Why Single Payer Health Care Can't Solve Our Problems

And for that matter, why our current "insurance" based system can't work.

First a very brief primer on what market economies do. There are two key fundamentals to markets and what market do. When people make choices in what they buy, they are motivated to get the best value for their money where that value is determined by their personal criteria. The second thing is that markets then respond to servicing what people are buying. Thus markets serve to allocate resources in order to deliver to consumers what they deem to be of most value. (As a side note, this is why jobs get shipped overseas in spite of our protestations: when we make the choice to buy, we place higher value on price, eg. Walmart, rather than US jobs.) This eliminates waste since resources are utilized to provide that which is valued most and not wasted on providing that which is not as highly valued. When resources are not tied up providing that which is of lesser valued, there are then more resources available to provide that which is more highly valued.

Now consider what single payer does. Consider a restaurant. Now in a market system, people choose items off of the menu that provide that which they most highly value. If you have a choice between chicken or lobster you will consider if the value to you of lobster over chicken is worth the additionally higher cost of lobster over chicken. If, to you, the value of lobster does not justify the additional cost, then you will choose the chicken. Now consider a single payer system. Since you will be sending the bill to the "single payer" the additional cost of the lobster is of no consequence to you. If you like lobster more than chicken, you will always choose lobster regardless of the actual cost of either. Now, the "single payer" will be paying the cost of providing the lobster even though you don't think the lobster is worth the extra cost. The cost of the meal has been removed from the equation of the person making the choice. Since government is that "single payer," the money to pay for the meals must come from somewhere. That somewhere being taxpayers. Thus we end up being taxed to pay for lobster dinners even though we don't think lobster is worth the additional cost. Thus the only way to control cost in this system is to decree that everyone shall only get chicken. The result now being that even if on occasion, you may feel that lobster is worth the extra cost, that option is not available to you and you no longer have a choice in what to eat. Thus the ultimate result for a single payer system is that either we pay for lobster whether or not we think it is worth the cost or we only get chicken and have no choice in the matter.

So for heath care this is disastrous. The result must necessarily be either that we have out of control health care costs (lobster) or we get no choice as the whether or not to receive certain tests or therapies (chicken). The only way to control health care costs is for those receiving the service to be the ones to decide which tests and therapies actually produce value. Health care costs are reduced because we are not paying for tests and therapies that don't add value and we are not wasting resources on those tests and therapies and making them available to provide tests and therapies that add more value. In order to reduce cost and waste in any market, cost vs. value must be considered. When cost is removed from the equation used to make choices, either waste and excess cost result or rationing and elimination of choice result. People calling for a single payer system are simply trying to avoid making the real choices that must be made and are living in denial that in reality there are real limitations and choices to be made and those choices have real affects on health care costs and resource allocation and utilization. Trying to live in denial of the need to take responsibility for our health care choices, including the costs of those choices, only consigns those choices to be made by government bureaucrats (or insurance bureaucrats). We just get what bureaucrats value, not what we value. Single payer simply replaces one dysfunctional system with another dysfunctional system and gets us no closer to affordable, quality, and abundant health care.

Fundamentally, our current system of health care that allows us to shirk the responsibility to make value based choices is what got us in this situation in the first place. And single payer simply does not fix that problem but merely propagates it. Our "insurance" based system allowed us to ignore the costs of our choices and single payer simply allows us to continue to ignore those costs. Until we stop trying to deny that there are real costs and resources and economic principles to consider in providing health care, we will never be able to deliver affordable, quality, and abundant health care. Those realities can't be swept under the rug by trying to hide those costs with a dysfunctional "insurance" system or with a dysfunctional "public" system. The sooner we face those realities, the sooner we can get the health care we want.