Mt. Vernon Register-News

Opinion

May 1, 2014

Single-payer system won't save U.S. health care

(Continued)

The problem with this idea is that U.S. health insurers already buy in bulk. They cover more people than many of the countries cited as cost-control models for the U.S.:

But we already have a public option. As mentioned, we have several. And Medicare doesn’t control costs noticeably better than the private sector does:

On the other hand, seniors vote, and thus, politicians are very reluctant to tinker with reimbursements. Prices are set the way that other governments set them — by a centralized committee. But they’re set high.

There are two potential outcomes for a “public option” health insurer: It could set rates high, in which case it wouldn’t control costs, or it could jam them down to Medicaid levels, in which case no one but the very healthy or the very desperate would buy that insurance because it will be hard to actually use that coverage.

That brings us to the most sophisticated version of the argument: that we can use monopoly power to bring our health-care spending in line with that of other countries. As long as there is private-sector competition, the argument goes, prices will stay high, because doctors can refuse to accept government reimbursement.

But if the government is the single provider of health care (or at least, the single price setter), then we can drive down reimbursements and drug prices to something approaching European levels.

This idea has a number of problems, starting with its constitutionality. Here’s a big one:

Think that’s just because conservative ideologues are preventing the government from doing its job and controlling costs? Well, here’s an even bigger problem with the idea that getting government involved is going to bring our costs down:

What you don’t see is any government cutting health spending by any significant amount. Oh, Germany managed, once. Canada kept it level for a while. But no one has cut by anything like 35 to 40 percent — which is what we’d need to get our spending in line with Canada’s.

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