People who know me are sometimes surprised when I describe myself as "conservative on some issues." And to be sure, I'm mostly a raging lefty. But I've always wondered why "conservatives" oppose single payer systems. I believe a single-payer system like Canada's would be a net benefit to the United States and could be justified by "Buckley-esque" conservative ideals.
In the United States the cost of treating acute conditions in the uninsured comes from the public purse. So let's say you don't have health insurance and you're rendered unconscious in a car crash. You're taken to the hospital emergency room and revived. The hospital has already spent money on you before they could determine you couldn't pay for the treatment. So you're stabilized, shown the door and usually, the local county picks up the bill.
That's a bit of a contrived example, but it clearly shows what happens: if someone doesn't have insurance to cover the cost of medical care, it's the state that picks up the tab. Something that's a little more likely is due to some unforeseen circumstance or a previously hidden chronic condition, you need acute care. Maybe it's an accident around the home. Maybe you didn't have cash to pay for an annual colonoscopy and you have abdominal pain from stage 3 colon cancer. Treating a patient for complications due to late term cancer is considerably more expensive than detection and prevention. Put another way, appeals to the public purse are minimized if indigent and low income workers who cannot otherwise afford effective health care are provided with preventative care.
But in this country, we tie health insurance to employment. This made a lot more sense fifty years ago when the cost of health care was lower and employee turnover was lower. Health insurance was originally offered by employees as an incentive, but as costs increased it became more of an expectation. This is bad because employer provided health insurance introduces an artificial attachment to under-productive employment. That is, instead of working the job that best uses your talents or allows you to maximally contribute to economic productivity, you go for the job that offers the best health care.
In my own case, I left a "good job" to pursue an entrepreneurial opportunity. I was lucky I had enough cash to pay for COBRA coverage while my new business venture became a going concern. Other people will not be in this situation. A worker who thinks of a new process or a new invention will be hampered in their pursuit by the cost of health insurance. Minimizing the out-of-pocket expense for entrepreneurs during the initial "start up" phase of their business, gives them more "runway" to go from concept to minimum viable product. Reducing the cost of entrepreneurship increases the incidence of start-ups; increasing the incidence of start-ups increases the likelihood productivity-enhancing intellectual property is delivered to the marketplace.
And from the perspective of a mature enterprise, health care costs are now the single fastest growing expense and the least easy to predict. When I was an entrepreneur, our health care costs doubled every year as benefits went down slightly. The current system benefits large employers with larger risk pools at the expense of small and medium sized enterprises who must deal with unpredictable increases in health care coverage.
Also, the United States has the third highest per-capita health expenditure while enjoying the lowest rate of positive health outcomes of the top 17 industrialized nations. If we could replicate the Canadian model, shifting to a single-payer model would facilitate better negotiation for end consumers and more consistent pricing for health care services and medicines.
This is a just an outline of a real argument, but I think it presents the basics. We're already in a situation where the public pays for some coverage: emergency rooms, medicare, medicaid. Tying insurance coverage to employment encourages under-productive employment and minimizes the United States' competitive stance with respect to productivity-enhancing intellectual property which is frequently developed by small organizations with no stake in existing solutions.
Single-payer health care:
In the United States the cost of treating acute conditions in the uninsured comes from the public purse. So let's say you don't have health insurance and you're rendered unconscious in a car crash. You're taken to the hospital emergency room and revived. The hospital has already spent money on you before they could determine you couldn't pay for the treatment. So you're stabilized, shown the door and usually, the local county picks up the bill.
That's a bit of a contrived example, but it clearly shows what happens: if someone doesn't have insurance to cover the cost of medical care, it's the state that picks up the tab. Something that's a little more likely is due to some unforeseen circumstance or a previously hidden chronic condition, you need acute care. Maybe it's an accident around the home. Maybe you didn't have cash to pay for an annual colonoscopy and you have abdominal pain from stage 3 colon cancer. Treating a patient for complications due to late term cancer is considerably more expensive than detection and prevention. Put another way, appeals to the public purse are minimized if indigent and low income workers who cannot otherwise afford effective health care are provided with preventative care.
But in this country, we tie health insurance to employment. This made a lot more sense fifty years ago when the cost of health care was lower and employee turnover was lower. Health insurance was originally offered by employees as an incentive, but as costs increased it became more of an expectation. This is bad because employer provided health insurance introduces an artificial attachment to under-productive employment. That is, instead of working the job that best uses your talents or allows you to maximally contribute to economic productivity, you go for the job that offers the best health care.
In my own case, I left a "good job" to pursue an entrepreneurial opportunity. I was lucky I had enough cash to pay for COBRA coverage while my new business venture became a going concern. Other people will not be in this situation. A worker who thinks of a new process or a new invention will be hampered in their pursuit by the cost of health insurance. Minimizing the out-of-pocket expense for entrepreneurs during the initial "start up" phase of their business, gives them more "runway" to go from concept to minimum viable product. Reducing the cost of entrepreneurship increases the incidence of start-ups; increasing the incidence of start-ups increases the likelihood productivity-enhancing intellectual property is delivered to the marketplace.
And from the perspective of a mature enterprise, health care costs are now the single fastest growing expense and the least easy to predict. When I was an entrepreneur, our health care costs doubled every year as benefits went down slightly. The current system benefits large employers with larger risk pools at the expense of small and medium sized enterprises who must deal with unpredictable increases in health care coverage.
Also, the United States has the third highest per-capita health expenditure while enjoying the lowest rate of positive health outcomes of the top 17 industrialized nations. If we could replicate the Canadian model, shifting to a single-payer model would facilitate better negotiation for end consumers and more consistent pricing for health care services and medicines.
This is a just an outline of a real argument, but I think it presents the basics. We're already in a situation where the public pays for some coverage: emergency rooms, medicare, medicaid. Tying insurance coverage to employment encourages under-productive employment and minimizes the United States' competitive stance with respect to productivity-enhancing intellectual property which is frequently developed by small organizations with no stake in existing solutions.
Single-payer health care:
- reduces the per capita cost of health care
- removes barriers to technological innovation
- eliminates disparities between large and small enterprises
How is this not conservative?
I agree. I originally expected something like this from Obama, and look we got. We kept the main source of the problem, which is the insurance companies.
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