The latest meme being propogated by our moderate friends (see myth #3) and responsible liberals is that the claim of administrative cost savings under single payer are wrong, overstated or even "snake oil."
This is part of an concerted effort to keep single payer advocates frome even being part of the conversation.
It is incomplete, wrong, and frankly a little disengenuous.
Their apparent rejection of the goal to get rid of the unnecessary and wasteful private for-profit insurance companies in general, and going to single payer in particular, is based on several false premises and ignores many studies and facts.
May I humbly point out some of the items they fail to address:
- That NO other industrialized country in the world uses private for-profit insurance companies as the main source of coverage, and they are all able to achieve real universal and comprehensive health coverage, lower individual costs and no medical bankruptcy, lower system-wide costs (e.g., %-GDP) and equivalent or superior care and outcomes.
- Only the U.S., by accident of history depends on such a system. We also have by far the highest overall costs (%GDP going to health care), incomplete coverage, un-insurance, under-insurance, and the highest individual out pocket costs including medical bankruptcies.
- The many independent studies from the GAO and CBO in the 1990s through Lewin's analysis of California's single payer proposal done two years ago, and others even more recently, showing that it is best way to go. These the critics do not want you to know about.
- The endorsement of Single Payer by many other economists and health services researchers and experts as the best way to go (even if hedged as in principle, or if starting from scratch). Like Obama, the heads of Commonwealth and Kaiser Family Foundations and of AHRQ have said at various times that single payer is the best way to go in principle, even if they consider it politically unfeasible at this time. Again, not acknowledged by the critics.
- They fail to explain how their proposals will control costs including individual out-of-pocket costs (premiums, co-pays, deductibles, denials of covergage or reimbursement) amd system-wide percent-of-GDP, as well or better than Single Payer, while still retaining the fragmented non-system dependent on for profit insurance companies; and while achieving care that is universal and comprehensive.
As PNHP's Don McCanne points out:
The authors understand that a single payer or "Medicare for all" model of reform is the most rational competitor to their preferred model of reform - thus their attack on the administrative savings that a single payer system would bring us. They concede that the savings are not a myth as they are considerable, but they still understate the savings because they exclude the tremendous financial burden that our dysfunctional, fragmented, multi-payer system places on the health care delivery system. They also incorrectly state that the administrative savings are a one-time event. In fact, the efficiencies that are achieved are permanent, shifting the trajectory of health care cost increases downward.
Their dismissal of single payer reform (see Emanuel's "Healthcare, Guaranteed") as merely an inadequate administrative measure, considering the complexity of the systemic problems in our health care delivery system, ignores the most important benefit of the single payer model. A single payer system creates our own public monopsony, or single purchaser of health care services. Many economists agree that, by controlling the spending of our health care dollars, we can finally demand value in our health care purchasing, introducing infrastructure changes that will lead to the high-performance system for which we are already paying, but not experiencing.
Because Medicare controls health care spending for only about 15 percent of our population, it is a very weak monopsony. Nevertheless, it has been able to introduce some spending efficiencies. Think of how effective it would be if it covered all of us.
Medicare is our most popular, most efficient, and most equitable health care financing program, yet it is being dismissed as a model for all of us because of the idea that it somehow represents an ideological extreme. In health care, political compromise based on ideology is not only bankrupting individuals, it is killing them.
Now, I am willing to debate the politics. Alas, I actually agree that, thanks in part to their pre-emptive surrender to the for-profit private insurance industry, that Single Payer will probably not win the day this round. Representing what I laughingly will call the right wing (heh) of Single Payer advocacy, my belief is that it is important to frame this so that if/when the next reform does fail, that the reform-after-the-reform is single payer ("you see, those compromising moderates did not go far enough") and not a return to free market fundementalism ("you see, those liberals were wrong").
The only problem with the building blocks models being proposed as politically realistic is that they won't work. So, as Lend Rodberg asks, who is really being realistic?
Ultimately their argument are about politics. Becasue in fact as a matter of pure policy, their arguments for retaining the for-profit insurance companies are knowingly incomplete and wrong. They are actually being made to pre-emptively shut us out of the conversation. Not going to happen.