. Now that the government has made health insurance unaffordable and undesirable while simultaneously mandating its purchase, the only solution is to further involve the government. I guarantee that this will finally solve all the problems thus far created by the government, but even if it doesn't we could always outright ban any private competitors to this new government option.

[Sam Bankman-Fried]

Because no other country has figured this out, right??

[Idaho-Bob]

No other country has figured out how to provide quality (key word) health care to every citizen. They do provide quality euthanasia for the depressed, elderly, and chronic.

[Vernon Depner]

A national health service can't work without strong, independent death panels. There is no natural limit on medical care spending. Someone has to say no when treatments are unnecessary or not worth it.

[DesigNate]

Why is this even taken seriously enough to debate in a “libertarian” magazine? Especially when the article could be summed up with “Fuck no.”?

[Sam Bankman-Fried]

You pay for my health care. Every good and service purchased in America includes the costs of someone else’s health care!! America has what amounts to a VAT to pay for health care for Americans ages 18-65…and then payroll taxes and income taxes pay for babies and children and elderly. So thanks!!

[charliehall]

Both Friedrich Hayek and Milton Friedman supported mandatory universal health insurance. They just wanted it run by the private sector not the government.

[JesseAz (Prime Meanster of Sarcasia)]

Insurance. Not Healthcare. What do they teach at fake harvard?

And it was for catastrophic outcomes, not general Healthcare checkups. The plans aca outlawed.

[DesigNate]

This might surprise you, but Hayek and Friedman weren’t libertarian Jesus.

[Eeyore]

What if we just jump directly to the endgame and only provide abortion and M.A.I.D. services?

[Sam Bankman-Fried]

No, I will never pay for the Planned Parenthood clinic in the black neighborhood with the highest murder rate in the country!! PP is genocide!! More black babies!!!

[Eeyore]

If you can convince the mother that life is over you can provide a two for the price of one procedure.

[TJJ2000]

Insurance within its own definition *is* a "public health" cost plan.

How STUPID does one have to be to think giving an insurance company the power to Gov-Gun down the people (Gov Insurance) is going to be good? Who will ensure Justice? You just as well be lobbying to make Big-Insurance the government. It's the exact same thing.

Get it through your greedy selfish criminal heads leftards.
'Guns' don't make sh*t.
If you can't afford it without 'armed-theft' crime you can't afford it period.
THEFT is a Zero-Sum resources game.

[Sam Bankman-Fried]

But adding trillions to the debt isn’t “theft”??

[charliehall]

"How STUPID does one have to be to think giving an insurance company the power to Gov-Gun down the people "

Friedrich Hayek and Milton Friedman were stupid?

[JesseAz (Prime Meanster of Sarcasia)]

Parody intentionally represents what both claimed. News at 11.

[Idaho-Bob]

No, but you are for taking them out of context.

[Incunabulum]

We already do. It's called Medicaid.

Unless the public plan is charging at market rates then its just Medicaid.

What we need to do is decouple health insurance from employment by simply just making all medical and medical insurance payments pre-tax for everyone, not just whatever plan your employer might see fit to offer.

[JesseAz (Prime Meanster of Sarcasia)]

Medicaid actually pays at 92% costs, cost shifting a lot of costs to private plans.

[Social Justice is neither]

Which costs? Direct, indirect, fully allocated? How much of total hospital costs are in that deceptive metric?

[Vernon Depner]

There is no such thing as "market rates". Rates are set by the amount of the subsidies.

[Neutral not Neutered]

Insurance companies will never let this happen. The only way for the US to adopt a universal plan like Canada's is for the Gov to purchase the existing insurance companies and absorb them or grow exponentially and try to compete against them.

The cost of "insurance" will drop because there will be no profit in the premiums if a Universal system is adopted.

However there will also be reduced services across the board.

For example, the US has 10 times the amount of MRI machines than Canada per 100K population.

But Canada is allowing Private clinics to open for those who don't want to wait and are willing to pay for services.

Health insurance companies cover the secondary items, prescriptions, ambulances, chiropractic or physical therapy, messages, etc.

[Incunabulum]

The cost of insurance is not dropping in Canada or the UK.

So . . . there goes your thesis out the window.

[TJJ2000]

LMAO... The cost of "insurance" will drop...

And exactly what market has government taken over that has been the result? How many times do you have to proven STUPID before you LEARN anything?

It'll work this time... Nope. It'll work this time... Nope. It'll work this time... Nope. It'll work this time... Nope. It'll work this time... Nope. It'll work this time... Nope. It'll work this time... Nope. It'll work this time... Nope. It'll work this time... Nope. It'll work this time... Nope.

FFS. Stop believing 'Guns' are going to make you something.
THEFT just doesn't. It just makes everyone else have to pay more.

[Sevo, 5-30-24, embarrassment]

You bet! Look how well our government retirement plan works!

[MollyGodiva]

Every other peer country has some form of universal healthcare. They spend less and have better outcomes.

[InsaneTrollLogic (Muting Sarc like he mutes us)]

Again, Molly shows her ignorance. No, Molly, not every other country has a form of universal healthcare, and those that do tend to spend more and have worse outcomes. Ask a Canadian or a Brit how long it takes to get a procedure done.

[MollyGodiva]

I know Canadians. They think the US system is stupid and mock us. They might wait, but they get health care, which is more than what everyone in the US gets.

[TJJ2000]

Great.. They can STAY in Canada then... And you can go there as well.

[Chumby]

What did ML to deserve that?

[Sevo, 5-30-24, embarrassment]

"They spend less and have better outcomes."

MG.
Is.
Full.
Of.
Shit.

[TJJ2000]

So what are you still doing in the USA??? Get the F'Out!
Go enjoy your Venezuelan pipe-dream.

It's people like you destroying the American Dream.

[DesigNate]

Wow, three wrong assertions in one post. Well done, doc.

[AT]

Ten facts you MUST accept before you can ever even have this discussion. If you don't agree with them, you are discussing in ignorance (or worse, bad faith).

1) Health care is not a right.

2) Health care can never be a right.

3) Health care and Health insurance are two very, very different things.

4) Insurance is an industry that isn't about whatever word prefixes it. It's the for-profit business of risk management, plain and simple.

5) The role of insurance is not for the routine and regular. It is for the unexpected and catastrophic. That is what the company is betting against, and what you are paying into for security if it occurs.

6) Any insurance model that requires coverage of "pre-existing conditions" is either A) 100% doomed to failure; B) guaranteed to bring down the entire industry. Or both.

7) Some people are uninsurable. Meaning, in terms of risk management, they are guaranteed losses and forcing an insurer's coverage of them is nothing more than a socialist redistribution of those losses onto the premiums of the insurable.

8) Your health is, ultimately, nobody's responsibility but your own. This is especially true for self-induced maladies - everything from obesity to gender transition to addiction to extreme sports. And their derivative effects. Insurance should never cover these things. (It's like expecting collision coverage for a derby car.)

9) Government involvement in health care necessarily drives up the cost of health care, along with wasting its resources and increasing the likelihood of patient abuses. Everything from EMTALA to Medicaid. They do far more harm than good.

10) A lack of transparency with regard to up front medical costs - both to insurer and consumer - is a recipe for fraud and corruption.

If you agree to all ten of those things, then you're a serious participant in the health care debate. If you disagree with anyone, then you're a clown. Probably one with a collectivist axe in your hands and a sadistic smile on your face.

[But SkyNet is a Private Company]

Well said

[Sam Bankman-Fried]

Most of what we refer to as health insurance isn’t actually insurance…Google “self-insured”. So health insurance companies are actually managing health care expenses for a company. Congratulations, you are now slightly less of an idiot! 😉