Republicans Repudiate Single-Payer Health Care

Yeah but The basic problem with health care is the dire need we all face to begin rationing resources. There’s simply no way to keep going with wildly expensive new life-saving and life-extending devices and expect the entire system to subsidize their development and use.

In my view, the focus on the excess profits and marketing costs in the industry issues the main point. Those phenomena are symptoms of the sick industry, not the cause. They help drive faster-than-inflation cost increases, but they’re not the root cause. The basic cause is our understandable refusal to say “no” to things that can save lives. 

Of course people who can pay for those things – or health plans that can pay for those things, however painful the rise in premiums might be – are the source of major profit, so that drives the dysfunction on the supplier side too.

The only way rationing is ever done rationally is via individuals. Much as I hate it, my employer’s move to an HSA undeniably has an effect of making me think a little more about what I’m spending money on.  Which is part of the point. That in itself doesn’t yet affect the problem I’m talking about, the need to rein in technology and research spending. But it may be a step in the right direction. As people begin to understand the actual economics of health care, there’s hope that pressure will emerge – informed pressure – to reorient spending overall.

By itself, single-payer does nothing to address the technology and research spending issue. It just sets up a bureaucracy to make these decisions, and that never works for long.

More generally, eager proponents of single-payer need to take into account  a simple reality: health care is a huge chunk of our economy. One-third, I’ve read?  Taking the money aspect of it out of the economy – that’s a decision to be made a little carefully.

“misses” the main point Not “issues” the main point. Sheesh.

This puts them opposite of Sen. Coleman on the issue – nt

And yet another clarification What I meant to say toward the end is that single-payer sets up a bureaucracy to make the necessary rationing decisions on the consumer side. And that never works – a central body making decisions on complex industries is what screwed up the Soviet Union. (Its presence also killed development of the middle-man industry, the wholesale industry, the omnipresent industry in the US and any free market which is where all kinds of small resource-allocation decisions end up getting made.)

And that’s actually the hopeful take, to believe rationing decisions on consumer spending are transferred from individuals to a bureaucracy.  Because the immediate reality is that single-payer seems to remove the need for such rationing decisions from each individual’s life; and rarely has there been a middle-class government entitlement program that hasn’t given in to the urge to keep being nice about things.  To keep paying, that is.

And all this while it does nothing inherently to address rationing spending priorities on the supplier side. It arguably institutes a body, a political entity, that could enforce wise spending. But I actually would be surprised if the left would make an argument that government regulation of industry usually promotes the interests of the people

Single Payer as in HR 676 enhances consumer choice It actually increases the choice of providers available to end-users, and would guarantee comprehensive coverage to all. It does this at a savings by removing the inefficient layers of billing, insurance, collections, administrative overhead, and insures that much more of every dollar spent on healthcare is actually spent on health care.

Fewer people in need of health services wil go with out or be delayed because of insurance issues, and that will also reduce costs – people who can treat chronic diseases as needed can avoid catastrophic health expense later – that we usually over as a society, when spend-downs and often bankruptcies are are necessary before people can get existing overwhelming bills paid by MA/medicaid. It will also help preserve the dignity and financial independence (assets in the form of housing/transportation) of many of the terminally ill and elderly that now are relegated to homelessness or hospitalization.

What is so threatening about that?

Your use of the word “threatening” – hints at a mindset that perceives conservatives as either scared or mean.

If you were replying to me, I said nothing about feeling threatened. I just quickly laid out reasons that single-payer may not be a panacea; and may do nothing to deal with and may even exacerbate what I see as the main underlying issues with health care. 

I’m not even sure I oppose single-payer. I just don’t think it’s the slam dunk moral issue that its supporters want to believe.

You’ve described some reasons to consider it. At first glance, I don’t think they do much to address the issues I brought up; from my perspective, your reasons seem to accept as core issues things I perceive as side issues; and your solution – in addressing the side issues – run the risk of making the core issues worse. (Whether you were responding to me or not.)

“corruption tax” It does this at a savings by removing the inefficient layers of billing, insurance, collections, administrative overhead, and insures that much more of every dollar spent on healthcare is actually spent on health care.

Or what I like to call, a corruption tax.

Fact is, single payer systems works all
over the rest of the civilized world.

But I guess we have a few too many Ayn
Rand fanboys for something so sensible to
happen here.

But hey, if you really want to see what
the Invisible Hand can achieve, go to
Iraq.

Think of it- a weak central government, lots
of guns, and competition, as in, all against all.

Obviously, it’s paradise.

The situation in Iraq – used as evidence we need a single-payer health care system?

Congratulations.

But anyway, the blanket statement that single-payer “works” “everywhere” is in need of more detailed challenge than I can muster. 

If the basic purpose is to make sure everyone is covered, you don’t need universal single-payer to do that. It’s a different issue. Universal single-payer would do that, but it’s not all it would do; it’s not even primarily what it would do. 

Primarily, it would cut way back on all the bullshit we all have to deal with now regarding payments and plans and annoying annual decisions, with statistically powerful increases in the levels of bullshit as we all move to HSAs.  Or at least at first single-payer would have that effect, or it sure seems like it. 

My opinion is that as the need to restrict costs keeps bobbing to the surface, the bullshit  would return, but still this is a powerful argument in favor of single-payer. Most people who talk about individual choice and efficiency mean what they say, but they don’t take into account a sad fact: the large majority of individuals hate dealing with hard-core, look-reality-in-the-face financial choices in any context, and especially in this context. They don’t want to deal with it, and tend to ignore it.  I include myself in that rabble.

(The response is that the nation is built on freedom, and freedom isn’t just a right, it’s a responsibility; and does it make sense for the Government, for the Good of the People, to keep making it easier not to face reality? Isn’t facing reality head-on the essence of freedom, used meaningfully? Isn’t that after all the lesson that, say, Harry Callahan leaves us?  These are arguments whose power would have to be acknowledged, except I’m not paying attention because I’m have a whiskey sour and listening to Skynyrd.)

Co-primarily, and incredibly importantly, universal single-payer would de-couple health coverage from specific employment. There’s not a sane person on either side who knows how ridiculous, constrictive, and economy-harming our current state of affairs is in this regard.  I do believe, however, that the conservative approaches also try to deal with this.

Clarification (I’m not really having a whiskey sour and listening to Skynyrd.)

Vague generalities There are many possible ways to discuss the notion that single-payer works everywhere.

But the notion I’m bringing up is what I perceive genuinely concerns conservatives: taking one-third of the economy and turning it into another gigantic entitlement program, the biggest of all. One effect of which would be, to cement in place the fantasy that there are no actual serious limitations and problems to deal with in health care.  Or if there are, don’t worry, “we’ll take care of it.” 

It’s a basic precept that when you have a guaranteed pool of money to pay for things in health care, the things will be done and the money will be spent. 

The “entitlement’ issue also relates to the argument that singe-payer works everywhere. In Europe, the entitlement mentality has had – as genuinely seen by conservatives – a ravaging effect in many places. Remember the striking French students earlier this year, enraged at the new “conservative” government’s feeble attempt to legalize the firing of young workers? 

And it relates to issues like assimilation of immigrants. What’s better -  rings of suburbs housing newly-arrived immigrants with no need to worry too much about maintaining body and soul and health care and with plenty of time to nurture resentment at the lack of opportunities (teh presence of a lot of un-fireable young po-mo French people does have its downside); or newly-arrived immigrants working their asses off and establishing themselves and in the process meeting other people of all kinds?

Yeah but The basic problem with health care is the dire need we all face to begin rationing resources. There's simply no way to keep going with wildly expensive new life-saving and life-extending devices and expect the entire system to subsidize their development and use.

In my view, the focus on the excess profits and marketing costs in the industry issues the main point. Those phenomena are symptoms of the sick industry, not the cause. They help drive faster-than-inflation cost increases, but they're not the root cause. The basic cause is our understandable refusal to say “no” to things that can save lives. 

Of course people who can pay for those things – or health plans that can pay for those things, however painful the rise in premiums might be – are the source of major profit, so that drives the dysfunction on the supplier side too.

The only way rationing is ever done rationally is via individuals. Much as I hate it, my employer's move to an HSA undeniably has an effect of making me think a little more about what I'm spending money on.  Which is part of the point. That in itself doesn't yet affect the problem I'm talking about, the need to rein in technology and research spending. But it may be a step in the right direction. As people begin to understand the actual economics of health care, there's hope that pressure will emerge – informed pressure – to reorient spending overall.

By itself, single-payer does nothing to address the technology and research spending issue. It just sets up a bureaucracy to make these decisions, and that never works for long.

More generally, eager proponents of single-payer need to take into account  a simple reality: health care is a huge chunk of our economy. One-third, I've read?  Taking the money aspect of it out of the economy – that's a decision to be made a little carefully.

“misses” the main point Not “issues” the main point. Sheesh.

This puts them opposite of Sen. Coleman on the issue – nt

And yet another clarification What I meant to say toward the end is that single-payer sets up a bureaucracy to make the necessary rationing decisions on the consumer side. And that never works – a central body making decisions on complex industries is what screwed up the Soviet Union. (Its presence also killed development of the middle-man industry, the wholesale industry, the omnipresent industry in the US and any free market which is where all kinds of small resource-allocation decisions end up getting made.)

And that's actually the hopeful take, to believe rationing decisions on consumer spending are transferred from individuals to a bureaucracy.  Because the immediate reality is that single-payer seems to remove the need for such rationing decisions from each individual's life; and rarely has there been a middle-class government entitlement program that hasn't given in to the urge to keep being nice about things.  To keep paying, that is.

And all this while it does nothing inherently to address rationing spending priorities on the supplier side. It arguably institutes a body, a political entity, that could enforce wise spending. But I actually would be surprised if the left would make an argument that government regulation of industry usually promotes the interests of the people

Single Payer as in HR 676 enhances consumer choice It actually increases the choice of providers available to end-users, and would guarantee comprehensive coverage to all. It does this at a savings by removing the inefficient layers of billing, insurance, collections, administrative overhead, and insures that much more of every dollar spent on healthcare is actually spent on health care.

Fewer people in need of health services wil go with out or be delayed because of insurance issues, and that will also reduce costs – people who can treat chronic diseases as needed can avoid catastrophic health expense later – that we usually over as a society, when spend-downs and often bankruptcies are are necessary before people can get existing overwhelming bills paid by MA/medicaid. It will also help preserve the dignity and financial independence (assets in the form of housing/transportation) of many of the terminally ill and elderly that now are relegated to homelessness or hospitalization.

What is so threatening about that?

Your use of the word “threatening” – hints at a mindset that perceives conservatives as either scared or mean.

If you were replying to me, I said nothing about feeling threatened. I just quickly laid out reasons that single-payer may not be a panacea; and may do nothing to deal with and may even exacerbate what I see as the main underlying issues with health care. 

I'm not even sure I oppose single-payer. I just don't think it's the slam dunk moral issue that its supporters want to believe.

You've described some reasons to consider it. At first glance, I don't think they do much to address the issues I brought up; from my perspective, your reasons seem to accept as core issues things I perceive as side issues; and your solution – in addressing the side issues – run the risk of making the core issues worse. (Whether you were responding to me or not.)

“corruption tax” It does this at a savings by removing the inefficient layers of billing, insurance, collections, administrative overhead, and insures that much more of every dollar spent on healthcare is actually spent on health care.

Or what I like to call, a corruption tax.

Fact is, single payer systems works all

over the rest of the civilized world.

But I guess we have a few too many Ayn

Rand fanboys for something so sensible to

happen here.

But hey, if you really want to see what

the Invisible Hand can achieve, go to

Iraq.

Think of it- a weak central government, lots

of guns, and competition, as in, all against all.

Obviously, it's paradise.

The situation in Iraq – used as evidence we need a single-payer health care system?

Congratulations.

But anyway, the blanket statement that single-payer “works” “everywhere” is in need of more detailed challenge than I can muster. 

If the basic purpose is to make sure everyone is covered, you don't need universal single-payer to do that. It's a different issue. Universal single-payer would do that, but it's not all it would do; it's not even primarily what it would do. 

Primarily, it would cut way back on all the bullshit we all have to deal with now regarding payments and plans and annoying annual decisions, with statistically powerful increases in the levels of bullshit as we all move to HSAs.  Or at least at first single-payer would have that effect, or it sure seems like it. 

My opinion is that as the need to restrict costs keeps bobbing to the surface, the bullshit  would return, but still this is a powerful argument in favor of single-payer. Most people who talk about individual choice and efficiency mean what they say, but they don't take into account a sad fact: the large majority of individuals hate dealing with hard-core, look-reality-in-the-face financial choices in any context, and especially in this context. They don't want to deal with it, and tend to ignore it.  I include myself in that rabble.

(The response is that the nation is built on freedom, and freedom isn't just a right, it's a responsibility; and does it make sense for the Government, for the Good of the People, to keep making it easier not to face reality? Isn't facing reality head-on the essence of freedom, used meaningfully? Isn't that after all the lesson that, say, Harry Callahan leaves us?  These are arguments whose power would have to be acknowledged, except I'm not paying attention because I'm have a whiskey sour and listening to Skynyrd.)

Co-primarily, and incredibly importantly, universal single-payer would de-couple health coverage from specific employment. There's not a sane person on either side who knows how ridiculous, constrictive, and economy-harming our current state of affairs is in this regard.  I do believe, however, that the conservative approaches also try to deal with this.

Clarification (I'm not really having a whiskey sour and listening to Skynyrd.)

Vague generalities There are many possible ways to discuss the notion that single-payer works everywhere.

But the notion I'm bringing up is what I perceive genuinely concerns conservatives: taking one-third of the economy and turning it into another gigantic entitlement program, the biggest of all. One effect of which would be, to cement in place the fantasy that there are no actual serious limitations and problems to deal with in health care.  Or if there are, don't worry, “we'll take care of it.” 

It's a basic precept that when you have a guaranteed pool of money to pay for things in health care, the things will be done and the money will be spent. 

The “entitlement' issue also relates to the argument that singe-payer works everywhere. In Europe, the entitlement mentality has had – as genuinely seen by conservatives – a ravaging effect in many places. Remember the striking French students earlier this year, enraged at the new “conservative” government's feeble attempt to legalize the firing of young workers? 

And it relates to issues like assimilation of immigrants. What's better -  rings of suburbs housing newly-arrived immigrants with no need to worry too much about maintaining body and soul and health care and with plenty of time to nurture resentment at the lack of opportunities (teh presence of a lot of un-fireable young po-mo French people does have its downside); or newly-arrived immigrants working their asses off and establishing themselves and in the process meeting other people of all kinds?