Wednesday, December 03, 2008

Discussing a Single-Payer Health Care System

Sen. Baucus (D-MT), the chair of the Senate Finance committee, will be at the forefront of the discussions on health care. Baucus said yesterday that the only option that is off the table is a single-payer health care system.

Left in the West, a progressive blog in Montana, had two good posts up yesterday about a single-payer health care system.

Jay Stevens looks at Baucus' plan in Single-payer Health Care v. the Baucus Plan, while Matt Singer takes an in depth look at the difficulties of getting a single-payer health care system passed in Separating Wheat from Chaff on Health Care Policy. He gives these two reasons why...

  • Transforming 16% of the Economy is Hard. This is the first argument. Our health care system is simply larger and more complex and more costly than any system in the world. That means that any mistakes we make in the transition are magnified. It means thinking through the details is crucial. What gets covered? What isn't covered? Who processes the claims? Simply because these decisions are made by a government agency instead of by an insurance company, there is no reason to expect that the answers become clear overnight.

    These aren't the only difficult questions. Health insurance companies employ a lot of people. Do we nationalize them, merge them, and start through a round of layoffs? Do we build a national health insurance company and leave the Blues fighting for the high-end scraps (I think it'd be difficult to envision a scenario where the U.S. government literally prohibits private insurance or paying for some forms of care out-of-pocket) and watch as round after round of layoffs commence? How do we evaluate risk models? How do we experiment with cost controls?

  • Transforming 16% of the Economy Overnight is Painful. It's hard enough to figure out how to transform the economy, but there is no way to do it without causing massive harm, unless you're looking at a 20-year timeline, or so. Again, the folks in private sector health insurance will largely be let go. Hospital billing departments will also downsize. That's where the administrative savings come from. But these administrative savings, as large as they may be, simply aren't what is ultimately going to make or break the bank when it comes to the higher costs of American health insurance.

    If reining in administrative costs isn't the panacea, but it could be a major source of pain, the question has to be -- why would we try to do it overnight?

A new health care policy will be a hot topic in the first couple years of the Obama administration and I hope to discuss health care at great lengths here.

Chime in with your thoughts.

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