Why a Single Payer System is Better

There are a lot of problems with a single payer system.  A single payer system is a healthcare system where the government pretty much just pays all medical bills.  It's a popular government healthcare system in Europe, but it comes with a list of problems.

In the U.S., the biggest arguments against a single payer system include long wait lists for medical care, higher taxes, and death panels.  These are certainly serious accusations, and most of them are even true.  That does not mean that a single payer system is inherently bad though.

Comparatively, a single payer system is pretty good.  The primary stated goal of Obamacare was to help poor people to afford healthcare better.  In reality, it hardly helped anyone.  Initially, it helped some people find existing affordable healthcare, but the primary group this helped was the lower middle class, a group that could already afford health insurance, but was paying more for it than necessary.  Most of the poor who could not afford health insurance were not magically provided with options that fit their budgets, and the fine imposed for not buying health insurance does not apply to anyone below the middle class, because it is covered by standard deductions.  Of course, the rich are who really paid for it, because many of the rich can already afford to pay medical bills out-of-pocket and wealthy people tend to be healthier in the first place, thus needing less medical care.  This would not have been such a bad thing, if Obamacare had actually helped anyone in the first place, but it had a very bad start and it got worse from there.  Even now, those in the small group that it may have made a slight difference for are getting priced out of the market, as Obamacare approved health insurance providers are starting to increase their prices.  In short, nearly anything is better than Obamacare, even a single payer system.

Compared to Obamacare a single payer system starts off by actually helping poor people, who cannot afford their own healthcare or insurance.  A single payer system will actually do the job Obamacare was supposedly designed to do.  Because a single payer system automatically covers everyone, it will lose the overhead of medicare, medicaid, and any other system that has to hire a vast staff of administrators to make sure every single applicant meets the requirements for qualifying.  This overhead is enormous for pretty much any form of government welfare restricted to low income individuals and families.  We will discuss this more in a moment, but even the tax cost of a single payer system is less of an economic burden than Obamacare, which includes profit margins, administration, and shareholder benefits for the insurance companies.  Given that much of the cost of Obamacare is on rich people who don't strictly need health insurance in the first place, it is possible that even the higher taxes won't cost as much to the rich as Obamacare does.

What we had before Obamacare was Medicaid and Medicare, which helped only very narrow portions of the population.  These programs missed a huge swath of poor, who made too much money to qualify, but who still could not afford healthcare without help.  It was pretty clear back then that something needed to be done, but the Republicans wouldn't touch government healthcare with a 10 foot pole, and the result was that a horribly bad Democratic "compromise" got put in place to plague us for the better part of a decade.  Many Republicans and even some Democrats think that the previous system of approximately nothing is better than Obamacare, and they are probably right, but repealing Obamacare and stopping there still leaves us with a major problem.  The reason anyone thought Obamacare might be a good idea is that we had (and still have) a serious healthcare problem in the U.S.

Sentencing people to death for poverty is wrong, and sins of omission are still sins.  Somehow, the less religious left seems to understand this, but the highly religious right does not.  Most religions, and especially Christianity, teach that the rich should help the poor.  Many go so far as to assert that to withhold aid is to be responsible for whatever happens to the person.  The interesting thing is that no religion teaches that aid should come exclusively from individuals, without any government involvement.  As far as I am concerned, if people vote to be taxed more so that the government can provide for the poor, not only is this sufficient to meet the requirements of deity, it is also far more efficient than millions of people spending billions of hours looking for poor people to help.  I am not going to bother trying to argue this point with a focus on less religious people, because I am pretty sure they already understand this.  Anyhow, the fact is, we can't just let people die because they are poor!  Poor people need healthcare too, and neither Obamacare nor what was there before are sufficient to meet this need.

Besides the fact that poor people need healthcare too, there are some practical considerations that make a single payer system better than what we currently have, with or without Obamacare.  The first is that the government is already paying for some healthcare and hospitals are footing the bill for a lot more.  As I mentioned before, Medicare and Medicaid have a great deal of administrative costs in making sure people who get it meet the requirements.  Going through applicants bank records and doing background checks to make sure people are not trying to cheat the system is actually quite expensive, and some estimates suggest more than half of the money spent on these programs goes into this administration.  A single payer system has minimal administrative costs comparatively.  Second, there are Federal laws requiring hospitals to serve certain classes of patients whether they can pay or not, and often the hospitals end up footing the bill.  What this means is that hospitals have to charge paying patients more to make up these costs.  Costs for patients who cannot pay add up to a lot more than just the healthcare costs though.  Hospitals often end up paying collections agencies to harass these people for up to several years, in an attempt to recover some of the costs.  Often this is a losing battle, benefiting only the collections agency getting paid by the hospital.  There are also losses in the form of interest (either potential interest on the money owed or business debt interest that the hospital has to pay, because it does not have the money to pay the debt off sooner).  This costs pretty much everyone.  The government loses, because it cannot tax money owed that is never paid.  Poor people lose out, because hospitals are tempted to provide inferior service to get the poor patients out so they have more room for paying patients.  Paying patients pay more, because someone has to pay for the care given to the poor.  Health insurance companies also pay more, for the same reason paying patients do.  In short, our current system is costing tons of overhead.

So how does a single payer system compare?  A well designed single payer system covers most non-elective healthcare no-questions-asked.  This means no administrative overhead for making sure people don't cheat.  It also covered rich and poor equally.  This means that it actually does help the poor.  One worry with a single payer system is long waiting lists, and this has been a problem in the past.  Almost three decades ago, it was common in many European countries to have waiting lists for visiting doctors up to three months long.  It was a running joke in the U.K. that most people ended up in the emergency room before getting to the top the waiting list.  This is no longer the case though.  Waiting lists on the order of a week or two are not uncommon, but I have not heard of anyone having to wait much longer than that in almost a decade.  The European single payer systems have gotten so fast and efficient that sometimes Americans visit Europe for an extended stay for the high quality state-paid health care, and their healthcare systems are efficient enough that they don't even mind this.  I once told someone raving about socialized healthcare that if their claims that it worked well were right, we should do it immediately, but that their claims were not right, and that it did not work well enough to be worth doing.  Well, that time has come.  If we use successful systems as a model for our own, it will work significantly better than anything we have ever had.

The tax question comes down to the fact that even if it does end up costing more in taxes, taking the burden off of the hospitals will be beneficial enough to our economy to make up for it.  And frankly, I am not entirely convinced that it will cost much more in taxes, given how much money eliminating the anti-cheating infrastructure will save.

That covers everything but death panels.  I am pretty sure death panels was an idea thought up by people opposed to any kind of socialized healthcare.  It was recognized by opponents early on that any kind of socialized health care must have limits, or we will end up keep tons of medically dead people physically alive at great cost without any benefits.  These opponents took this idea, turned it into groups of people who decide how gets medical care and who does not and named them "death panels."  The need for these is certainly a concern, but one look at the current system should make it obvious that it is less of a concern than the current situation.  Currently, when a person is on the verge of death and only being kept alive by machines, the question of life or death belongs to the hospital and any relatives of the person.  The decisions are made primarily on financial and emotional concerns.  People are allowed to die in hospitals regularly, because their families can no longer afford the medical bills and don't want to get into huge amounts of debt.  At the same time, people who are medically dead are regularly kept alive for days, weeks, or months because family members just cannot bear to let them go.  It is a travesty that cost of healthcare is a dominating factor in live and death, and this is one thing that a single payer system would fix.  With a single payer system removing the financial factor though, it is very reasonable to assume that a lot of people would want to keep their medically hopeless relatives alive indefinitely, holding out on some one in a million chance of miraculous recovery, and this would make the tax burden of a single payer system untenable.  Government rules could be made to govern cases like this, but there are so many fringe cases that legislation is bound to fail in a great number of them.  The best solution is to get panels of experts to objectively consider things like probability of recovery.  Yeah, the idea of death panels sucks, but it is already better than how it currently works!

Besides the fact that death panels are a better system than deferring to financial concerns and emotions in making these decisions, they also don't have to be the final word.  Death panels would not be deciding whether people live and die.  They would only be deciding whether or not the government will continue paying for the care of a patient who seems unlikely to recover.  Continued care would up to anyone who might be willing and capable of paying for it.  Most single payer systems allow people to pay for their own healthcare out-of-pocket.  This allows people who can afford it to circumvent government restrictions on healthcare, and while this might seem unfair, it is no less fair than our current system.  In addition, this allows health insurance companies to remain relevant.  In countries with single payer systems, customers that can pay out-of-pocket often have access to premium healthcare that is not available a normal government pay scales.  Again, this may seem unfair, but the government paid healthcare is generally comparable, if not better than the average healthcare currently available in the U.S. (see Canada, where the free government healthcare is often considered significantly better than standard healthcare in the U.S.), so there is no loss of quality to people using government paid healthcare.

What it all comes down to is, a single payer system is more effective, cheaper, and better for the economy than anything we have had in the U.S. so far, including Obamacare and completely private healthcare, and even the scare tactic idea of death panels is both better than the current system and easy enough to circumvent for anyone that could afford it in the current system.  As a national healthcare solution, the single payer system has been turned into a well oiled machine in Europe, and if we are smart enough to learn from their mistakes and successes, we can have a successful single payer system ourselves, that works properly right out of the gates (unlike Obamacare).