Single-Payer Systems Do Not Cost Less Than the U.S. Health Care System
By Dr. Merrill Matthews, resident scholar with the Institute for Policy Innovation
Almost every claim proponents make about single-payer health care systems—where the government taxes the public and then pays their health care bills—is wrong, or at least should be qualified.
They don’t cost less, but they do spend less. That’s an important distinction. The U.S. spends about 16 percent of its gross domestic product (GDP) on health care; most other developed countries with single-payer systems (or something close to it) spend between 8 percent and 12 percent of GDP.
The key distinction is that in the single-payer countries the government, not the market, decides how much will be spent on health care. That means health care spending is a political decision, not a medical one. Because there are several valid claims on taxpayer money (e.g., education, defense, welfare, etc.), the government has to weigh and balance them with the funds it has available. Thus the fact that single-payer countries spend less than the U.S. on health care tells us nothing about their efficiency. Their governments have simply made an arbitrary decision to spend less, but they will also get less.
Now, that doesn’t mean that there isn’t waste in the U.S. health care system. Almost every health economist believes there is—perhaps as much as 25 to 30 percent. The question is where is the waste and how do we get rid of it. Single-payer systems try to do so from the top down by restricting access and imposing price controls. The better way is from the bottom up, by giving patients a reason to be value-conscious shoppers in the health care marketplace. Consumers will root out most of the waste if only they have the necessary economic incentives to do so.
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The Uk has the NHS, it's paid for out of taxes . You get sick, have an accident, want a check up, whatever, you go to the doc and no one says how are you going to pay for this?. If you don't like that, go buy private health insurance from providers like BUPA.
I was watching tv a couple of days ago and a free clinic was taking care of a middle aged single mom working at Home Depot part time with 3 children , she hadn't seen a doc not even for a mammogram more than a decade. Free clinics don't reach 10s of millions of people. If you were one of her kids what would you vote for?
I think that is wrong with us americans is we are all lazy. Everyone wants to get paid instead of work. What people are saying by passing this thing is that the middle class and higher will be paying for those who don't work and sit on there ass. Thats just wrong. Now when I say this I understand the people who got laid off because they at least try in life. Thats why the bill for Universal Health Care will not be passed. And for those who are abroad and are living in a foreign country, it wont work for them
Other than the mercenary-motivation point that has so miraculously failed in general on the capitalism argument, all things being equal, how can any system that includes a profit margin not cost more than the same system that is nonprofit?
The whole point of having free market solutions is to improve efficiency and resource allocation. Yet you mention right in your argument that there is a lot of room for improvement.
How long have we had this system? How long has it been inefficient?
It is ruthless, unjust, and immoral that insurance companies PROFIT from healthcare. That means that by denying people health, profits are distributed to shareholders. Simply put, profits in healthcare equate to denial of healthcare to people who need it.
Obviously, innovation isn't happening and the free market isn't working. The free market works when you're providing tangibles, like shoes or biscuits; when you can realise economies of scale. But insurance, almost by its very definition, is not free market at all. It is socialisation. But having that fragmented into several companies (all with their independent systems which costs doctors and healthcare workers time to code and enter into different systems), and all of them needing to run at a profit equals an inferior healthcare product--and one that has been growing in size and need exponentially.
Admit it: market economics aren't working this time. They work in many other sectors, but not this one. Additionally, doctors don't do this simply for the money--if they did, they'd do something else because with malpractice and student loans, you don't end up making all that much money.
Where is this free market you are talking about?
People are not allowed to buy insurance from companies in other states. Insurance companies have per-state mandates on what services they must cover. The tax code ties people's health insurance to their job by not providing the same tax benefits if you buy insurance on your own and also by forcing your employer to pay a large sum of it. Insurance itself has become a non-market by removing the need for patients to consider the costs of the doctor's services. The government already pays for 50% of all health care related expenses.
What aspect of any of that is even remotely similar to a free market? The fact that profits and money are involved? That's a shallow argument. What we need to is to free the health care market by removing government interference that limits choices and encourages higher costs by making them hidden from the consumer. People also gain profits from food, in fact, if it was not for that profit you can be certain that food would not be so easily available.
Also, no one is denying people health care by refusing to provide it. You aren't denying your brother the services of a doctor if you refuse to pay because you aren't stopping me from paying for him
"Where is this free market you are talking about?"
I sure would like to know. I think much of it is currently being held hostage by licensing laws:
http://www.cato.org/pub_display.php?pub_id=9640
http://www.cato-at-liberty.org/2008/09/17/does-government-licensing-improve-health-care /
http://www.cato.org/pressroom.php?display=news&id=160
First you start with a dishonest heading: "Single-Payer Systems Do Not Cost Less Than the U.S. Health Care System" Then you admit within the first couple of sentences that the title is nonsense.
But in any case, your argument only makes sense -- national-healthcare systems spend less because they choose to spend less -- if the results were worse...if the choice led to worse healthcare. But this clearly isn't the case. The US spends more -- vastly more -- on healthcare per capita than the Western national systems, and yet...
* Tens of millions of people are not directly covered by the system
* Most of these people do not receive good healthcare, because they simply can't afford it themselves
* Citizens under the national-healthcare systems live longer
* Babies born in the national-healthcare systems are more likely to survive
* Citizens under the national-healthcare systems are healthier than Americans
* There's no evidence that the enormous extra cost of the American system provides any real benefits over the service received by citizens of countries with national-healthcare systems!
Not much here I haven't addressed to someone else: http://www.opposingviews.com/comments/lies-and-inaccuracies
"First you start with a dishonest heading: "Single-Payer Systems Do Not Cost Less Than the U.S. Health Care System" Then you admit within the first couple of sentences that the title is nonsense."
Actual quote is as follows:
"They don’t cost less, but they do spend less. That’s an important distinction."
They also continue in the article to explain how much of the larger wads of cash SPENT on UHC is eaten up by bureaucracy:
"The key distinction is that in the single-payer countries the government, not the market, decides how much will be spent on health care. That means health care spending is a political decision, not a medical one. Because there are several valid claims on taxpayer money (e.g., education, defense, welfare, etc.), the government has to weigh and balance them with the funds it has available. Thus the fact that single-payer countries spend less than the U.S. on health care tells us nothing about their efficiency. Their governments have simply made an arbitrary decision to spend less, but they will also get less." (From the 3rd paragraph)
"But in any case, your argument only makes sense -- national-healthcare systems spend less because they choose to spend less -- if the results were worse...if the choice led to worse healthcare. But this clearly isn't the case. The US spends more -- vastly more -- on healthcare per capita than the Western national systems, and yet..."
Before I get into each of those talking points, let's examine some of the claims you just made. You just stated that the US ALREADY spends the MOST tax money on healthcare and that various problems exist, yet you suggest that we adopt a system which would be even more guilty of high costs than the current one.
Now as for those problems:
"* Tens of millions of people are not directly covered by the system"
Any chance they might be rich fucks who don't qualify because they don't need it?
"* Most of these people do not receive good healthcare, because they simply can't afford it themselves"
So we should raise taxes on productive people who actually worked their but off to get benefits?
"* Citizens under the national-healthcare systems live longer"
I'm sure the 2-year difference between the US and Canada CAN'T POSSIBLY have anything to do with the poor lifestyle choices Americans tend to make considering the fast food nation we are, right?
"* Babies born in the national-healthcare systems are more likely to survive"
I would like a reference on this, and see the above point.
"* Citizens under the national-healthcare systems are healthier than Americans"
Not that it has anything to do with healthcare (again, see the point about that menial 2 year life-expectancy difference).
"* There's no evidence that the enormous extra cost of the American system provides any real benefits over the service received by citizens of countries with national-healthcare systems!"
Right, so abolish Medicare and Medicaid and send SCHIP to hell.
Public spending is already 50% of health care related costs. That means we already spend more per person than France, Canada or the UK does... in fact, only Germany and Iceland spend more per person than the United States when it comes to public funding.
http://www.nationmaster.com/graph/hea_hea_car_fun_pub_per_cap-care-funding-public-per-capita
So even if we assume the metrics you provided are actually related to health care, as opposed something else like lifestyle and crime, it simply doesn't follow that more government funding will fix the problem.
I hadn't seen this data...very interesting.
It just buttresses my point. To say "Single-Payer Systems Do Not Cost Less Than the U.S. Health Care System" is clearly not true! They clearly do cost far less than the US system, as the numbers you so clearly provided prove!
The US system is dysfunctional in many ways. One reason that public-funding of healthcare in the US is so high is that the US has to treat people who are very sick, who didn't get the healthcare they needed in the first place...they arrive at a publicly funded institution once they are really in trouble. Private hospitals dump very sick people without insurance on the public system.
Also, the entire healthcare market has become distorted, corrupted, in the US, with medical procedures and services costing far more in the US than in other countries. This affects both private and public healthcare.
I certainly wouldn't say that "more government funding will fix the problem." The system needs fixing, not more funding. One thing that has to be done is to remove the insurance companies from the equation, which will lead to immense savings.
I agree with your point, but I think you missed the original point... the distinction between costs and spending.
The original author suggested that Single-Payer systems spend less, not by more efficiency or lack of medical necessity but by political decree. They cut corners and spend less by denying patients who need services and by reducing payments to doctors. This doesn't mean they are making health care less costly -- they are just reducing how many of the costs they are willing to pay for.
If you stop driving your car and instead walk to work then you are not making gas cost less you're only reducing how much you spend paying for it.
...you end up with a simple equation.
The national-healthcare systems spend less...and the results are better.
The typical metrics used all fall short of being reliable when discussing the quality of a health care system.
Life expectancy and infant mortality, for example, have more to do with genetics, lifestyle, and crime then they do with the health care system. Infant mortality also has a strong correlation with the age of the mother and birth weight.
Why we don't we compare life expectancy of places like China, Cuba, N. Korea, etc. to the US? Would those be fair comparisons?
What sense does that make?
Here's the problem: http://www.msnbc.msn.com/id/27670605 /
The insurance companies have already usurped the doctors by mandating treatments, while leaving the docs liable for the legal ramifications of their practice. Just why are the insurance companies in the way for health care? Money. This is a non-productive health care cost to the citizens. In fact it is a barrier for many to get the care they may need.
As usual the proponents for the status quo neglect talking about the amount of savings to the public if insurance companies were no longer doling out the health care in the most minimal way possible.
One has to look at what goes to the actual functions involved in care for individuals. We would be saving billions if health care were universal, in terms of what people and companies currently pay.
More than half of the "profits" in the health care "business" are being eaten up by insurance companies. They have taken over authority for healthcare and left the liability for the doctors to suck on.
Imagine if the healthcare industry didn't have to make the doctors pay for their insurance coverage, and if the public didn't have to pay for the mandated administration costs and directives for treatment of patients. Imagine a place where everyone didn't work for and pay the insurance companies. That is the sweet pot the insurance companies would have us do.
Get sick, and who do you call? Some of the insurance companies that are "supposed" to provide the health care everyone pays for, would have you get "preapproval" to call an ambulance. Too bad the insurance company didn't contract an ambulance company in your region. Too bad you have to wait for the particular ambulance to be available while you have your heart attack. Too bad they rushed you to the closest hospital and not the one on your policy.
Too bad everyone is screwed when medicine is run by insurance companies. Doctors, patients, everyone.
Get rid of the unnecessary overhead, get insurance companies out of medicine.
"Almost every claim proponents make about single-payer health care systems—where the government taxes the public and then pays their health care bills—is wrong, or at least should be qualified."
This is a tricky debate, and starting off with a frankly ridiculous blanket statement without showing us any evidence to support your position comes across as a real stretch and lessens your credibility from the get-go. This shows that you are an a priori thinker who will disregard claims because of their source rather than their factual accuracy, which is not a good way to structure an extremely intricate debate. We should examine our sources, but I was hoping for more substance if you're going to throw out broad statements like this.
The article tries to draw a distinction between the cost of healthcare and how much is spent on healthcare. That is playing with words. What it is actually getting at is the difference between the cost of healthcare and its efficiency.
As the article points out, most single-payer systems cost between 8 and 12% of GDP whereas the US system is 16% of GPD. Remember that the US GDP per person is typically significantly higher than other industrialised countries. So we are talking about a higher percantage of a higher number. The cost/expense of healthcare per person is MUCH higher in the USA than other industrialised countries.
Is this money being spent efficiently? Do US citizens get far superior healthcare to say French, Canadian or English citizens? It is important to look at the figures - not just quote newspaper headlines (especially the Daily Mail!). The article from the NPA ( http://www.opposingviews.com/arguments/it-is-the-patriotic-thing-to-do ) show that US healthcare is not outstanding compared to other industrialised countries and is rather poor in some respects.
You might look at the 22 to 35 percent of the cut the insurance companies take out of the costs.
Medicare runs only a 4 to 6 percent overhead.
My parents on Medicare, get better care than I do and I spend over 16,00 dollars per year on insurance.
I favor nationalized health care.... or at least a single payer system.
An insurance plan is all about spreading the risk. Private companies reduce their risk by disqualifying people that exhibit risk. The people who need health care most are the least able to afford or even get private insurance.
Yet, we all pay for the consequences of a decrepit health care system. We all pay for those emergency room visits by uninsured people.
Or, we can just let people die. We CAN be that uncaring. We do have that capacity.
Michelle
This is not an issue of whether or not we let people die. No one is telling you not to donate to charities that provide help for those that need it. Government control is not the equivalent of caring about people.
The fact we care is why we are having this debate, it is not why we must choose universal health care.