Senate Finance Chair Max Bacus (D-MT) 2008: "Everything is on the table....The only thing that is not on the table is a single-payer system. That's going nowhere in this country."
You now know by now that America's health care system is broken, much like its auto industry. Yet the Washington elite refuse to adopt the health care system common in peer nations. America has a lower life expectancy, higher infant mortality, and higher rates of mental illness than countries with universal health care programs. Yet Americans spent $2.4 trillion on health care in 2008, more than any other nation. Politicians talk about "reform" but insist on market based solutions that are not necessarily the answer to every social problem. For one, the demand for health is very inelastic. Political demagoguery aside, polls show that a plurality of Americans are ready to accept what is generally referred to as "socialized medicine"[1]. Our political leaders' narrow-minded intransigence is due to several wholly subjective factors: a zealous ideological commitment to capitalism, faith in technological elaboration, and the potent political influence of what earlier populists called "the money power".
Markets are created to produce profit and the more a market grows the more profit is made. Private health care and health insurance is a big market. At least one-fifth of our economy will be devoted to health care by 2017[2] and most of that money will be spent on technological elaboration, not basic or preventive care of citizens. The health industry is growing without meeting the needs of an increasing number of citizens who are simply left out. A great deal of cost goes into deciding who should get health insurance coverage. Those left out are marginalized by the system: to do without care or to be dumped on hospital emergency rooms. The cost of health care is rising so fast that employer provided insurance, the mainstay of the current system, it causing financial distress. The annual premium an insurer charges an employer for a health care plan covering a family of four averaged $12,700 in 2008 a rise of 5%[3]. The cost increases are so bad that even the insurance middlemen who profit from the current set up are willing to entertain non-market solutions, provided of course profit can be derived from a replacement. The health insurance company lobby group, AHIP, is willing to provide "guaranteed issue"--nobody can be turned down for their medical condition--in return for a law mandating the purchase of private insurance. Forty six million Americans do not have health insurance. The California Nurses Association described that proposal as a "Marshall Plan for the health care industry" that "fully privatizes profit while socializing the health care risk. The public systems could be bankrupted by their responsibilities to care for the sickest while guaranteeing huge new profit streams".
The usual criticisms of a single payer system are that a government run system will cost too much, and that it will lead to rationing of health care. Right now we have a problem with over treatment because more treatments generate more profit. Routine PSA testing is a case in point. The National Cancer Institute does not recommend routine PSA testing because the majority of men diagnosed with slow growing prostate cancer will die of something else before overt symptoms arise. Treating prostate cancer leads to other treatable side effects like erectile dysfunction and incontinence. The prostrate market is worth $300 million annually[4]. Just watch the evening news--the numerous drug company commercials will deliver the message. Physicians for a National Health Care Program says that adopting a single payer system would save more than $350 billion per year by eliminating the massive private bureaucracy that consumes one-third of every health care dollar. Whether we admit it or not, rationing under the private insurance system already occurs. About 20,000 Americans die each year due to lack of access to health care.
In college my public finance instructor talked about the "bliss point" of public policy making. He briefly described that as being the point at which you do the most good for the most people given the inevitable trade offs in any funding solution. The current bloated mess we have to deliver health care in our country is a long way from a bliss point[5]. But it does one thing quite well: deliver profits to the private sector. And the price of maintaining the status quo is quite low compared to the lost profits to be expected from a government regulated system. The health care lobby gave $150 million to Congress and presidential candidates last year. Now that is bliss.
[1] Harper's Magazine, Sick in the Head, 2009
[2] www.nchc.org/facts/costs.shtml. Health care spending accounted for 10.9% GDP in Switzerland,10.7% in Germany,9.7% in Canada, and 9.5% in France
[3]id.
[4] op. cit.
[5] Harvard University found that the average out of pocket medical debt by those filing for bankruptcy was $12,000. 50% of bankruptcies studied were partly the result of medical expenses. About 1.5 million Americans lose their homes to foreclosure every year due to unaffordable medical costs.