The fact is we are in the midst of a crisis, and the various players (doctors, hospitals, insurance companies, drug companies, employers, governments) are more-or-less inert about it. I don’t like a government single-payer system, and imagine that over the long run it may do more harm than good, but it is inevitable unless those of us who oppose it can come up with a decent alternative quickly.
A local businessman and I once did some spadework on the idea of Medical Savings Accounts, although they would be a complete departure from MSA’s as people now think of them. The premise is that, if each of us were self-insuring, then we would care how much money we spend, and we would demand some market discipline. Our plan would be universal and government funded. By the way, the businessman (a conservative Republican) believed so deeply in this concept that he paid thousands of dollars to an actuarial firm to confirm the basic soundness of the idea. The quick version:
For most people, the cost of health care is very low when young, and gradually escalates. There are exceptions, of course, which can be both catastrophic and hugely expensive. So…
At birth, each of us would get an endowed MSA from the government with, say $5,000 in it. Each year, on our birthday, an additional (say) $2,000 would be deposited. The money would be invested in an IRA-like vehicle. Each year, a small amount would be deducted from your account in return for catastrophic coverage. You would be totally responsible for the costs of your own health care, which would be paid for in the form of drafts on your MSA account. For most people, by the age of 55 or so, the account would have a value in excess of $1,000,000. Most of this money would have to remain in the account, of course, to fund for your continuing (and growing) health care costs. However, a small amount, perhaps 1% per year, could be distributed to you as supplemental retirement income. On your death, what you haven’t spent would go into your estate, perhaps subject to a special tax (if necessary) to fund the next generation’s MSA. Some people would expend all their funds (and more besides, taken from the catastrophic care policy), and die with an empty account. That’s fine, as our purpose was to provide for their health care. Most would die with at least a small surplus.
This plan has at least three benefits: First, every American would be covered, cradle to grave. Second, because we are now spending our own money, the market discipline would drive down costs. Third, the existing system of health care woud remain mostly intact. Doctors, hospitals and drug companies could charge what they decided to charge, constrained however by the fact that too high a charge will result in fewer customers.
What about the costs, and why should the government bear them? Aggregate costs would be much lower than today, owing to much higher efficiency and the fact that consumers will bargain for better prices. It pretty much has to be the government that pays, as newborns have no employer, nor do the parents of some newborns. However, both employers and individuals, free of the current high burden, should be willing to pay higher taxes (GASP! I can’t believe I said that!), particularly when their aggregate out-of-pocket costs will be lower.
As a conservative, can I justify this philosophically? Yes, I think so, although frankly, maintaining idealogical consistency is less important than solving the problem. My conservative argument is that this will save money, it will reduce government involvement (to writing a check rather than administering a program), and it puts the discipline of the marketplace to work.
Ah, gentlemen, what you have beautifully crafted is a government-endowed single payer health care system. It's a perpetual motion machine in which I'll actually get richer as I get closer to dying, if i can just avoid getting hit by a falling airplane! It has the not so subtle ring of school vouchers to it...amazingly, the premium on many basic health care policies will be...you guessed it, $2,000. Rich people will "supplement" their MSAs and create a two-tiered health care system. There are a few bureaucratic questions as well. Who "manages" the MSAs? Who keeps me from taking my $2,000 a year and going to Hawaii? A government bureaucracy? Let's say I decide to "make my own decision" and get a shitty health care policy that doesn't cover X,Y,Z. Are you conservatives willing to let me die for my bad choice? Are you willing to say, "screw him. He had a lapse of personal responsibility, and that's why he is an alcoholic?" This plan is not inherently more efficient. It's a "free market" fig leaf on a single payer system. Higher taxes. No regulation. No cost containment.
I suspected liberals understood nothing of economics, and would resort to name-calling when their weak minds were inadequate to the challenge of responding intelligently. But I am getting old and forgetful, so it is good to be reminded, from time to time, that these suspicions have substance. Thank you, Sam. Maybe a spritz of sulphur dioxide would perk you up some.
This is why we need single-payer:
1. You pay taxes/premiums to Uncle Sam.
2. Your see your doctor.
3. Uncle Sam pays your doctor.
Three steps — it doesn't get any simpler. See Rep. Weiner's explanation.