Well, our progressive friends are once again calling for single payer health care. The ironic pretext this time is that Obamacare has collapsed into chaos. The health care “reform” law they assured us would cure the ills of our medical delivery system is disintegrating before their eyes. But the advocates of the “Affordable Care Act,” as these people stubbornly refer to it, refuse to accept that the crackup was caused by the inevitable incompetence of government bureaucrats. They believe the real problem was avaricious insurance executives.
Thus, people like Michael Moore, Paul Krugman, and even Colin Powell urge us to cast out the money changers and wholly surrender our health care to the tender mercies of the federal government. Powell’s off-key contribution to this single payer chorus was as embarrassing as it was surprising. In December he told a group of cancer survivors, “I don’t see why we can’t do what Europe is doing, what Canada is doing, what Korea is doing …” To his credit Powell did admit, “I am not an expert in health care.” This was a prudent caveat.
If Powell possessed any expertise in health care policy, he would know that the U.S. has spent nearly half a century experimenting with the kind of system he advocates. Paul Krugman puts a name on this experiment in a recent pitch for single payer, “In this hypothetical system you wouldn’t have to shop for insurance, nor would you have to provide lots of personal details… we don’t have to imagine such a system, because it already exists. It’s called Medicare.… So why don’t we just extend that system to cover everyone?”
That’s right. Medicare is a single payer health care system for seniors, and it is Exhibit A in the case against government-run health care. “Medicare-for-All” is what single payer advocates usually mean when they refer to universal health care. Most of these people naïvely believe that such a system could be paid for with a few modest tax increases. Krugman, however, is an economist and knows perfectly well why we don’t “just extend that system to cover everyone.” He knows Medicare-for-All would bankrupt the country.
Indeed, Medicare threatens to break the bank even without the vast expansion that would be required to convert it to a single payer system covering all Americans. The most recent Medicare Trustees report reveals that the program is encumbered by an unfunded liability of $43 trillion. This is the amount by which the program’s promised benefits will exceed the tax revenue available to pay for them. $43 trillion is three times the nation’s GDP. Thus, the Trustees also project that Medicare will become insolvent in 2026.
How, then, can we afford to expand it to cover everyone? We can’t, of course. Yet single payer advocates continue to mislead the public. And their prevarications aren’t limited to matters fiscal. Krugman’s claim that Medicare-for-All wouldn’t require us to “provide lots of personal details” is a case in point. The Centers for Medicare and Medicaid Services (CMS) has long maintained a vast central database, the “Common Working File” (CWF), that contains intimate personal health information as well as demographic data on every Medicare patient.
This information is updated by data transmitted to CMS by hospitals, doctors, and various other health providers every time a Medicare beneficiary receives care anywhere in the country. Even if a senior is covered by a private insurer via the Medicare Advantage program, providers must submit a “shadow” file to CMS for every encounter the patient has with the health care system. The CWF must be fed, and its appetite will increase exponentially if all Americans are herded into a single payer system that falls under the aegis of Medicare.
On top of all this, Medicare patients endure many of the same difficulties gaining access to decent health care that plague the Medicaid patients discussed in this space last week. As the Wall Street Journal reports, “Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules.” And, like the patients “covered” by Medicaid, Medicare patients have worse outcomes than patients with private health care insurance.
And yet most progressives believe that Americans would be better off if we dumped the private insurance industry and herded everyone into “Medicare-for-All.” This group includes President Obama, who can be seen on video declaring himself a proponent of “a single payer universal health care plan.” Obamacare was a fallback plan, as Michael Moore recently pointed out in the New York Times, “implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go.”
This is an unusually candid appraisal, coming from a man for whom honesty is not a primary personality trait. Moore even mentions the Obama administration’s “clueless planning,” its “lousy website,” and the President’s serial lies. But, like most single payer advocates, he fails to connect the dots. Bad planning, worse technology, and dishonest officials are standard features of all government programs. That is why Medicare threatens to bankrupt us and why a single-payer system based on that program would crash and burn.
Progressives like to think of themselves as smart, technically savvy “first adopters.” Yet they aren’t willing to try a health care delivery model that has never been attempted in this country. This model would eliminate regulatory impediments to provider efficiency, remove perverse tax incentives for patients, and permit real competition among insurers. This cutting edge solution is called “the free market.”