Why Single-Payer Health Care in the US?


At last. An article which comes close to explaining what single-payer is and what are its possible advantages.

I’m not going to set out the entire article in my post. You can read it. But I will spell out my preference: hybrid. Facilities provided privately. You pay for private health insurance, if you or your employer can afford it. Otherwise, the federal government, in some form, subsidizes the paying of either your medical bills direct or your health insurance.

Before I get to why that is my preference, a few caveats about the article itself. The British NHS, lauded by the author of the article, Paul Waldman, as the closest thing to a single-payer system in practice, is not in fact working.

Every single health care system in the Wester Hemisphere is beset by the same problem: funding. And that occurs because of the aging populations in the Western Hemisphere. Coupled with a decreasing tax base (which, by the by, is why there are so many advocates in said WH for any kind of immigration).

Now, I know there are those who will say that, especially in the case of the British NHS, the funding problem is the fact that those holding the reins of national power in the UK (the British Conservative Party) are tight-fisted, uncaring neanderthals.

Actually, a recent and respected poll found that some 63% of the people who use the NHS are satisfied with it. Plus, barely seven years ago, there was a substantial majority of those going to the polls who agreed that the British government spending deficit was way out of control. It is still out of control.

I don’t bemoan the hypocrisy of electorates. It’s a given in a democracy. You take the medicine for so long. And then you want the sugar again. I just point it out.

Plus, if there was an overwhelming majority of the British electorate actually in favor of throwing caution to the wind, and flooding the NHS with taxpayer pounds. Without care or consideration for the consequences to their individual tax bills. Then, with respect, the British Labour Party, which was pretty much offering that, would have won the recent UK General Election. As opposed to coming second.

This is one of the primary factors in my mind when considering a solution to funding problems in any health care system. It ain’t just about doing sexy things with the pubic dollar/pound/franc/whatever. It is also about taking into account whether or not those earning and holding the tax money want to hand it over. Clearly, in the UK, a majority decided they did not.

All of the national election results in the past twenty or so years in the US suggest much the same. It’s all very well Paul jumping up and down with glee, stating that single-payer is going to become the norm for national Democratic candidates going forward. An essential litmus test. It matters not a doctor’s rusty stethoscope, let alone a tinker’s cuss, if Democrats fall in love with single-payer, if the voters we need come election time are still not convinced. And there is no evidence that there is anything like a groundswell among the general US electorate for single-payer.

However, it is becoming clear that there is a general horror at the suggestion that 20+ million Americans will lose health care insurance under any of the schemes being proposed by the Republicans. At the end of the day, that will be Obama’s primary legacy. The fact that he swung the pendulum enough that there is now a consensus among the US electorate for some form of government subsidy for some health care funding.

So. We work with that. And also with the fact that many of those swing voters Democrats need to pick up are not overwhelmingly taken with the notion of a rise in taxes. And we come up with a hybrid.

Government has no business being in business. That is my personal view. I accept that. But I say that the provision of almost all services falls within the category of business. And, after some forty-five years of politically knocking on doors, I have yet to be convinced that there is any service that can be provided (‘publicly’ or privately) more efficiently than by properly-monitored private contractors. Moreover, it has been my experience that such provision reduces the burden on the public purse.

I actually made a speech to the British Conservative national conference, in about 1985, in which I said that, in order to make room within national public expenditure for more important priorities, we should abandon the concept, in effect in the UK since the Second World War, that everyone should be entitled to certain ‘public’ services, regardless of their means (pic attached).

I said, and still say, that, pretty much with all public services, if you can afford to pay, you should pay. I was met with rapturous applause. Not least because the gathered dairy farmers and blue rinses were too dumb to work out that I was telling them they would have to sell the second Jaguar.

Like I say, I still take that view. So, as much as I may be excoriated for saying so, we keep private health insurance. And make public finds available only on the basis of a means test.

As for pre-existing conditions, I’m not clever enough to come up with solutions as to how to make that work. I can only offer my general viewpoint. Which is that, in my opinion, every single individual living in the US is entitled to the health care they need to stay alive and be reasonably healthy. Provision should never be governed by means. If you can pay, you do. If you can’t, the government pays the bills. Um. Period.

What that does to insurance premium policy I leave to others more clever than me to work out. Bearing in mind that, if you have an individual who must pay for health care privately, and you make his or her insurance premiums too expensive, you are in breach of my generalized position.

Right. That’s it for me on US health care provision today. I say again. Paul, dance in the streets all you like about single-payer. If it becomes the norm for national Democratic candidates going forward, when the great US electorate are not prepared to foot the bill, you and others are likely consigning the Democrats to many more years in the political dustbin. In my humble opinion …

(Facebook comments here.)

Published in: on July 9, 2017 at 8:30 pm  Leave a Comment  

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