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Politics : A US National Health Care System?

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To: Road Walker who wrote (1778)	8/1/2007 7:06:31 PM
From: TimF	Read Replies (3) of 42652

I believe the mechanisms you have proposed for saving money through single payer include the savings from economies of scale of having one large insurer, and the savings from additional simplicity for the hospitals and medical practices from only having to deal with one form of insurance claim. I don't see how such savings could come close to the difference in medical care costs between the US and the other countries you mention. Also they would be set against the competitive pressure for efficacy that the market typically provides. Additional savings could be found if the single payer rations care more than our current insurance companies, but that would be lowering cost by lowering the amount of health care provided. If your trying to save a big portion of the costs, without cutting back on the quantity or the quality of care its not easy. Esp. if you count reducing the rate of future improvements in quality to be cutting back on quality, or at least something you strongly want to avoid. The biggest differences are probably the costs for health care professionals (esp. doctors) in the US, and the cost of prescription drugs. You could use a single payer system to form a monopsony buyer for drugs and force the price down. But that won't effect non-drug costs, and also it will discourage R&D on drugs. You could try to use the same monopsony power to force down renumeration for health care professionals. But you will get a lot of opposition, and likely some of the normal problems you get when you impose wage ceilings and other types of price controls. You will find (to a greater extent than today) that certain specialties or certain areas of the country don't get sufficient service. Tort reform should help, but its not a cure all. The direct and indirect additional costs from lawsuits, malpractice insurance, and more defensive medicine, are large, but completely eliminate the additional level of costs we have in the US and we would still pay more. Also wide spread tort reform isn't a simple or easy change.

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