First, I support any proposals that give equitable access to healthcare and single-payer proposals in Massachusetts could very well do that. What's wrong with the U.S. health system is largely a distributional issue (the least healthy and wealthy get less care and quality). The fact that the U. S. wastes a lot of money to get this inequitable result is secondary. Afterall, I can think of a dozen reform schemes (including direct state provision of care or unregulated cut-rate HMO's running wild) that would get us lower costs. Focusing on costs is arguably a bad strategy, but focusing on costs independent of the many and varied distributional issues involved is even worse.
This may be too fine a point politically. I don't know. I don't make this point because I think support of single payer--by those that do support it--is wrong. I just think it's wrongheaded to let the Mass. Medical Society lead the charge. Physician support for single-payer is in part reactionary. Physicians can maintain higher incomes and greater autonomy under single-payer than they can in an increasingly "managed" care system. Physicians can also maintain greater power over others in the health care delivery system under single-payer ("managing" care has increased the power and responsibilities of other health care providers--but not necessarily their incomes).
>Mass spands $36G on health care each year, and the
>admin savings plus 'other aggressive savings based on
>the single-payer model' (they don't say what those
>would be) would cut $5G from that. All currently
>uninsured residents could be covered, plus coverage
>upgraded for those who have insurance now, for $4G of
>the $5G, whence the reckoning that there'd be an
>immediate $1G savings.
(I take it "G" stands for "1000 Million" because many readers would need to see the "B" for "Billion").
My second criticism is technical. I have been working on estimates of the uninsured in Massachusetts (that's currently my job) for nearly a year. The estimates vary widely in the state and are actually a bone of contention. The Dept. of Health Care Financing and Policy commissioned a study that showed the rate was 8.1% for early 1998 compared to 12.6% in the CPS for 1997 and around 11% in the Urban Institute's Nat. Survey of America's Families for early 1998. This was a political issue in the governor's race (I was one of the few "outside" people who had worked with the data during the governor's race and unfortunately was contractually prevented from poking holes in some of the distortions conveyed in the Globe and other sources).
Anyway, the number of uninsured is just one of the variables that could be reasonably estimated a variety of ways. Hence, the "cost savings" are also "cost increases". It just depends on needlessly technical issues and who's pushing what buttons on the computers. What matters is that people suffer and die needlessly because of their bank accounts.
The first political issue is show the consequences of the differential access to health care (death, disability, suffering, job loss, etc.). Then we need to see whether people even given a damn. I think they do. The costs are important. Good policy would reduce costs, it's just that reducing costs is not so hard in the country that spends the most per capita on health care. (Canada, largely single payer, spends the second most!).
Focusing on the importance of the inequality of pain and suffering enables one to look beyond health care as the source of that inequality as well. One could reduce health care spending by lowering interest rates, improving equity in education, increasing interpersonal skills, and making sure everyone had a good job as well.
Peace,
Jim
" . . . they never told him the cost of bringing home his weekly pay
and when the courts decide how much they owe him
how will he spend his money
as he lies in bed and coughs his life away?"
from "He Fades Away" by Alistair Hulett