Wednesday, June 28, 2017

Healthcare Wars 2017 Part 2 - What Did I Just Tell You About That Pony?

At least until somebody writes a bill they can read
Single payer. Two words, a simple concept. There are variations, but the core principle is that every citizen is entitled to free health care, and the government sets up a system for paying the costs incurred with public funds. It's really two pieces - there is the insurance, or payment side, and the delivery side. On the payment side, it's easy - mostly. Just like Medicare or Social Security, the government merely sets up a straightforward bureaucracy to make the payments to doctors, hospitals, dentists, nurses, specialists, pharmacies and the rest of the health care delivery infrastructure. Because the government is a monopsony - the only buyer on the market - they can set their payment/reimbursement rates at any level they choose, much like a monopoly can set prices for their goods at any level regardless of market imperatives. The only 'challenging' portion of this part of the process is to raise the funds.

The other side of the Single Payer question in America is how to make the current privatized delivery system work in this new publicly funded process. Private for-profit insurance companies would just die - quickly - because no one would need to purchase insurance anymore, and only wealthy people would buy policies that provided them with access to better service than the public delivery infrastructure. So, somehow, in a free market in a democratic nation, the government would have to take control of virtually every doctor, hospital, pharmacy, dental office - trillions of dollars, millions of people - and then pay them a fraction of what they are used to receiving in the current for-profit private health care world.

So, when you think about it, it's hard to imagine what this single payer legislation would look like. You'd end up with a whole bunch of unemployed people in the private insurance industry, and whole bunch of doctors and hospitals that simply refused the government's mandated payment rates, only accepting patients from the remaining private insurers that paid full freight. And you'd end up with a massive constitutional problem - you can't privatize the health care delivery industry, and you can't force them to take patients they don't want.

And, of course, there's getting the people to buy in. 80% of Americans get their health insurance as part of their employment. That means they pay for insurance with lower wages, but that's baked into the cake by now. So they never see an actual insurance bill, and their only out-of-pocket expenses are deductibles and co-pays to their delivery providers. So now, if we come skipping up with our bright, progressive smiles and tell them that they're going to get a somewhat poorer - but perfectly acceptable - level of coverage, and we're only going to raise their income taxes 35% to give it to them, do you really think they're going to get really excited and tell their representatives to make it so?

See, that's what a pony looks like...

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