By Ivan Moore
Anchorage Press, July 12, 2012
To be honest with you, Iâm not much of a fan of the âindividual mandate.â I donât think itâs much of a solution, given the soaring costs of health care and health insurance, to say âYou must have it!â and fine people if they donât. Iâd much prefer a single-payer system.
Single-payer is the jargon that refers to a system whereby the health insurance companies are replaced by government funding of health care. The single-payer option didnât get much traction back when the overhaul of the health care system was being considered, which is why we ended up with the mandate.
I wonder why not?
A single-payer option would work something like this. As I pointed out last week, more money gets spent per capita on health care in the U.S. from government funding than most other countries spend in total expenditures. These government-funded programs, for better or worse, would provide the care they currently provide ⊠Medicare, Medicaid, the VA, health insurance programs for public employees, plus those lavish Congressman and Senator benefits. The rest, the portion that is currently financed through private health insurance, would be made public.
The tax structure most often discussed would entail a personal tax on income of about 2 percent, plus a payroll tax on businesses of about 6-7 percent. This would raise a sufficient amount of revenue to entirely replace the private portion of health care expenditures, and render every single person in the country covered.
Think about what a 2 percent tax on your income would be, what it would come to dollar-wise. If you havenât currently got health insurance, you just got a screamer of a bargain. If you do have health insurance, the 2 percent is very likely to be less than the amount you currently have to pay each year to cover deductibles, co-pays and those procedures your insurance company says they wonât cover.
Now think about the 6-7 percent payroll tax on employers. If the employer currently provides health insurance to their employees through a private plan, the payroll tax amount is very likely to be less than what they currently pay. The only employers who lose out are the ones who donât currently provide insurance benefits to their employees. Oh dear, so sad.
(This raises the side question of why, in a country where the vast majority of health insurance is employer-provided, we arenât talking about an employer health insurance mandate. Shouldnât companies who hire people and put them to work be mandated to provide health insurance to those employees? You could argue that a company that provides health insurance to their employees puts themselves, at least in respect to labor costs, at a competitive disadvantage over those that donât. Great incentive, that.)
A single-payer system is one where everyone is covered. Where everyone receives access to the same standard of care. Where there are no longer any out-of-pocket expenses that you have to fork over. Where insurance companies donât refuse to cover something that goes wrong with you. Where they donât jack your premiums up or cut you off if you get too expensive.
The thing that people opposed to a system like this donât get is that the health care itself remains pretty much unchanged. The doctors arenât suddenly working for the government. They have their private clinics just like they do now. You would be able to choose your doctor freely, instead of being restricted to a roster chosen by your insurance company. Health care decisions wouldnât suddenly be made by government bureaucrat death panels, theyâd still be made by you and your doctor, just like now.
The bill just gets paid by the government, out of one big pool. The single payer.
Itâs so simple. So bleeding obvious. Bleeding obvious⊠thatâs a good Englishism for you. The American equivalent is âDuh!!!â
So why didnât it happen? Well, the health insurance companies and their army of lobbyists on Capitol Hill, the ones with an iron grip on the wherewithal of every single Congressman and Senator, made sure it didnât happen.
Itâs quite a cash cow, the health insurance racket. Makes them lots of money. Your money. And theyâre not letting go of it without a fight. So they dole out enough campaign contributions to keep their elected representatives quiet, no doubt in good Abramoff style, whisk them off on junkets, on holidays and to sporting events, and the end result is that single-payer doesnât even get off the ground.
God forbid, theyâd have to switch to peddling other forms of insurance, because health insurance essentially wouldnât exist any more.
Think about all that expense for a minute. Not only the insurance company lobbyists, but the CEO salaries and the bonuses, the staggering administrative costs, the advertising costs so they can all compete against each other, and so on⊠all passed on to YOU in your premiums. The overhead cost for a government program like Medicare is about 3 percent, your average HMO spends 20 percent. Think about it, all of that would be gone.
So yes, I know what youâre thinking⊠a single-payer system really would be cheaper. Once everyoneâs covered, what would be the point of having these government programs targeted towards the more needy populations, the Medicares and Medicaids and VA programs? Theyâre all safety net programs that only exist because our health care is not universal. So yes, gradually, bureaucracy would decrease. And costs would go down.
And yet, people still rail against the idea. Rail against something that is categorically in their interest to support.
Funny how that happens, hey?
Ivan Moore is a public opinion pollster who lives in Anchorage.