Why Single Payer Healthcare Works 3

It's often pointed out that the United States is the only rich nation not to provide healthcare services to its citizens at government, that is taxpayer, expense.  The implication is that we are inhumane for expecting people to pony up their own medical costs, or to go without.

In reality, hospitals long since lost the right to refuse treatment to patients who can't pay; in effect, they are subsidized either by other patients who can, or by the taxpayer.  Our system is so inefficient and obfuscated that, as a nation, we pay more in medical costs than do other nations which do cover all their citizens.

The proposed solution, of course, is for government to directly take over all medical needs and pay for them out of general tax revenues, much more cheaply.  Often conservatives argue against this plan by pointing out that government nearly always does this more expensively than the private sector - but as we saw in the earlier articles in this series, that's not true here.  A single-payer healthcare system really can save a lot of money - the true problem is that these savings come at a very large, but non-obvious cost.

Let's look at one more way in which the Left's plan can achieve very real financial savings, but by forcing us to lose something valuable.

First, Kill All the Lawyers...

There's one final way in which a single-payer system saves money: lower malpractice and insurance overhead costs.

In America, an individual doctor must pay thousands of dollars for medical malpractice insurance; hospitals and larger practices pay correspondingly more.  While there have been liability reforms leading to fewer lawsuits and lower payouts, we still hear about "jackpot" judgments where patients take home millions of dollars in settlements.

In a way this makes sense: obviously, an incompetent doctor can do severe and permanent harm to a patient, and taking care of (say) a paraplegic for the rest of an unhappy life costs a fortune.  On the other hand, the lawyers usually take up to half of the money and the insurance company has operating expenses and profits too.

A nationalized single-payer health care system would eliminate many of those costs.  It's hard to sue the government, and you don't usually get much even when you win, so most lawyers will only accept the most extreme, open-and-shut cases.  Also, since a national health care system pays for all your medical needs anyway, and most of the financial harm done to an injured patient are medical costs, there's less need to sue in the first place.

Once again, on paper, a single-payer health care system has a clear opportunity to save billions of dollars in costs while taking money away from those greedy lawyers everyone loves to hate.  What's not to like?

The trouble is, there's a reason we allow lawsuits: it provides a way to keep things honest.  If a company, provider, doctor, insurance company, or anyone else, is too dishonest or incompetent, some lawyer will seize an opportunity to fleece them.  This provides an incentive to stay within reasonable bounds, at least reasonable enough to be able to make that argument to a jury.

This is particularly important when you are dealing with a monopoly or oligopoly.  Most people hate their TV company, but there's very little they can do about it because only one or two providers serve their home.  That's why streaming services, where everyone competes with everyone, are growing so quickly - it allows people to abandon a hated, overpriced cable TV monopoly with legendarily bad service.

How are you supposed to escape single-payer healthcare?  The whole point of it is to entirely cover all medical services under one vast bureaucracy, from which there is no escape short of leaving the country.

Even with a monopoly, lawyering can help keep things at least a little bit honest, though generally much delayed, as the unfortunate water-drinkers of Flint, Michigan are discovering.

In a national health care system, this force is greatly lessened if not eliminated.  Yes, voters can express their displeasure at the polls, but only in a very general way: no politician ever runs on a platform of firing Doctor X or Hospital Administrator Y.

Thus we find that, in places like England and Canada, there are some excellent hospitals, and others with rats running around in the operating room.  Don't like it?  Too bad - you go where you're sent or not at all, and there's nothing you can do about it.  That would never happen here in the United States: some enterprising lawyer would spy a massive payout and sue, and the filthy place would be shut down forthwith.

A century ago, Henry Ford decided to offer his Model T to customers in "any color they wanted, so long as it was black."  He chose to do this because black paint was cheaper and dried faster so he could manufacture his cars quicker and sell them for less.  Since most Americans of the day did not own a car and had limited funds, they were willing to accept this tradeoff; Model Ts sold in the millions.

But as time went on and Americans grew richer, they started to feel like they shouldn't have to live and drive in a black-and-white movie.  Other car companies began to offer their cars in an assortment of colors; after several decades of resistance, even Ford grudgingly put forth a palette.  Today, cars come in an astonishing variety of hues, a fair number of which are stunningly ugly, but every person has the opportunity to exercise their personal taste or lack thereof.  Our society is wealthy enough to afford this.

A national health care system represents a decision that our society is not wealthy enough to afford choice - you get what you get, and that's that.  For some countries that's appropriate.  Is that truly what America wants?

If so - well, we get the government we deserve, and perhaps the doctoring as well.