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the price of healthcare
Healthcare Is Too Expensive No Matter Who Pays For It

As Obamacare flounders, progressive Democrats have started to warm to the possibility of going even further and socializing health insurance altogether. Some commentators have speculated that the next Democratic Party presidential nominee will run on single-payer if the GOP has its way and guts the Affordable Care Act. But like many liberal social planning schemes, single-payer healthcare starts sounding much less appealing when accompanied by the mammoth tax bills that would be required to pay for it.

Reason reports on some fiscal forecasts for New York State’s proposed single-payer system:

The single-payer health care plan that cleared the lower chamber of New York’s state legislature on Tuesday would require massive tax increases to double—or possibly even quadruple—the state’s current annual revenue levels. […]

To pay for the single-payer system, [an advocate] suggested that New York create a new tax on dividends, interest, and capital gains that would range from 9 percent to 16 percent, depending on how much investment income an individual reports, and a new payroll tax that would similarly range from 9 percent to 16 percent depending on an individual’s income.

It was a similar prescription for massive tax hikes that sank Vermont’s experiment with single-payer health care in 2014. Funding it would have required an extra $2.5 billion annually, almost double the state’s current budget, and would have required an 11.5 percent payroll tax increase and a 9 percent income tax increase.

These eye-popping numbers point to a truth about healthcare that is often lost in Washington’s endless back-and-forth about how much the government should subsidize it: It simply costs too much no matter who is paying for it, and until we can find a way to sustainably bring down the cost of treatments and delivery, healthcare will continue to be an area of fierce contention and political warfare.

Yes, our policy should be oriented around expanding access to coverage in the near-term where possible. But in the long-term, our policy must be oriented around making healthcare cheaper—through new research programs, de-regulation, tort reform, intelligent immigration policy, and efforts to “push competencies down” so that medical professionals can do the same work with less training.

Ballooning healthcare costs are a menace to the middle-class and to public budgets. This is true now, and it would be true under single-payer. Our debate should be less focused on changing who pays for healthcare, and more focused on making it cost less in the first place.

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  • QET

    progressive Democrats have started to warm to the possibility of going even further and socializing health insurance altogether.

    A bit disingenuous, as compelling arguments have been made since 2009 that Obamacare was deliberately, or at least knowingly, designed to implode as it has done precisely in order that the implosion would propel the US “public” into demanding single-payer. Of course, single payer has worked so well in other industries, like supplying the military. Single payer really brought costs down there; no fatcat ever got fatter supplying the military; there was never such a thing as the military-industrial complex. Yessir, single-payer health care must be the answer.

    And naturally, when single-payer health care results in either heavy taxation or rampant inflation, the “public” will then be primed to demand single-provider healthcare, a la the NHS. And THEN we will be in the golden age! And I assure you: in this golden age we will witness favored donors (Dem, GOP, it won’t make any difference any more; it hardly makes a difference now) growing rich as “providers” (pharm cos, medical equipment makers, the expanding legion of “administrators”) even while, to “reduce costs,” the government will finally see the way to eliminate the MD guild education and licensing requirements. We will all be elated to discover that more and more complex medical procedures and care can be provided by “technicians” and “doctors” who only needed 2 years post-high school to learn all they needed to know to provide your loved ones with the care they need for their cancers; their kidney failures; their heart failures. “Doctors” in Borneo earning US$3.00 per hour will be able to perform your Dad’s angioplasty using “technology.” All that cost saved! And at absolutely NO reduction in “quality of care.”

    Of course, in the fictional universe inhabited by the Left, there are always enough Republican fatcats to tax to pay for “social programs.”

  • KremlinKryptonite

    Americans just make too much money, and SS plus welfare already account for more than 60% of the total federal budget (and growing). America is getting close to 330 million people, and the average household income is well in excess of $50,000.
    A perfect example is my Irish friend here in Korea. He was balding – quickly – so he started taking the name brand hair loss medicine made by Merck called propecia.

    It’s purely cosmetic, so obviously not covered by insurance. The namebrand stuff here costs the equivalent of about $150 for a three month supply, and the doctors visit for a renewed prescription is about $20. Not bad. And it works!
    He traveled to Boston, where some of his family lives, and he needed a refill….$200 for the doctors visit just to give him a prescription. $370 for a three month supply.

    Naturally, he couldn’t believe it and he thought the lady was either trying to steal from him or was joking with him. Unfortunately, it’s not a joke. Even the generic version is about $200.
    What’s the difference then?
    Well, in Korea the average household income is considerably less, as in $20,000 less or more. But they make enough money to save up to travel the world if they want, and they have all the luxuries of a first world life including appliances and electronics in the car and a decent place to live.

    Americans just don’t understand it, and so many millions of Americans think they want more money as if that would help the situation.
    The company produces the pill for probably $.10, and they’re making a profit whether they sell it for $1.60 in Korea or $4.10 in America. But asking them to charge the same amount in America as a country where people make so much less money is not how markets work

    • Dan Kearns

      Which Americans “just make too much money”? All of us?

      • KremlinKryptonite

        Americans in general. That’s how you get a household income average in excess of $50,000. Look at North Dakota, highest per capita GDP in the country thanks to high paying energy sector jobs. God bless, but that’s a lot of money and in USD to boot. The currency also matters. They’re getting paid over 50,000 in US dollars. The currency is strong and appreciating even more. It’s gained something like 20% in the last 2 1/2 years…. making US exports even more expensive and increasing the trade deficit, by the way.

        • Josephbleau

          Regarding North Dakota, let me repeat the gloat “If money talks, oil shouts.” North Dakota should not bind the mouths of the kine that tread the grains.

    • Suzy Dixon

      Very similar story, perhaps more extreme, in China. Americans often get the wrong impression as the Chinese they meet here are among the 300 million or so that do earn what we would consider a true middle class or upper middle-class income by first world standards.

      But behind them are about 650 million Chinese earning a Chinese middle-class income, second world. That’s about $10,000 equivalent per year. Especially outside the coastal megacities, that $10,000 a year is middle-class, they don’t live in a real fancy place but they do have Internet and a computer and maybe a smart phone. And of course behind them are another 300 million or so living in abject poverty worse than Africa, I saw that too.

    • Eurydice

      Ok, but the argument here is that health care in the US is becoming unaffordable regardless of average household income. In other words, health care costs have risen more than has average income. It’s great that Koreans can buy propecia for $50 a month, but Am

      • KremlinKryptonite

        Sure, and healthcare is simply going to be more expensive in America as it stands because Americans make more than most people on this planet.
        Of course the ACA did not help. Sick people simply cost more, so the money has to come from somewhere. Expecting young, healthy people to accept the ACA version of a catastrophic plan with a much higher premium and higher deductible was destined for failure.

        Americans could choose to have a national health insurance plan and make it either de facto or de jure government-run. But that doesn’t mean costs come down necessarily, and it almost certainly means care is rationed.
        Canadians spend something like $1.5 billion on American healthcare for a reason.

        America is not a microstate, or even a moderately sized state. As a very large state with a very large, diverse population and different regional economies, etc., it would seem the best answer is undoubtedly deregulation and perhaps something like Germany’s “sick funds” to assist those with demonstrable chronic problems AND a low income.
        Being able to buy healthcare from any state, possibly even from an insurer based outside the US should be possible and easy. And don’t forget the role the FDA plays, as it tends to create monopolies. Remember the recent EpiPen fiasco?

        It’s a little bit less in Korea. Certainly not over $30K equivalent. There is simply nothing here akin to the United States where we see counties and cities with $80K considered “low income” and people considering $30k to be ridiculously low. The cost of living here in Seoul is considerably cheaper than a small American city.

        • Eurydice

          Sure, all of this. But again, you’re talking about health care costs in absolute rather than relative terms. Cost of living is a relative calculation – if the cost of living is lower in S. Korea and Koreans can live in a style similar to Americans, then they are just as rich as Americans.

          • Unelected Leader

            They are mostly definitely not! Americans make more money, and in a more widely accepted currency. Useful for buying imports obviously. Americans make more money than much of the world, and go into debt on top of that! The effect is that Americans make even more than they really do. If Americans were smart and not so frivolous they would live below their means during their working life. Americans love regulation of services and of the wages those services pay workers. America runs a huge trade deficit. America does little to protect its top 20 exporting industries.

            This all spells “disaster” said in trumps voice. And if he doesn’t address any of this in a meaningful way then expect things to get more out of whack. Nobody else can really harm the US. We are going to be the architect of our own demise and go the way of the British Empire this century if we don’t wise up in a hurry

          • Eurydice

            Again, relative not absolute. My family in my country of origin make less than I do, but they can afford much more – a large house, a summer home, a maid, a car. I can only afford an apartment and my health insurance. So, which of us is rich?

          • Unelected Leader

            Chances are excellent that you are more wealthy. It’s really simple. How much money do you make and in what currency? Sounds more like you need to move to a cheaper area if you have a low income where you are. $50,000-$60,000 is quite a lot of money except in a place like San Francisco where it’s considered low income. That doesn’t impact your net worth though. If you’re worth $30,000 then you are richer than much of the world.

            Americans definitely make more money than most, and are in debt on top of it. SAC used to mean strategic air command. Now it stands for student loans, auto loans, credit cards. America has $1 trillion of each! That’s more than the entire economy of Russia, yet we are supposed to be afraid of Russia. At least that’s what dummy Americans think.

          • KremlinKryptonite

            Ha! I love that appropriation of SAC and tying Russia in for good measure. I’m stealing it.

          • Eurydice

            Such easy solutions. If I moved to a cheaper location, I wouldn’t have the job that I have. Not complaining – I make do with my choices.

          • Unelected Leader

            That’s really the most important thing. You know what options are available to you, so long as you live with your choices. I’m 26 years old with no debt besides my mortgage, that is a 15-year fixed rate mortgage (payments are about 26% of my take home). Ive made smart decisions, and I have not lived beyond my means. I have precisely zero sympathy for people twice my age that bought too much car, too much house, and so on, for their income and lost it a decade ago.

          • Eurydice

            Well, it’s a good thing that you’re economically savvy at such a young age. I’m considerably older and I can tell you that life can present unexpected obstacles no matter how prepared you think you are. At those times, you may require some sympathy from your fellow humans – so I wouldn’t be quite so quick to judge. Then again, life may turn out perfect for you – I hope it does.

          • KremlinKryptonite

            There is definitely a difference between sympathy for a genuine crisis like the death of a spouse or a sick kid versus stupid decisions like a mortgage that’s more than 50% of one’s take home pay. It sounds like he’s making very conservative decisions with money, and that is good preparation for a real crisis.

    • Andrew Allison

      Your argument doesn’t pass the smell test: average wages are higher in Luxembourg and about the same in Switzerland, but healthcare costs half as much and produces better outcomes than in the US.
      Let’s start by separating drug costs from the provision of health care. Drug costs are high because insurance companies will pay for them and current law prohibits Medicare from negotiating drug prices. Simple solution: require generics when available, and buy drugs from Canada. Big Pharma will, of course, squeal like the pigs they are that we’re cutting off research, but the fact is that we’re paying for research which benefits other countries.
      The cost of care is also grossly distorted by private health insurance, which not only adds significant overead but pays for uneccesary and/or elective procedures. Contrary to the assertions of those at the trough, the US does NOT have the best health care, just the most expensive. Simple solution: a single insurer which, as the only game in town will negotiate the lowest possible prices.
      The fundamental problem with health care, however, is that we’re living too long. The sad fact is that no country can afford to provide the quality of care to which the privately insured have become used. The choice is simple: provide a basic level of care to as much of society as you choose (all the other OECD countries think that this means everybody), and private insurance for those who want more and can afford to pay for it.
      Finally, it should be obvious that optional health insurance which covers pre-existing conditions is bound to enter a death spiral. The ONLY way that pre-existing conditions can be covered by insurance, as opposed to Federal funding (the taxpayer) is by making insurance mandatory, i.e., throwing everybody into the risk pool.

      • KremlinKryptonite

        Sure does pass the smell test because you’re basically expanding upon my posts 🙂 but comparing the US to micro states is almost always wrong, and it certainly is here. Beyond that, you’re talking about deregulation benefits versus national healthcare benefits! I’m going to continue to err on the side of deregulation given the size of the US and average income, etc.

        • Andrew Allison

          No, I’m not expanding on your comment, I’m challenging your hypothesis that health care costs are associated with national income, which they’re obviously not. We can discuss average wage, per capita GDP, or whatever, and you’re still wrong. Regarding national healthcare, are you enjoying that provided by your country of residence, or are you getting (US taxpayer funded) coverage [grin]?

          • KremlinKryptonite

            You’re still talking about how to bring down cost. No matter if you make the government the purchaser of all the care and all of the drugs – effectively letting it tell companies what to charge outside market forces – or you massively deregulated America’s hyper regulated healthcare and take that power away from insurance monopolies and near monopolies.

            That may well address cost of care, to say nothing of quality though. Drugs simply cost more because people make more money, hence my example of a drug for hair loss. A Korean with insurance and an American with insurance still see the difference simply due to average income. Hopefully, in time, enough deregulation will address that, too.
            I’m in the military here. although, I’m tempted to take the physical and buy into the NHI system here. Better than the US govt care as it stands.

          • Andrew Allison

            No, I’m not talking about cost; I’m talking about your nonsensical argument that US healthcare costs are high because income is. Glad to know that the taxpayer is paying for your health care; it puts your comments in perspective.

          • KremlinKryptonite

            You’re simply not doing any homework. If you would just look at data to see globally who spends what on healthcare and what their average incomes are you would see it for yourself.
            Then it becomes a cost-benefit analysis of government-run care with its rationing and often limited new technology and limited access to new drugs, as Suzy is explaining to you.

            What does my military, frankly crappy, insurance have to do with anything? I don’t even use it. I’m still relatively young being under 50, and I take very good care of myself. Haven’t had to use any sort of healthcare for about seven years now.

          • ——————————

            Are you in the US military?

          • Suzy Dixon

            You sound like you swallowed the government line trying to sell you on giving it more power. Britain, France, Germany, Sweden have all introduced market-oriented reforms to their ailing versions of national healthcare. In fact, France provides only very basic care through a national health insurance plan, and then encourages French adults to buy additional, supplemental private insurance. Over 80% of French adults do.

            British NHS likewise encouraged people to buy private healthcare if they can. Hilariously, British NHS contracted with HCA (only one of the biggest private American hc providers) to use their facilities to treat 10,000 NHS cancer patients!

            You often hear about elderly Americans traveling into Canada to buy some drugs. You don’t hear about Canadians spending more than $1 billion a year on American healthcare, and buying drugs in America that are literally not for sale in Canada. Government-run systems cut costs by rationing care and that’s a fact. But worse they also restrict the availability of the newest or most expensive drugs.

          • Andrew Allison

            Oh, please. You are usually very cogent, but this is absolute nonsense. My suggestion was that the rational approach is that adopted by every other member of OECD, namely basic care for all and better care for those who wish for and can afford it. The alternative is the disgraceful mess we now have where only those enjoying taxpayer subsidised employer-provided insurance get inappropriate care, those not so fortunate get either insurance they can’t afford or deductibles so high that they can’t afford care, or (good luck with finding a provider) Medicaid.

          • Suzy Dixon

            That’s a pretty weak sauce response to my factually correct post with examples. This isn’t hypothetical. And I see your comments to KK. I don’t know if you just don’t have the heart to admit you were wrong or what, but he’s totally right. Almost without exception, international comparisons show the wealthier countries spend a larger portion of their GDP on healthcare, and this is an old story! Americans don’t have to deal with the same kind of rationing and limiting of drugs available, instead having more immediate care and hospital beds are not full of chronic patients leaving acute patients untreated and waiting.

          • Andrew Allison

            Keep digging Suzy. First, I factually demonstrated that KK’s argument was nonsensicaL. Second, I’ve never proposed, and would oppose, national health care. Second, I proposed exactly what France and all the other OECD (except the USA) do. Third, you are obviously ignorant of the percentage of GDP spent by OECD countries on health care. And finally, you appear not to have grasped the fact that only some Americans don’t have to deal with the same kind of rationing and limiting of drugs available, instead having more immediate care and hospital beds are not full of chronic patients leaving acute patients untreated and waiting.

          • Suzy Dixon

            Classic projection:) you clearly didn’t anticipate stumbling upon somebody who has done some homework, dear. You know, a widely used measure of hospital efficiency is average length of stay. By this standard, US hospitals are ahead of their international counterparts. The average length of hospital stay in United States is about 5.3 days compared to 6.2 in Australia, 9 days in the Netherlands, 9 days in Germany. Keeping nonemergency patients in hospital beds is not efficient, and to the detriment of acute patients.

            In his classic 1977 in 1981 studies, health economist Joseph Newhouse found that 90% of the variation of healthcare spending among developed countries is based on income alone. Same results repeated time and again 30 years on.

            Aneurin Bevan, the father of the NHS, declared that “everyone should be treated alike in the matter of medical care.” But more than 30 years into the program, in the 80s, an official task force created the Black Report and found little evidence that access to healthcare was any more equal then when the NHS was started. 20 years later, a second task force, the Acheson Report, found evidence that access had become less equal in the years between the two studies. Shall I go on?

          • KremlinKryptonite

            That’s all super interesting, Suzy. I don’t think you need to go on. You’ve brought more facts to the table than any of us. Although it is worth mentioning the survival rates being better in the US. For example, only 19% of men with prostate cancer die in the US, and more than 50% of them die in Britain. Also, I think it was finally changed, but for years the codeveloper of the brain cancer drug Temodal, British man name of Dr. Newlands, could not even prescribe it to his NHS patients!

          • Suzy Dixon

            Well thank you. And I was just about to bring that up 😉

          • Unelected Leader

            This is all very interesting. It really reminds me of the proponents for a $15 or even $20 minimum wage. Aside from the obvious impact it will have on prices of just about everything, it actually defeats its own purpose lol. $15 or $20 minimum wage equals more expensive, less competitive exports. Cheaper imports. In other words, fewer manufacturing jobs. Unemployment depresses wages. Amazing how one simple, well-intentioned policy prescription can cause so much harm.

          • f1b0nacc1

            Actually the minimum wage rarely impacts manufacturing jobs (most of them pay far, far more), but it DOES impact service jobs (think fast food as the most obvious example). Other than that, you are entirely correct.

          • Unelected Leader

            Oh I know that. But the hike in the minimum wage puts upward pressure on all wages though due to pricing. Everything is bumped up artificially. If mcdonalds burger flipping is worth $15 tomorrow then making cars has to be worth more, or its effectively a pay cut. Either way not good.

          • f1b0nacc1

            We agree, and I should point out that it is even more direct than that. More than a few union contracts specifically reference minimum wage as a basis for compensation, i.e. that pay increases are often tied directly to minimum wage in a given area. Thus by increasing the minimum wage, one ‘forces’ other compensation increases elsewhere….a waterfall effect of sorts.

          • Andrew Allison

            So now we’re reduced to cherry-picking. “survival rates in Canada, Japan, Australia and Cuba were all comparable to or higher than U.S. survival rates on all types of cancer that the Lancet study examined, except for prostate cancer” (http://www.factcheck.org/2009/08/cancer-rates-and-unjustified-conclusions/).
            As Suzy points out, Nye Bevan wanted equality of care for all. That’s only affordable if cost are controlled, hence the “rationing” of certain forms of treatment. As Churchill famously said “Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery.
            For the facts on Temodal, see http://scienceblog.cancerresearchuk.org/2013/07/18/the-story-of-temozolomide/

          • Unelected Leader

            Dude, what are you even talking about at this point. It seems that you have only partially read their posts, or rather had poor comprehension of them. They both stated the fact that rationing is used to control costs by govt healthcare. Suzy cited people and reports spanning decades that found the inequity of the NHS system exists and persists.

          • Andrew Allison

            I fear that it is you who has the reading comprehension problem. Let me try and make it simple: universal healthcare requires stringent cost control; if a country chooses to provide it there will be “rationing”. Note the use of quote marks. What they mean is that if a procedure or drug is not demonstrably better than the alternatives, it’s not approved. To use KK’s Temodal example, its use is approved if much less costly alternatives don’t get the job done. I thought I had addressed Suzy’s inequality straw man but, to repeat, the explanation is that more people are able to afford better care than the basic care provided to all. No country can afford to provide the level of care provided by private insurance to everybody, so it comes down to whether you want everybody to have basic coverage and allow those who can afford it to upgrade with private insurance, or to only provide care to those who have private insurance. Here’s another thought about Suzy’s inequality red herring: would you rather have a society in which everybody has access to health care (e.g. NHS) or one in which only those who private insurance or Medicare do?

          • Andrew Allison

            Please do continue digging sweetie. However, it would be nice if you could stay on topic. Having done much more homework than you appear to have, I’ll be happy to debate your non sequiturs. What I originally wrote was that KK’s argument doesn’t pass the smell test: average wages are higher in Luxembourg and about the same in Switzerland, but healthcare costs half as much and produces better outcomes than in the US. This are simple facts. The latter makes it clear that the argument that shorter hospital stays are better is also ridiculous on its face.
            Like the good socialist he was, Nye Bevan indeed wrote that everybody should be treated alike and, in fact, everybody relying upon the NHS is. Furthermore “In an era when Britons disdain their politicians and detest their bankers, government officials see the National Health Service as “the most revered public institution in this country,” said Chris Ham, chief executive of the King’s Fund, an independent health care charity.” (https://www.nytimes.com/2015/04/26/world/europe/britains-national-health-service-creaking-but-revered-looms-over-elections.html). The explanation for the increasing inequality is quite simple; more people are able to afford private insurance. I assume that you are aware that virtually all single-payer countries permit private insurance for those who wish for better than the basic level of care available to all and can afford to pay for it. I’ll be happy to knock down any other straw men that you come up with.

          • Sapulpa

            What you say about the French health care system is correct, and I hope adding some detail to the point will inform the discussion. I am an American ex-pat and I work full-time in a health care clinic in France as a technician (not a physician or nurse). I can say based on several years experience as both a patient and as an employee that the French model doesn’t intentionally ration care, but that is the practical effect of certain policies and geographic realities. An example is access to care. In theory, everyone has an equal right to access to health care. But paying for medical transport services is very expensive, and the further away it from the clinic/hospital, the more it costs. So if you live in a remote mountain region where the nearest volunteer firefighter/paramedic (Sapeurs-Pompiers) station is 30 minutes away, in an emergency they’re not coming any faster than that–end of discussion. And for more routine visits if you have difficulty driving yourself, it costs hundreds of euros for a private ambulance, so a GP (family medical doctor) is far less likely to authorize this than if it’s just across town–he/she gets audited periodically by the departmental Sécurité Sociale and has to justify all of these. So health care is effectively rationed because Sapeur-Pompiers stations and private ambulances are expensive, though the official policy is that everyone has equal access to health care.

            Another thing that contributes to effective rationing, is abuse of the system by neurotic people. There is a certain percentage of the population that invent symptoms, refuse to comply with prescribed medication then make a follow-up appointment to complain that they aren’t any better, etc. In my (unscientific) estimation this is only about 5-8% of patients, but they increase the wait time and expense for everyone else. In the American system at least, they bear the costs of their own use (or abuse) of the system.

            A lot of people in the US media complain that the French system does not deliver state-of-the-art care. And this is true as far as it goes in the vast majority of department-level hospitals and clinics since most medical cases and most hospitals don’t usually need it. In the southern half of the country where I work, severe cases are stabilized and evacuated to Marseilles, Lyon or Paris. At the large city near where I work, the medevac chopper lands three or four times a day doing this. This is much less expensive than paying for more hospital than you regularly use.

            In these situations I’ve discussed, some individual cases which are statistical outliers fall through the cracks, but overall the system delivers a more affordable level of care for the majority of people.

            Another way the system keeps costs down is that is is very difficult to even bring suit against a doctor for malpractice. If you do get to court, you are less likely to receive an award, and it will definitely be a lot smaller than a comparable case of negligence litigated in the US system. Yes. I raise my right hand and testify that as a result of this the number of doctors of mediocre competency who malinger on in the French system is higher than in the US because it is almost impossible to sue a marginally competent French doctor out of seeing patients. People lives are tangibly hurt by their shortcomings sometimes; I’ve seen this. On the other hand, no one goes bankrupt because of a medical condition or accident here in France whereas it happens thousands of times a month in the US. So tort reform and professional competency reviews have to be part of the conversation when you talk about health care costs.

            I’m not grinding any ideological axes, not taking any sides–just relating my experience. There are costs, benefits and trade-offs in any system and I leave it to the reader to make up his/her own mind.

    • SenatorSting

      Government spending drives all of this, and there is no end in sight.

  • seattleoutcast

    Anything subsidized will become too expensive. One simply needs to look at education, real estate and health care and how prices ballooned after government intervention. It really isn’t any harder than that. Of course, without subsidization, there is no government control, and that would make meddlers, i.e. progressives, mad.

  • RedWell

    It’s a good point on taxes and the root problem of expensive health care (which, incidentally, is similar to education: labor continues to increase because it cannot get much more productive in those sectors).

    However, the presumption, here, is that a universal system would be supported alongside all the existing insurance plans. New Yorkers would be paying for two systems, but if employers dropped their own insurance (which many would likely do over time), it’s not hard to imagine people coming out about the same in terms of take home wages.

    This does not mean that single-payer is a great solution or that it will solve the problem of cost, which is real. Only that the picture is more complex than simply people losing more of they pay to taxes.

    • Isaiah6020

      “their pay”

  • D4x

    This is all a set-up, to blame the GOP-controlled NYS Senate when this bill fails – must be the Dems new GOTV strategy for 2018.
    Good thing the Village Voice is covering this while the NYT is too busy looking for impeachable offenses, lest their readers find out how many more billions in taxes they will have to pay. http://www.nytimes.com/pages/todayspaper/index.html?action=Click&module=HPMiniNav&region=TopBar&WT.nav=page&contentCollection=TodaysPaper&pgtype=Homepage
    http://www.villagevoice.com/2017/05/16/new-yorks-legislature-is-on-the-brink-of-passing-universal-healthcare/

    Guess the NYS Medicaid fraud spigot is running dry. How else will NYS pols fund their retirement in Florida?

    Time to re-calibrate my cynicism meter.

    • Isaiah6020

      New state motto for NYS: We make New Jersey taxes seem like a bargain!!!!

      • D4x

        Corollary: home health care in NJ is half the cost per capita of NY.

      • Josephbleau

        The goal in New Jersey is to make it unlivable for the poor at a radius of 75 miles of Princeton. Good democrats them.

  • GusIII

    The free market is an option. Get out of the way. Repeal the ACA and get government out of medicine. Medicare and Medicaid should go as well. Let us return to paying the doctors directly for services rendered. Take out the middleman of insurance. These things have destroyed our health care system.

  • FriendlyGoat

    In times past, I have seen B-to-B cost control work like this: The corporate customer arrives and announces to the supplier of a manufactured item , “We’re looking for 5% price reduction on the product this year, again next year and again the year after that. In three years, we’ll discuss whatever our then our new goals might be at that time.” Sometimes the supplier simply could not do it and the customer goes elsewhere (including, most notably, overseas). Often, the suppliers found ways to do it.

    We have this idea that the loose assortment of sick and injured individuals, insurance companies, self-insured employers, and some miscellaneous government plans can somehow, some way, exert this kind of pressure on a whole medical complex. Forty years of evidence tell us they cannot and have not—-even with lots of trying from individual pieces.

    So, we need new messaging. We should be telling every high school student that, if you get married, have a few kids of your own and work an average post-high-school job, there is a chance that as much as 100% of your income could be needed for medical care at American retail. Don’t like the sound of that? Get your government in gear. There is no cost control until all the citizens work together in concert, a thing done at the federal government level. We pretend that the route to change of trend is “hard” on every conceptual level. It isn’t. The route to change is that virtually every medical profession is licensed by citizens IN CONCERT. We have not been talking about the pricing IN CONCERT as a condition of licensure. The statistics tell us we are forty years foolish in our dithering.

    • Isaiah6020

      Wait, so you are saying solution to this problem is more control by the State? Wow… Didn’t expect that from you. Is that one of those ORIGINAL thoughts you claim to have?

  • Fat_Man

    The health care industry is just another example of the classic American policy pattern — Subsidies for Demand and Restrictions on Supply. The policy always produces calls for bigger subsidies and more restrictions so that the feild is not overwhelmed with “destructive competition”.

    As dire as the effects of the SDRS policy pattern are on spaces like Higher Education and Housing, Health Care is far worse because the system now occupies such an enormous part of the Federal Budget, and the total economy. Any effort to decrease subsidies, or even get Federal expenditures under control will be met with ferocious resistance.

    I attended a meeting of a charitable organization I am involved with. The organization, among its many activities runs a retirement/nursing home. They were deeply concerned with proposed changes to Medicaid.

    A Doctor present at the meeting commented that Obama care should be replaced by single payer. I asked him if he would accept wage and price controls as a trade off for single payer. He did not answer.

  • Boritz

    “But like many liberal social planning schemes, single-payer healthcare starts sounding much less appealing when accompanied by the mammoth tax bills that would be required to pay for it.”

    Nobody will hear anything about mammoth tax bills. What they will hear is oh, you’ll get a subsidy. It’s affordable with a subsidy. Most people will qualify for a subsidy. There will be a subsidy. Subsidy.
    Not sure why I believe it will be sold that way. Couldn’t tell you. Just have a feeling for some reason. Oh, almost forgot, IYLYPYCKYP.

  • markterribile

    This article: https://market-ticker.org/akcs-www?post=231949 has a set of free-market reforms that could remove perverse incentives and allow the kind of consumer choice (NOT insurer or government rationing) that could pull costs way down. I’d add one more: enforce the takings clause on governments that require hospitals to treat the indigent on the paying customer’s dollar.

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