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Monday, October 2nd 2006

Well If California Is Thinking About It…

Just Think, This Isn’t Even The State’s Wackiest City!

A few weeks ago, while the rest of the country snored at the 46 million uninsured Americans, California Dems decided to try the nation’s most radical approach to covering their uninsured (they stand about 18%).

SB 840 probably had no chance of making it past the Governator. It was an attempt to be forward thinking and progressive and get their votes on the roll and get Schwarzenegger’s opposition out in the open for his tough November election.

Who Needs Access To Health Care When You’re In This Good’ve Shape?

What was alarming was just how “progressive” the measure was. It eliminated private insurance in California and provided for a single payer system. The op/eds which chided Governor Schwarzenegger over his veto had the typical flavor – “The system is falling apart! Abandon ship!”

The American Health Care System?

From UCSF health policy Professor Kahn,

“SB840 is not about socialized medicine,” he said. “You would still have public and private health care providers. What this is really about is simplifying the finances of health care.”

Semantics Make William Shatner Angry

Well, let’s all give Professor Kahn his due for being technically correct. But the bill, like all single payer sytems, would’ve made all health care providers defacto government employees, deriving all their income from the government coffer.The bill eliminates any pressure to maintain provider or hospital reimbursement. It had no financial figure attached to it, but would undoubtedly have had a huge cost.

From the California Health Care Foundation,

Newly insured people, as well as those who are now underinsured, would consume substantially more medical resources than they do now, which would add to real costs. But, of course, this is the logical result of the desired policy.

Real costs could increase for other reasons. If many people now in prepaid, integrated plans were to switch to the fee-for-service option, costs could rise. Integrated plans are generally thought to be more efficient; fee-for-service payment is generally thought to encourage providers to prescribe more services.

Inevitable decreases in physician reimbursement without competition (not that there’s much with the current system with so many fee schedules based off what Medicare pays), would’ve been offset by wave of procedures. Which would’ve led to? Rationing. The inevitable consequence of single payer systems.

If you’re not…hopeful…about being able to avoid rationing, you face the question: Should people be allowed to opt out of rationing if they can afford it? That is, if the system (private or single-payer) won’t pay for the $100,000 pill, should you be able to pay for it yourself? Fear that this would not be allowed helped to kill the Clinton health-care reform 13 years ago. But explicitly granting some people life and health while denying these things to others is hard, even though this disparity has existed throughout history and is probably unavoidable. In fact, a serious defect of single-payer is that it makes all sorts of unbearable trade-offs explicit government policy, rather than obscuring them in complexities.

The California plan didn’t answer that question. I guess they were going to make it up as they go along.

In any case, single payer proponent arguments that rationing isn’t inevitable don’t ring true to me, nor do I think they should with everyone. The real argument is that while rationing comes about it doesn’t have to cost us anything in terms of the most important health care quality measures. The funding of systems like California’s busted plan is more than adequate so that we can effectively ration healthcare, to maintain (nay, improve) the bottom line quality measures (such as life expectancy, child mortality, and some preventitive variables).

But the system cannot, by its nature, give everyone everything they want or think they ‘need’. As other systems – both single payer and true socialist systems – have shown, with a global budget you sacrifice timely care in terms of “elective” procedures.

It is those greedy bastards at the AMA’s most persuasive argument: “You’re going to have to wait 6 months for a hip replacement!”

I Wonder If The Excess California MRIs Would’ve Shown Up On EBay
I Would’ve Been All Over That!

Single payer oversolves the “patients consume all available health care” problem. That is the idea of supplier induced demand. For instance, that physicians can make demand for health care. Not only be ordering excessive tests or doing excessive procedures, but by merely being present in an area. Demographics alone cannot explain why NYC can support X specialists per 100,000 while Iowa has similiar health care results with X-5 specialists per 100,000 people.

The result is a drop in some health care quality measures – waiting times, satisfaction, quality of life issues – which single payer proponents are willing to choicely ignore or deny.

In a utilitarian sense the extension of life saving health care access to those who currently lack it under a single payer system (especially when talking about numbers like California’s 7 million uninsured) has a moral benefit which easily outweighs what you may lose in terms of “quality.”

My unpopular libertarian view is such benefit does not outweigh the loss in liberty which single payer must come with. Indeed, which any attempt to redistribute wealth comes with. Sorry if your political science professor tried to convince you otherwise but liberty and equality are largely mutually exclusive. That support of personal liberty has been the tenet of this blog, so I sound like a broken record once again denouncing single payer efforts in a post and ending with this “conclusion” of mine.

Only California could’ve put something like this out there, and so sitting safely in a conservative state I fear this not. Still, as the health care system implodes without moves to control costs and extend access, we get closer and closer to a “radical” solution being pushed through on a wave of frustration. If I and others are going to shout down single payer we better have reasonable and effective answers of our own…and sooner, rather than later.