Having written the below as a comment on my previous post , I realized it should perhaps be its own post.
My previous post drew notice to Malcolm Gladwell's recent article and blog posts about the competitive disadvantage our employer-based health-insurance system (and retirement system) inflicts on many American industries. Only hours passed before a commenter offered the (well-worn) argument that providing the obvious solution to this problem -- a national single-payer system providing universal health care -- "would be disastrous ...[if done] before tackling the cost issue."
This "but what about the costs?" argument against single-payer is a canard, and ignores that our system is already a disaster when it comes to costs. We will need to address costs as part of a single-payer system, but it seems unfair to ask that we do so ONLY if (and before) we move to such a system; the insistence implies that costs are only a problem in a universal plan and not today's "system." Yet rising costs are just as ruinous in the present system as in a single-payer system. They drive up premiums every year, making it ever more painful for companies and individuals to buy adequate coverage and preventing others from getting any. And our private-insurance system clearly rots at curbing costs. If it's so good at controlling them, why do we spend almost twice as much per capita as otherwise similar countries (France, Germany, Canada, the UK) with single-payer universal care and better health outcomes?
The skilled blade of Dr. Joseph Abate, Burlington, Vermont, cleaning up my knee cartilage last month. My insurance (which cost me dearly) covered this procedure, but only because I'd already exhausted my $5000 deductible (paying out $5000 cash on top of the $8000 in premiums my family pays for the $5K deductible plan) undergoing a different (nonelective, very painful) operation earlier in the year.___________________________________________________________
Some single-payer skeptics worry about costs because, well, we need to worry about costs. But others, I think, love to raise the "what about costs?" question because it gives them an unfair advantage. As a rhetorical point, insisting that single-payer advocates solve the cost problem puts them uniquely on the spot for answering tough questions about what gets covered -- and in doing, so, ignores that our present system is already answering these problems, silently and badly, in the way we spend our health-care money.
It ignores, for starters, that we spend some 25% -- that would be about $500,000,000 -- on insurance operating costs; Medicare spends less than 5%. It also ignores that our have v. have-not approach, in which the insured get almost anything and the uninsured almost nothing, already makes gruesomely unjust decisions about which costs are most important. Should we spend huge percentages of our total health-care spending on the last few days of people who stand little chance of surviving -- while many sick people can't even see a doctor? Should cleaning up my knee cartilage so I can play baseball on weekends be a more important cost to cover than examining an uninsured person's mole or a funny lump early enough to detect and treat their cancer?
Most of us would say no to either question. Our present system says yea to both. We spend vast sums on the last 2 days of death while ignoring millions of illnesses and injuries that simple care could make better. And we apparently think it makes sense to fix my knee (if I happen to be insured, which I am, on my own dime -- many, many dimes) than it does to examine the lump of someone who's uninsured and forgoes examination till the lump grows large. Somewhere, while I play baseball this weekend, grows a detectable but unexamined melanoma that will kill its uninsured host.
We can make a healthy start -- and save hundreds of billions -- by nationalizing not health care but health insurance. (Opponents of single-payer love to call it "nationalized health care" or "socialized medicine." But single-payer doesn't nationalize or socialize the care, which would be provided by the same mix of providers we have now. It simly rationalizes the insurance coverage.) People love to come up with nightmare implications for single-payer, but in essence it's MediCare extended to everyone. Medicare's poorer cousin, Medicaid, of course, is a troubled program, as Congress seldom hesitates to short the poor and because Medicaid relies heavily on funding by cash-strapped states. But Medicare is (the new prescription drug plan aside) a success, ensuring that our elderly get most of the medical care they need from the providers and hospitals they want. Want a model of how a single-payer system could work in the U.S.? We already have one. It's called Medicare.
The California plan that just passed the legislature proposes something along these lines. Another, national proposal, HR 676, simply Medicare to cover everyone. And the Physicians for a National Health Care Plan have proposed another single-payer system model
The solutions are out there. What lacks is the leadership.