As the nation careens toward the true launching of Robertscare (a.k.a. Obamacare) – and even here, there is a disconnect between the insurance exchanges to launch on October 1 and the subsidies for them, which don’t start until January 1 – there is talk that the entire edifice will crash in a mess of incompetence, fraud, and confusion. This has led many to wonder if and when the left will claim that the only real way to fix health care is to go to a “single-payer”, government monopoly system, one that they claim exists in the United Kingdom and Canada – and that most in the center-right decry as “socialized medicine”.
I should note the theoretical advantages of single-payer: the federal government could, in theory, have monopsonistic power that would enable it to drive down health care prices and costs; health insurance would cease to be a cost for many businesses; and citizens would no longer have the uncertainly of health care cost to impact their future spending and investment decisions. These are not only the defenses that are used by the single-payer backers; they are also cited as the reasons the UK and Canada have “single payer.” Less knowledgeable folks on the left will even assume the rest of continental Europe has single payer – and cite the above as reasons for it.
Of course, each of the reasons has their drawbacks – drawbacks which completely undermine the theoretical advantage. In practical terms, Medicare already gives the feds monopsony power – and they handed that market power to the AMA, thus making that group a monopolist (and revealing the failure of the monopsonist argument in the first place). Firms liberated from the cost of health insurance will end up stuck with the tax bill for the government-run system; a trade that will hardly improve business climate. Finally, as Medicaid recipients are already discovering, insurance from health care cost is not the same thing as access to care.
With the theoretical arguments thus debunked, one might ask why any nation would have “single payer.” The answer is simple: in the democratic world, no one actually has single payer.
In continental Europe, for example, all nations use some sort of public-private mixture for health care, just as we do. Most believe Europe’s health systems are more government-controlled (I’m not so sure, given what I now know about Medicare’s power), but none of them claim to have the government-monopoly system credited to London or Ottawa.
This leaves those two capitals, which supposedly fund and directly control health care in their respective countries. The trouble with that assumption is that it is not true. Contrary to political myth, Canada’s provinces decide health care allocation. Ottawa subsidizes the provinces, but does not make spending decisions for them. Thus, health care in Canada can vary from province to province. I would argue that the most dramatic example is Ontario, which charges its residents a health insurance premium, meaning that in Canada’s largest province, “single payer” health care isn’t even “free.”
Unknown to nearly all Americans, the British health care system is also provincially directed as a result of the 1990s devolution. There is not one “payer” in the UK, but rather four. The only province with health care under federal control is in England – and that’s only because England has no provincial assembly of its own.
So what does this mean for the United States? One of two things: If the (Un-)Affordable Care(-less) Act fails, and the left gets what it wants, the American health care system will be more radical and government-directed than that of any democracy on Earth. If instead, the (U)ACA “succeeds” – or, as more likely, wheezes through – our system will become somewhat more government-directed than it is now.
Either way, so long as the corporatist relationship between the federal government and the AMA remains intact, things in health care will get worse, and worse, long before they get better.
Cross-posted to the right-wing liberal