The Single Payer Plan to Save Healthcare in the US

What I do not see on AB is Bernie’s Plan. Take a moment and read what his plan is before you comment. If you read the plan, you will see Bernie subsidizes the expansion of single payer based on taxes on all households, separate taxes on the rich in income and also capital, the elimination of tax subsidies to healthcare companies, taxes on inheritance, the elimination of the income subsidy to people for ESI (this is also a tax break for companies), etc. Other than a few sentences on the issue, Bernie does not address ho he is going to control rising healthcare costs (other than eliminate healthcare insurance which is not the cost driver). He does not address it in his “How Much Will It Cost and How Do We Pay For It?.”

Ezra Klein comments on the reality of Bernie’s plan “individuals will have to fight with the government rather than private insurers when their claims are denied”. Ezra adds;

“But the implication to most people, I think, is that claim denials will be a thing of the past — a statement that belies the fights patients have every day with public insurers like Medicare and Medicaid, to say nothing of the fights that go on in the Canadian, German, or British health-care systems.

What makes that so irresponsible is that it stands in flagrant contradiction to the way single-payer plans actually work — and the way Sanders’s plan will have to work if its numbers are going to add up.”

Bernie tells you how much healthcare costs today, how much it will cost in the future, and what the price tag will be in taxes, etc. Bernie superficially glances at what also needs to be done in one paragraph of a couple of sentences and never really touches upon the real issue of rising healthcare costs. The progressives and the liberals skewered Pres Obama for giving in to healthcare companies, insurance companies, and having them participate in writing the PPACA, etc. Insurance companies are more efficient in writing plans as they have the experience and what was the issue was Congress.

Yet, here we see Bernie giving in to the same issues and sidestepping one important one. We will benefit from single payer, there will be savings and efficiencies galore, more people will be covered and everything will be “almost rosy.” The one thing Bernie does not say and exists in every other single payer plan is; “those promises can only come true if the government starts saying no quite a lot — in ways that will make people very, very angry.”

Something I have said time and time again as I have written about the PPACA and defended it is the savings must come through cutting healthcare costs by attacking the industry increases. Healthcare insurance is a reflection of the increases and are passed through. Just saying “single payer” as many people think does not lower costs and Bernie sidesteps it. Ezra Klein goes on; “The real way single-payer systems save money isn’t through cutting administrative costs. It’s through cutting reimbursements to doctors, hospitals, drug companies, and device companies.” Ezra is right when he says Bernie “gestures towards this truth;” but, the gesture is hidden away in two sentences and not given the emphasis it deserves under “How Much Will It Cost and How Do We Pay For It?.”

Another expert I have talked to for years and has presented these issues too, said this:

“Reform is a process and not an event–and the process is happening.By about 2020 I think we will see results that will begin to make you & I (not to mention folks like Elliot Fisher, Don Berwick, Diane Meier, etc. happy).

Medicare is beginning to negotiate better pricing (paying hospitals and docs for value, to volume) and in 2-3 years it will refuse to pay for many overpriced drugs. (This will make many Americans angry. They think they should have any drug that they think they need–or that their doctor tells them they need (even though their doc hasn’t read any medical research in 15 years) and that the rest of us should pay for it. . But eventually, people will adjust.

As for Single Payer parrots–just ignore them. They are clueless, can’t face numbers or facts, and think that there is a simple solution to our tremendously complex healthcare problems. They also know little about history or what is happening (and has happened) in other countries. They live in their own little world. If I sound exasperated, I am. Bernie Sanders, in particular, represents soft-headed liberalism at its worst.”

There is truth to the preceding statement and Ezra Klein’s, both of whom know each other and say pretty much the same on single payer. Just saying “single payer” is not a cure-all for everything which ails us politically and medically. There are going to be times when a government run Single Payer will not pay for some operation or medicine due to it being unproven, a low success rate, etc. and simply cost. True Single Payer, the type many of us will not want, will say no to doctors, hospitals,and the healthcare industry. Single payer will provide the the type of healthcare needed by most of the country with few exceptions; but, you will find yourself in the same discussions with the program as you did with your insurance company.

I found this article by Matt Bruenig over in the links at Naked Capitalism, “How To Use Single Payer Healthcare As Trojan Horse For A Good Welfare State.” Step past the title and read what he has to say about taxation and cutting costs.

“Under this scenario, we would initially raise the tax level by 8.5 points in order to cover the half of health expenditures that are currently paid out privately. Then, over time, we would cut healthcare expenditures by 7 points (from 17% to 10% of GDP). Assuming we didn’t lower the tax level over the expenditure-slimming period, we would be able to use those 7 points of savings towards other welfare programs (child care, child allowance, paid leave, etc.). And there is a lot of stuff you can get with 7 points of GDP.”

It is a sensible argument; but, I doubt our Congress would go forward with the 2nd and 3rd sentence. I am sure these funds would end up in the GF and used to fund tax breaks. Isn’t this where we started out, a Congress which is not responsive to what its constituents really need?