Third Party & Independents Archives

Sanders, Clinton and the Single-Payer Debate

While Hillary and Bernie in the Dems debate tried to push each other off the healthcare pedastal and raise their respective banners with shirt sleeves rolled up like a socialist realism sculpture, the fact is there is no utopia when it comes to health care. Only uncomfortable choices: economically and politically

And yes, Hillary was a little more pragmatic - keep what we've got - and Bernie a lot more self-righteous. But the point of what is doable and what it would cost, came home to roost on the debate stage with a question on Vermont's failed universal health insurance system. Even with the particularities of the northern state's electorate, it was seen as too costly and requiring of an enormous tax increase to fund it. And that's in Vermont. Never mind across the diversity of America.

Then there's the administrative/actuarial question: are doctors better at assessing patient risk and better at achieving cost efficiencies than insurers? The obvious answer of no, needs to be leavened with a reflection on how much the insurance industry itself costs America in their role of efficiency seekers. And that leaves one knee-deep in a debate on administrative systems and incentives, and how much those incentives themselves cost.

Maybe there should be no overriding national solution, bowing instead to individual state solutions. But that leaves progressive advocates screaming about discrepancies between the accessibility and quality of care across different states. And as soon as you legislate a right, it becomes the purvey of lawyers rather than doctors or insurance actuaries. At least in America.

One does not have to see The Barbarian Invasions - a dark comedy by a Quebec filmmaker that has Quebec's notorious health care system as it's background scenery - to know that a Canadian system would mean dramatic changes for most Americans, and not of the best kind. You don't have to live in Germany or France to know that adopting their systems would mean an enormous regulatory (include union-based) burden on American business.. And you do not have to live in Liverpool like George Harrison, to know what the rationing of services in an English (or UK) system implies about the quality of care you would receive.

Should Bernie Sanders win the Democratic nomination - not at all impossible if fairly unlikely - his plans will almost certainly have to be modified if he has any hope of being elected. And in the absurd likelihood that America elects the Vermont Senator as the next president, those plans will never make it out of Congress.

But the single-payer debate will plod on and act as one factor among many in determining how America - or each of it's individual states - deals with the challenges of providing reasonable healthcare at a sustainable cost to its citizens.

Posted by AllardK at January 19, 2016 9:56 PM
Comment #402093

The single payer debate was framed back in the 60’s with Medicare and Medicaid. It was always envisioned by the Progressives that we would have single payer and it wasn’t hard to predict, based on the demographics of the baby boom, that with these two programs on the books we would eventually end up with a national single payer system. That’s why in posts on this site from the 2008-09 time frame you can see I advocated we just debate single payer instead of Obamacare…

In 2014 we are at:

49% employer (and going down)
34% government (and going up)
16% other or uninsured

Honestly having the federal government choose my insurer is about as bad or as good as having my employer. And in a few years I’m going to go Medicare anyway. I just we the Progressives would let us “touch” Medicare and Medicaid and make them what they really should be: safety nets. But the argument on single payer was lost back when I was a snot nosed kid…

Posted by: George in SC at January 20, 2016 1:20 PM
Comment #402204

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