Yesterday, I suggested that some (many?) supporters of single-payer healthcare are in thrall to a fantasy, and unwilling to fact hard facts.
Let me offer one or two such hard facts.
Takings Clause
I've seen no analysis from proponents of single-payer of the potential claims from health insurers for compensation under the Takings Clause.
Yet the whole point of single-payer is to put the health insurance sector out of business (or out of 99% of its business).
My understanding is that claims under the Takings Clause are hard to make, especially where there is not an outright appropriation of private property by some government entity.
But - not to address the point, even if only to dismiss it, reeks of amateurism.
However, the more important thing here is the political Takings Clause.
Not since the Volstead Act has an industry been singled out in this way [On second thoughts, I'm not sure about PUHCA - there may be others]. And Volstead followed prohibition legislation in a good many states. And there was a world war going on - there was one when the res for the 18th Amendment (S J Res 18 (65th)) passed Congress, at least.
Which means (at least) two things:
First, an industry which is about to be annihilated by act of Congress is going to spend its last dollar in defeating that legislation.
Second, the industry is going to plead with the American people that the proposed confiscation is downright un-American, Big Government gone mad, proof that Dems are unreconstructed, etc, etc.
Harry and Louise, eat your heart out.
How do single-payer advocates propose to deal with the political pressure brought by interested parties on MCs and their voters?
(Clue: their answer had better be damned convincing.)
What's the cost of buying out the health insurance industry?
Take Wellpoint: for calendar 05, it had $2.47bn of net income (on $45.1bn of revenues); its current PE ratio is 15.76, giving a market cap of $47bn.
According to its 10-K, it had 34m members in 05, making the value per member of around $1,400 each. Estimating the US population at 300m, and the uninsured at 50m, that would mean (at the same value per insured) a very rough ballpark for the total value of the US health insurance business of around $350bn. (Others will actual expertise in the area will be able to hone this!)
Employment Issues
Any single-payer scheme relies on shifting outlays from nonmedical to medical expenditure.
That means hundreds of thousands of employees of health insurers, hospitals, doctors and who knows else become surplus to requirements.
What do the unions say about that?
And - why aren't single-payer boosters telling the rest of us what the unions are saying about it - and what they're saying back?!
But, on the other side of this equation - shifting outlays from nonmedical to medical expenditure - where are all the doctors, nurses and other medical staff to be found to do all the new work?
It's not only the 50m of uninsured: it's the loads of insured who are refused treatment (or the best treatment) by their insurance company; and the further loads of those who can get insured - but not for the preexisting medical complaint that they actually need the insurance for.
Who is going to perform the tests, operations, after-care - the whole thing - using the megabucks released by canning all these pen-pushers and stripping out the insurance company profits line?
(The US already hoovers up a good proportion of the world's medical staff - single-payer surely involves much more of the same. Is this liable to make the US more or less popular amongst its friends?)
What's the phase-in?
I note that HR 676 (109th) proposes a 15 year phase-in:
The conversion to a not-for-profit health care system shall take place over a 15-year period
which is an eternity.
Have any liberal reforms been phased in over as long as 15 years?
How is the transition going to work?
(As for HR 676, a wish-list doesn't magic into legislation just because you give it a bill number.)
It's bad enough to have the pressure of the opponents of single-payer during the legislative process.
A 15 year phase-in is a 15 year lobbying campaign by those opponents.
Let's have some numbers
The credibility of single-payer is greatly undermined by the lack of numbers. They need a model - which really needs to be made publicly available - to show skeptics how single-payer could be made to work.
Otherwise, reasonable people will suspect Zeno's Paradox at work.
The selling is up to single-payer proponents
They should be taking preemptive action to put the information on these points out there.
(If single-payer is such a tender plant that it dare not show its foliage for fear of attracting a dose of AHIP Agent Orange, fughedaboudit!)
And, when they're asked questions, they should have the information in depth to answer them.
Clearly, single-payer is sorely needed stat. But - part of being a grown-up is to recognize that many things that are sorely needed aren't necessarily provided.
Just because it stands to reason that single-payer is the way to go doesn't mean it stands to Harry and Louise.
Less Kumbaya and more spreadsheets would help.