Single Payer: Realistic or Just Politics?

There has been a growing push from the left wing to do a single payer system because of the complexity of implementing the ACA. There are obvious reasons why any Government attempt will be flawed, especially if the Government tries to do anything leading edge. Just look at DoD, it takes dozens of tries before anything gets done. In addition in DoD, just take a destroyer or a Littoral craft, they thrown everything including the kitchen sink into the design. In WW II we could build a destroyer in months, now it takes a decade. Why? Because everyone gets a chance to add and change. The cost is irrelevant.

Now the Princeton Professor has a piece arguing that as a result of the fiasco we should really do a single payer. He states:

Imagine, now, a much simpler system in which the government just pays your major medical expenses. In this hypothetical system you wouldn’t have to shop for insurance, nor would you have to provide lots of personal details. The government would be your insurer, and you’d be covered automatically by virtue of being an American. 

 Now is this the easiest and best way? Well it depends. A little more than four years ago I wrote a piece on how Health Care could be delivered to all using subsidies but via a private mechanism. Just like home, car, life insurance. It works, and often times better than any Government plan. Just look at Flood Insurance, the Government stalls and stalls just due to Government's inherent incompetence.

Now what are the benefits of Private insurance? Simple:

1. It already exists.

2. It is competitive and can be made more so.

3. It allows choice.

4. It is the negotiator for the buyer.

Now when I proposed such a plan I did so making a few changes:

1. The individual was responsible for their own insurance. No company or union paid plans. Also I would not allow a tax deduction. By the way, that is how Medicare works. It is the individual's plan, it is after tax dollars and you still pay even after you retire, often a high amount depending on your income.

2. The plan should really be for catastrophic coverage, not for oil changes. If some one wants a "oil change" plan so be it but they pay. It is not required. The biggest problem with the ACA is its demands for so extensive a coverage plan. For example, take a PSA test, one should not have to have that included but if you want one then you may pay out of pocket. Birth control, and many other life style choices should remain that way, individual choice and payment.

3. Penalties for life style based disease should be present and allowed. Thus for smokers, obese individuals, drug users, etc the prices should reflect the risks they have assumed. The same is true for life and auto insurance. If one has dozens of speeding tickets then the premium should and frankly must reflect the higher personal risk.

I then worked through the financial details. It worked! The Gnome from the South does not present any such plan or details. He suggest we just put it all on the Government tab.

Individual choice and responsibility is a core to our society. If we agglomerate everything to the Government we create a Collapse of the Commons syndrome, no personal choice or responsibility and abuse of the system. Frankly the explosive expansion of Food Stamps is a clear example. Childhood obesity is much more of a problem than starvation. I would argue that the obesity problem is a Collapse of the Commons.

As the Professor concludes:

In saying this I don’t mean to excuse the officials and contractors who made such a mess of health reform’s first month. Nor, on the other side, am I suggesting that health reform should have waited until the political system was ready for single-payer. For now, the priority is to get this kludge working, and once that’s done, America will become a better place. 

In the longer run, however, we have to tackle that ideology. A society committed to the notion that government is always bad will have bad government. And it doesn’t have to be that way. 

 There is no proof that America will be a better place. There is no evidence that a single payer is the better system. One can envision many deleterious "unintended consequences" from a single payer. It is a monopsony, with the Government as the single buyer, and the single arbiter, a rather off-putting thought.

Finally one should remember the two prime  elements of Marxist dogma; centralized control and planning, and Government (in Lenin's view the Party) control over all. Namely for any good Marxist there is a belief in the ultimate a predictable movement of society and the beneficial and necessary need for central planning by the select few. Sound familiar? One should read Asimov, Foundation Trilogy, the Gnome's idol.