>Anyway, here's the offending article:
Right - not yours - you just want to hear an answer. I hear this stuff so often I can answer it in my sleep.
I am going to snip when she pounds a point into the ground.
>I'm not going to wax sarcastic about it, because it's a serious piece that deserves a serious rejoinder. But I will point out that the primary thrust of his argument is that single-payer is less expensive in Europe than our system, and therefore it will be here, too. This is a common logical fallacy.
Except that the usual argument is a little more complex than that. Europeans spend not only less per capital than we do but less as a percent of GDP. So if they were less efficient than we out they would either spend the same or greater percent or have worse outcomes. But Europeans not only spend a lot lower percent of their GDP, they live longer, fewer of their babies die, and they spend more time healthy while they live! Also it is not just Europe. It is Canada, Japan, every friggin country in the world except the U.S. Also is the European economy really in sad stagnating shape compared to the U.S.?
Or put it another way. If higher health care costs reflect a more healthy U.S. economy then by Jane Galt's logic shouldn't we pay more for food, water and clothing as well?
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>For one thing, there's the empirical evidence that turning anything over tothe government makes it cost more, and suck more, than leaving it private.Exhibit 1, the Post Office, which provides worse service than UPS or FedEx, charges almost as much, and is still hemorraghing money despite its specialtax status and the implied government funding guarantee that lowers capital costs. Exhibit 2, municipal swimming pools. Exhibit 3, public educationversus Catholic schools. Etc. . . . You need some powerful model of howhealth care will be different to overcome that.
If I wanted to take the time, I could point out how each of these has been deliberately undermined. But to save time I will mention fire departments, streetlights. I can also point out that, as measured by death rates, public hospitals in the U.S. have the best quality of care, private non-profits the second best, and private hospitals the worst.
And single payer health is about socializing the health insurance industry. Socialized medicine is the *SECOND* step in our devious conspiracy.
>And how will it be different? Why, administrative costs, of course! Not so fast. Those administrative costs don't come from the outrageous price of paper; they come either from competing technological/administrative systems inefficiencies (and if you think that the government will fix these in a snap, note that some agencies are still finishing up their Y2K work), or labor. The idea that the government would arrange to fire a large group of potential voters is of dubious merit, and not borne out by historical experience, here or in Europe. Which applies to all labor costs: if you nationalize 15% of GNP, that means an additional 15% of our labor force in a civil service union. Prosperity is not just around the corner. There are certainly savings from having one set of billing procedures -- but absent competitive cost pressures, not as many as you'd think.
Ok - this requires some answer. First of all the largest cost of private insurance is not the money that goes to insurance companies. This is known as the "premium" and is the difference between money collected by insurance companies and the money paid out. This is still only about six or seven percent of all medical costs. (It is this low only because of public insurance programs like medicare. The *private* insurance premium is more like ten or fifteen percent - and with some private insurers the difference is much, much greater.) But around 26 percent of money spent by medical providers is due to compliance with insurer requirements. In short the problem with insurance companies is like the problem with cockroaches. It is not just what they eat; it is what they spoil.
So around 30% of your health care dollar goes to administrative expense plus profit - for your insurer and your provider. And the total cost in non-insurance run nations is between five and ten percent - again combined. So we can save between 20 and 25% percent of our medical costs. But for course single payer advocates don't plan to use these savings to cut spending but to provide care for the uninsured and to provide better quality care for the majority of us stuck in the mismanaged care mess.
The provider end is easy. Doctors and nurses can spend less time filling out forms, and more providing care. (Drastically less, and drastically more).In addition, not having to deal with insurance companies will eliminate the need for providers to hire million dollar CEOS. Million dollar ceos for healthcare providers was an innovation of the managed care process; it was not a standard practice in 1969, and does not need to be now. And there is a lot of administrative staff working in medical facilities these days who can be either fired and replaced with medical workers, or (my preference) retrained as medical workers themselves.
On the insurer end , there is no political problem with firing the people who work for health insurers or retraining them do useful work. Because they don't work for the government now, and in single payer health we are not planning to nationalize the insurance companies; we sill replace them. Very little of what they do is useful. The small portion that is could be contracted out as medicare does, or could be done by a huge expansion of the Health and Human Services in house staff.
>Please note that the wastefulness of competition was the almost plausible argument for every socialist system ever proposed. Which is true; it is wasteful. Just not as wasteful as a centralized bureaucracy that only knows how to do things the same way it always has. Anyone who wants to convince methat centralizing billing is going to provide all the costs savings we'll ever need is going to need a passel o' proof.
Well , as I said - it is the elimination of the huge micromanagement that private insurers do - and the time and and labor insurers use to enforce it and hospitals spend to comply.
>Other costs might be lowered, but not to good effect. Medical and pharmaceutical research, and medical technology entrepreneurship, are vastly more innovative here than in Europe. Because here it pays.
Umm - no. Compare patent rates and you will find that Europe matches us in pharmeceutical research, and medical technology. And a lot of the research here is aimed not at innovation but at extending patents or getting around them. And a lot of the funding for research here comes from the evil old government.
>But after we've realized those vast administrative savings,
and as I've shown they are vast.
> and taken out the incrediblymodest savings to be had from better preventative medicine (sure it saves money on more expensive emergency room treatments. Two problems: it also loses money to people who run to the doctor every time they have a sniffle.
Japan is the most extreme example of this. And they still save tons over our system. Emergency treatment is not just expensive. It is incredibly expensive.
>And the infrastructure for all that non-emergency care for the uninsured doesn't exist anywhere near where they live. Maybe we should build it, as amoral issue. But it isn't going to be cheap.
Umm I don't know any hospital capable of doing emergency treatment that is incapable of doing non emergency treatment.
>Third problem: much preventative medicine is dependant on the patients. Demonstrating that they will follow preventative regimes as well as the hyper-attended people in the expensive studies that showed reduced disease incidence will be a challenge.)
There is a motivation for following preventative regimes - not dying. Odds are that at least a high percentage will find this a strong incentive. You know Jack Benny used to have joke where a robber pointed a gun at him who said "your money or your life". It was the long pause that got the laughs.
> -- after we've done those things, there'sonly one place the money is coming from: price controls on inputs.
OK - I'm going to snip a lot of the rest - because it rests on the assumption that you won't have big savings from administrative cuts and prevention. Since I've refuted that:
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>Oh, you weren't going to let them join the civil service? I'm flat broke and I'll bet anyone who likes $1,000 that if we nationalize our health caresystem, all employees at nurse level or below, and possibly physicians, are unionized. But I'd check with the airline screeners before you make that bet.
OK - major anti-union red herring. First of all most doctors and nurses and so forth won't join the civil service because they will not be working for the government. Nobody is being nationalized. We are replacing the health insurance industry with public insurance. But as to unionizing; I thought a lot of nurses and medical workers in general are unionized. Those that are not should be. Then they can win better wages and working conditions and prevent a severe nursing shortage.
As to doctors: they already have one of the strongest Unions around. It is called the AMA.
>The executives? 'Kay -- though I'd be uncomfortable trying to run a hospital without some administrators. And if you think that the guys you're workingwith now are bad, just wait until you meet Big John, who's been toiling at aback desk in Health and Human Services for 20 years and just wants to get outin five with a higher pension.
Another randite red herring, but common enough to be worth dealing. There is a huge spectrum between million dollar CEOs and no administration. Sure providers, and even the goverment insurance body will need administrators under a single payer system. Just a lot fewer of them then in our present mad setup. And I honestly don't think we will need any million dollar executives or 300,000 dollar administrators.
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>Oh, those prescription drugs. How are we going to save money? Cap prices ondrugs and medical technology. And where are those savings going to come from?Well, the angry health-care investors you just bankrupted, of course (wouldn't try that in an election year!) That's not what we want, the advocates say, but c'mon -- if health care gets nationalized, you can kiss the biotech and pharmaceutical industries good-bye.
Single payer advocates would not nationalize health care. (Not saying there are not good arguments to be made for nationalizing health care - but that is not what single payer advocates are talking about.) Again the EU in general has a great biotech and pharmaceutical industry...The rest is just Randite raving, to be expected from someone who calls herself Jane Galt.
Umm and she never mentions the fraud prevention argument that RangerCat brought up. I will simply point out that not a whole lot of that 30% gross admin. expense is going to fraud prevention.
The main points are:
1) That between 20 and 40 rich countries get better health care than we do for less money - not only per person put as a percent of GDP. Nobody spends as much as we do on health care. Almost every rich country (and some poor ones) get better results.
2) We spend 30% of our health care dollar on administration. There is no reason a single payer system could not reduce this to 5 or 10 percent.
3) Better preventative care could save at least another 5 or 10%
4) Capping drug prices could save around 4 or 5 percent And the rest of the world gives us no evidence this would end medical innovation.
So At least 20% savings in admin. expenses. At least five percent in prevention. At least 4% in drug costs.
That means pessimistically that we could save 29% of every dollar - and redirect it to covering the uninsured and increasing quality for everyone.