Reply #70: Michael Kinsley made a point.

[ProSense]

You can debate whether it's right or wrong, bu there are a lot of issues with single-payer and countries like Canada are experiencing problems with their own systems.

http://www.amsa.org/studytours/CHS_FactSheet.pdf">Canadian Healthcare System Fact Sheet
American Medical Student Association
Prepared by Kao-Ping Chua, AMSA Jack Rutledge Fellow 2005-2006

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Cost of care: an international perspective
• In 2001, Canada spent $2,792 per capita on healthcare, whereas the U.S. spent $4,887
capita on healthcare. That is, Canada spent about 57% of what the U.S. spent per capita
• Despite this, Canadian healthcare is expensive by world standards (in 2001, 9.3% of
Canada’s GDP was spent on healthcare, compared with a median of 8.0% in other
industrialized countries). Provinces pay for most health expenses <1,4>.
Problems
• Budgetary shortfalls in the early 1980’s prompted the federal government to reduce
payments to provincial governments, which in turn decreased hospital budgets and
reimbursements to physicians <2>.
• The current push for privatization in Canada stems from the idea that private insurance
companies may be able to restore some of the funding to the healthcare system <2>.
this idea is extremely controversial, as many are concerned that privatization will result
inequities in the system.< BR>• There are coverage gaps in the healthcare system, particularly for outpatient prescription
drugs and home care <2>.
• There is significant tension between the federal and provincial governments over both
financing and jurisdiction, which has resulted in several heated battles in recent years
• Waiting lists for certain elective procedures is a problem for some Canadians <1>.

http://www.amsa.org/uhc/SinglePayer101.pdf">SINGLE PAYER 101
Written by Kao-Ping Chua
AMSA Jack Rutledge Fellow 2005-2006
February 10, 2006

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THE POTENTIAL DISADVANTAGES OF SINGLE PAYER

The vitality of any public program lies in its funding levels, and the biggest potential disadvantage to a single payer system is the threat of underfunding. There are several ways in which this might occur:

• Underfunding by a hostile government: a government that favors privatization might take measures to undermine the public system. In America, the strength of private special interests makes this possibility especially worrisome.
• Mismanagement: an inept or corrupt government could misallocate funds in a single payer system, taking away money from vital services and decreasing quality.
• Recession: public systems rely on tax dollars, which decrease during recessions.

Another potential disadvantage of single payer relates to one of its strengths: the ability to control costs. As noted above, all cost control mechanisms have downsides, and overly aggressive cost control could result in decreases in quality. For instance, inappropriately strict limits on the diffusion of technology might stifle positive innovation in technology. Along with underfunding, this can be avoided through prudent management of the health care system, but it remains a potential concern.

The transition from the current system to a single payer would undoubtedly be very difficult. Thousands of people who work for private insurance companies would need to be shifted to other sectors of the economy. Even though these individuals could be trained to work in the new public system, they would still experience a significant change in their lives. Because of these considerations, most single payer advocates and policy analysts believe that any transition to a single payer system would necessarily be gradual, taking place over the course of many years.

Finally, there are some important tradeoffs that Americans will have to make in a single payer system. The first is that technology-hungry Americans will have to accept limits on ineffective, questionable, or medically unnecessary interventions that would not be covered by the single payer system. Such interventions could be likely be covered by supplemental private insurance, as is the case in other countries with single payer. The second major tradeoff is that Americans will have to accept less choice in insurance plans. Some Americans want to choose the health insurance plan that is tailored to their individual needs, but a single payer system would give everyone the same insurance plan. The last major tradeoff is that Americans will have to accept more government control and less private control of the health care system. Neither the government nor the private insurance industry can currently claim great popularity with Americans, and the question is which entity Americans w ill trust more to manage the health care system.

CONCLUSION

This primer has endeavored to articulate the nature and advantages of a single payer system. Solutions that achieve universal health care through mechanisms that build on the current system of for-profit employer-based insurance, while potentially beneficial,do not achieve the philosophical purity, administrative simplification, or cost control potential that a single payer system achieves.

Single payer, however, has significant potential disadvantages that must be addressed. Although many of the disadvantages can be avoided through proper management of the system (e.g. funding the system at a very high level and insuring adequate capacity), others represent true tradeoffs that the American public must debate in its mind. The time for such debates is now. In the current system, insurance companies have a financial incentive to avoid insuring the people who need it the most, which means that more and more Americans suffer every year. It is only a matter of time before some type of reform takes place, and single payer should be a reform option that should be seriously considered.