Third Party & Independents Archives

A Conservative Argument for Single-Payer Healthcare?

Might a conservative argument exist in favor of a single-payer health insurance system? Yes, it’s a stretch, but our system is clearly failing many businesses and individuals, and taking such a sweeping reform off the table leaves us merely tweaking around the edges. The result is an ever more costly and complex problem that will only worsen as our population ages.

A single-payer system might be the greatest boondoggle in the storied history of government boondoggle-ry, but the issue is too critical to too many not to consider every option.

So why might conservatives support a single payer system? For one, health costs are crippling our global competitiveness. Domestic automakers spend more on health insurance than they do for steel. Disputes over coverage have led to costly strikes and work stoppages in numerous industries. The cost of caring for the uninsured is built into health care prices, which are passed on to business in the form of higher premiums.

The problem is even worse for small business, the conservatives’ darling of economic growth. With limited ability to pool risk – and insurance companies cherry-picking low risk firms away from groups when small businesses do unite to form larger risk pools – a single unhealthy employee or family member can drive premiums up by tens of thousands of dollars (My premiums once increased $24,000/year thanks to the condition of one employee’s spouse). Furthermore, the fear of going without health insurance is one of the risks that prevent people from pursuing businesses of their own, driving yet another stake through America’s entrepreneurial heart.

One reason conservatives rightfully endorse free markets is that they are extremely adept at wringing out bureaucracy and inefficiency. But our current system does neither. Instead, it adds redundant sales and underwriting overhead, confusing billing practices that increase administrative costs for doctors and hospitals, and absorbs a not insignificant portion of our health care dollars in profits and executive salaries. Not that those are bad things, but when health care dollars are at a premium, we should be looking to maximize our bang for the buck – an elementary conservative tenet.

Philosophically, even limited government advocates such as yours truly would agree that some needs are so vital that a degree of government inefficiency is tolerable in exchange for universal availability. Highways, schools and mail service come to mind. Granted, none of these are perfect, but if left to free enterprise, we’d surely see large gaps in service, much like we see today with health insurance.

Finally, no one is safe from the expense of unforeseen medical bills. A 2005 Harvard University study showed that half of all bankruptcies were due to medical bills, though three of four filers had health insurance. We’re all at risk.

This is not a liberal or conservative issue, but a human one. I’d be the first to argue that health care is not a right, but I’m far less prepared to argue it’s not a responsibility – one that we owe to ourselves and each other. Let’s not dismiss any solution.

Coming up: A liberal argument for privatized Social Security.

Posted by Paul Szydlowski at June 26, 2008 12:53 PM
Comments
Comment #256841

The problem is that our ‘duopoly’ of government control means that only two options will be examined. One by one side and one by the other. As a result, for partisan reasons, there will be a drive to one option or the other and all other options are effectively off the table.

If there were three major parties, or even more voice given to other views, we might find that better solutions are out there and waiting in the wings. But until that occurs, we are unfortunately left with two bad options, both of them ignoring personal liberty or solving the problem at all.

Posted by: Rhinehold at June 26, 2008 1:46 PM
Comment #256842

BTW, our current healthcare system is not a free market. That is one of the misnomers that gets made during these duopolistic arguments. It becomes ‘free market’ vs ‘socialism’ when neither one are in use or being offered.

And it is really sad, because we are the ones who suffer, not the politicians.

Posted by: Rhinehold at June 26, 2008 1:47 PM
Comment #256843

Paul,

Nice article. I once believed that single-payer was a very bad idea, but I have come around to it for exactly the reasons that you have outlined in your article above. The major question will be how do we implement?

I hope that those who are finally charged with it will use pragmatism as the watchword rather than try to use it as a chance to correct every perceived evil in the current system. First and foremost, I hope that the implementation will focus first on the paying and second (if it all) on the provision of health care.

Posted by: Rob at June 26, 2008 1:49 PM
Comment #256848

A single payer system can work, and it can be better, but only if it is managed better than the federal government currently manages Social Security and Medicare.
Otherwise, it will become another behemoth anvil hanging around our neck as we try to swim upstream.
In fact, it could be the last straw, with so much massive debt, massive future liabilities, corruption, and incompetence within the federal government and do-nothing Congress.
Never under-estimate the Congress’ ability to screw up the most simple of endeavors, much less a new vast and complex health care system.

Besides, it is quite possible what ails the health care system is really what ails many of our systems and our society.
It is possible that a new health care system will also fail, unless this nation first addresses these 10+ abuses and the 17+ economic consequences which have never been worse ever and/or since the 1930s and 1940s.

In each of those abuses, what is the core problem?
ANSWER: Corruption

  • Responsibility = Power + Conscience + Education + Transparency + Accountability
  • Corruption = Power - Conscience - Education - Transparency - Accountability

How do we reduce the corruption?

The point is, the health care system may be another barometer-like measurement of our society?
It could be telling us something about our society as a whole; about something that ails many of our systems.
What ever systems we design, they will fail and grow corrupt and dysfunctional without sufficient Education, Transparency, and Accountability.
As simple as that sounds, it is often absent, because the constant vigilance and diligence to preserve it is absent too.
Voters must learn that systems (organizations, governments, societies, etc.) require constant and vigilant monitoring; otherwise, they will grow corrupt and fail.

Thus, the root problem may not be so much the health care system alone, but a widespread problem of rampant corruption, lawlessness, usury, greed, plutocracy, cheating, institutionalized cheating in the way of regressive taxation, wars based on false intelligence, inadequate education to keep the electorate ignorant, massive debt, and essentially, wide-spread fiscal and moral bankruptcy?

Health Care Solutions…

Posted by: d.a.n at June 26, 2008 3:16 PM
Comment #256868

Paul,

As a response to Rhinehold’s post in another thread, I think there is strong economic argument for a single payer system. A universal health care system not tied to employers, will free up resources for many employers to more effectively compete in a world where we are the last bastion of corporate health care.

If we also begin to look at social security means testing, and perhaps extend retirement age, we can begin to deal with a significant portion of the US deficit problem.

Posted by: googlumpugus at June 26, 2008 8:14 PM
Comment #256876

I am not so sure I am convinced by a conservative/liberal argument.

The American model has always been free market to a point when it infringes on human rights. We had slavery and child labor for a while, and then society decided that “free markets” needed to be limited.

The recent rapid increase in medical costs has widened to haves and have nots to the point that our American system of free markets is in jeopardy. They need to be reformed.

There is a strong case for this in history. After the great stock market crash of the 1930’s was a time when the American system was reformed with some great legislation. This required margin requirements as well as full disclosure etc of securities. In the end free enterprised was reformed and flourised.

Our task now is to reform the system carefully so that all Americans have access to quality medical care, and that we do not give up our edge in innovation.

I am for a two tiered approach. I think we need to provide free basic medical care to all citizens that is much like the rest of the industrial world.

In addition we need to allow for those with means pay into insurance policies that give them medical attention on demand. I believe in helping the poor, I just do not believe in holdning back the affluent. A two pronged approach can accomplish this.

I wonder is such an approach might be cheaper in the long run than our current approach.

Posted by: Craig Holmes at June 26, 2008 11:45 PM
Comment #256894

What most of the conservatives miss in this whole thing is
You are already paying for the “uninsured” — however because you insist on not providing coverage for regular health care, not only do you (and I) get to pay the bills for the uninsured, but we get to pay for the MOST EXPENSIVE form of health care, and do it in the MOST EXPENSIVE way.
My wife works in a hospital, and believe me the uninsured get treatment, however
it is usually supplied thru the emergency room and extended stays in the hospital.
Emergency room because they cannot go to regular clinics, and cannot be denied at Emergency Rooms — and (and this leads to the second point) because they do not get regular health care, they usually do not go to get help until their condition is so bad that it requires extended hospital stays.
Great
So continue to insist on your “Free Market” and “no free-loaders” so that we can continue to absorb the costs of being FORCED to provide THE MOST EXPENSIVE HEALTHCARE IN THE MOST EXPENSIVE MANNER to those unable to pay for insurance, nor their own healthcare.

You just shot your self in the foot, and you still say
Yea, that sure shows THEM!!!

So, beyond the “fiscal” arguements that support “big business” and the entrepeneur (global competitiveness, profits, etc)
let’s get real with what really goes on, expose the fact that we are already paying for everyone’s health care get our heads out of our hind ends admit reality and apply some common sense to the whole thing.
The other thing that gets me is that under the “free enterprize system” the insurance companies are a big part of the problem in driving up health care (and health care insurance costs) and yet Conservatives STILL have the gaul to worry about how a government system might not be efficient!!!!
Have you seen how the insurance companies handle it??? if that is efficient in ANY manner — I will eat my hat.

Posted by: Russ at June 27, 2008 8:44 AM
Comment #256899

Russ,

You make the mistake of assuming that the uninsured, once insured, will change their behavior and plan ahead, going to a family care physician ahead of time instead of waiting until they need emergency care.

That doesn’t make sense to me, if someone who is uninsured were that forward thinking, wouldn’t they already have health insurance?

Right now we are in the untenable position of being responsible for other people’s irresponsibility through law (force). Moving to a universal insurance position will not change that flaw.

Posted by: Rhinehold at June 27, 2008 9:12 AM
Comment #256900

BTW, yes, the insurance companies are horrible. That is what happens when you create required monopolies like the health insurance business is now.

Try opting out of your company offered healthcare plan and getting one on your own. The first question any insurance company will ask is ‘Are you offered healthcare at your work?’ If you say yes, they, by law, cannot give it to you. There is no competition, no recourse if an insurance company behaves badly. You end up paying higher premiums for people in your ‘group’ that are higher risks instead of being rewarded for your responsibility in taking care of yourself and keeping your need for healthcare to a minimum.

How is that going to change when the pool is even larger and you don’t even have the option of going to a different company to attempt to get better healthcare?

I agree that the current system is horribly broken, but why do we think the best fix is to take all of the things that are broken with the current system and not only keep them but expand upon them?

Posted by: Rhinehold at June 27, 2008 9:16 AM
Comment #256904
Craig Holmes wrote: In addition we need to allow for those with means pay into insurance policies that give them medical attention on demand. I believe in helping the poor, I just do not believe in holdning back the affluent. A two pronged approach can accomplish this.
I agree completely. There’s no reason why some medical providers can’t provide their services to those wanting it now and willing to pay more. Obviously, this will apply (in most cases) to elective cosmetic surgeries and medical services.

Choice must be preserved too.

Some will argue that is unfair, and the wealthy will receive better health care. So? Is that a punishable offense? Are some people so envious and jealous that they can’t stand anyone to have more than them? If so, then why stop at medical care? We might as well limit people to the numbers and size of their home(s), car(s), amount of property, perhaps limits on income, etc.?

We should be careful that we don’t allow jealousy and envy disguised as claims of equality and fairness to control our choices, governments, organizations, and society. Otherwise, our government is actually what?

At any rate, the voters have the government that the voters elect (and deserve).

Posted by: d.a.n at June 27, 2008 10:43 AM
Comment #256908

Rhinehold,
I don’t know where you live but 2 years ago I did opt out of my employer sponsered health insurance and purchased my own. So here in the state of Oregon that statement is FALSE, so if you don’t like the laws of the state you live in why don’t you move somewhere that is more to your liking. And as for not seeing a docotor without insurance, I was in that situation and waited 2 months until my employer sponsered health insurance kicked in to see a doctor. I had a colapsed lung, I could have died because I wasn’t going to pay $100+ to see a doctor and didn’t believe the condition I had was life threatening.
Life isn’t black and white, as far as the ER goes, their are some hospitals makeing their ER/Urgent care a single check-in where ER cases are handled as ER and non-emergence are handled as Urgent care. Saving the consumer thousands, the hospital thousands and reducing the wait time to less than 2 hours.

Posted by: timesend at June 27, 2008 12:12 PM
Comment #256914

“the fear of going without health insurance is one of the risks that prevent people from pursuing businesses of their own”

A factual statement. A divorce settlement can also make a person legally liable for the health insurance of family members, with ensuing complications relative to changes in employment.

Posted by: ohrealy at June 27, 2008 12:44 PM
Comment #256932

And the problem is that instead of having a choice to have health insurance or not, because of financial constraints, they will be forced to pay for health insurance against their will.

That’s the way of our government…

Posted by: Rhinehold at June 27, 2008 3:12 PM
Comment #256950

Dan:

I lost a two dear friends in the Canada system. When it came time for the end, one of them, the hospital just said, they were dismissing her to go home. The family did not have the “choice” of what extreme to go to to preserve here life as here in America.

For a basic level of medicine, I think that if fine. When the taxpayer is paying the bill, society as a whole should be able to set those limits of care. Actually society needs to set those limits.

In a private pay level of the system, obviously the insurance contract would specify.

I am fine with such a two tiered system. With my friends death, I didn’t feel they were inhumain. It was just very clear about who was in charge.

Speaking as a capitalist, in our system, we give that choice to those who do not pay. If a person is dying and has no insurance, we pay those large bills. I think a government run hospital system for the uninsured allows for human treatment and rationing. It allows us to put limits on care.

I am not in favor of forcing all into one system however. The affluent should be able to have whatever coverage they can afford.

Posted by: Craig Holmes at June 27, 2008 5:59 PM
Comment #256952

Dan:

I also think we should use our tax system to our advantage. We should hook up nutritionists with actuaries to find out the cost to society in deferred medical costs for each candy bar, soft drink and hamberger. We should start taxing these items, not as a “sin tax” but as and actuarily sound way of predicting future medical costs.

There should be a big difference in cost between going to McDonalds and getting a cheeze burger with bacon, and going to Subway and getting a low fat sandwich. The reason this is just is because it is factually provable that there is a cost to society for each hamburger we eat.

Making medical cost visable through a national tax should change behavior and lower medical costs in the future. It shoud make us live longer as well. It should bring down that debt you talking about in several different ways. Actually in the same way we are all driving fewer miles today.

Posted by: Craig Holmes at June 27, 2008 6:06 PM
Comment #256962

The only thing wrong with McDonald’s is that some people eat there too often. I eat there about once every other week, and if you get the grilled chicken wrap, it’s not unhealthy. I used to have lunch at Subway almost every day, but the one closest to me closed. Subway is cheaper than McDonald’s here. Now we have Cheeseburger in Paradise, or the ironically named Potbelly. Getting up off your ass is the best health care you can provide yourself, I say while sitting with a laptop.

Posted by: ohrealy at June 27, 2008 7:11 PM
Comment #257025

Craig, Regarding your friends in Canada, was cost and affordability the issue with the Canadian system … the reason for not pursuing more treatments?

I agree with your ideas about access to health care (with more choices) and health care solutions. In fact, I can’t fathom living in a country that would prohibit medical providers from providing medical services to patients willing to pay for them. That would seem to go against so many of our most basic philosophies.

I’m not so sure about taxing McDonalds burgers and fries. As ohrealy pointed out, McDonalds is already more expensive. Also, I’m not keen on sales taxes, or taxing to modify behavior. McDonalds is already taxed (sales tax) and we already have far too many taxes already; so many it’s getting quite ridiculous.

Posted by: d.a.n at June 28, 2008 6:06 PM
Comment #257094

Rhinehold,

I see we agree there is a problem, and laws like the one you noted are a part of it. The only true competition in insurance is for risk pools. This is accomplished through cost shifting primarily. The uninsured (who don’t buy it because they cannot afford it, not because of a lack of foresight) and sick people are shifted to medicare and medicaid. This is the really stupid part of America’s healthcare system. Everyone needs to be in the same risk pool. This will stop this government subsidized freebie for insurance monopolies, and make it no longer a game that is profitable. Insurance has flip flopped on it’s original design. It no longer evaluates risk and gambles on a fair return. It removes risk through cost shifting.

Pools make sense in House or car insurance, although driving isn’t much better.

In evaluating House or Business risk, one can fairly evaluate risk. However, the game here is legal technicality, as we’ve seen in how Insurance molds pay out in disaster zones.

The problem with Auto liability is that recklessness is not really evaluated. This should be a licensing issue, not an insurance issue. The use of police to enforce civil insurance laws is problematic for me. The argument that enforcement of liability laws reduce cost is not born out by reality.

The broad brushes that are used to assess risk make little sense. Speeding tickets do not categorize risk. Zip codes do not evaluate risk, except in the broadest sense. The slight variations in these risk pools, are an excuse to discount more profitable insurance pools. In other words, by over charging for liability they can discount collision and other policies. It’s a regressively punitive tax enforced by law. They use law to maximize profit.

If insurance were truly competitive and a free market, I think we’d be better off. Of course, then we’d have many more of the fraud issues of companies unable to pay claims.

I personally think insurance should be a community cooperative. A private, for profit model could work, but the means of profit should be clear and transparent. The complexity of arbitrage and hedging make this difficult. Use of pooling as a cost shifting device should not be allowed.

Posted by: googlumpugus at June 29, 2008 3:31 PM
Comment #257097

Craig,

Actuary relationships can often be false. The notion that eating fat raises bad cholesterol is not certain, and may be wrong.

The Pritikin diet is based on eating protein to avoid the common metabolic syndrome. Business Week, a while back, had a great article on the questionable efficacy of anti cholesterol drugs. We don’t have dietary science down pat. Taxing based on myths and coincidental links is a bad idea.

I believe overeating and under exercise is the biggest problem in America, not the specific diet. Are we going to make a fat tax? Are we going to allot portions? Are we going to implant caloric meters in everyone to assure they burn off what they eat?

Sounds like a nightmare to me.

Posted by: googlumpugus at June 29, 2008 3:42 PM
Post a comment