Medicare and single-payer

I am consistently baffled at why single-payer pundits want to put our health care in the hands of the government. People like Ezra Klein and Paul Krugman simply don’t know what they are asking for, and have zero insight into how restrictive Medicare really is for a practicing physician.

Their ridiculous reimbursement decisions, rules and restrictions are far, far worse than any private insurer. Roy Poses agrees:

This is also a reminder that those who put their faith in establishing a single payer health care system to cover all US citizens may be sorely disappointed. If a single payer system continues the irrationality, opacity, and susceptibility to political influence of our current single payer system, having such a system cover everyone might just make things worse.

My question to single-payer advocates, for which I have yet to receive an answer. How do you explain the miserable failure of the single-payer funded Indian Health Service? And before you explain that it’s underfunded, why do you have such blind faith that the government will appropriately fund a national single-payer system? I would honestly like to know.

So, the liberal dragons have awakened. Thanks for your responses Graham and Ezra.

Graham is particularly inspiring:

Why do I think we need to do it? Because of the mess. The mess of billions of dollars wasted on duplicated tests and administrative overhead. The mess that millions of people in the richest nation in the world decide between eating and buying their medications (which would often prevent doctor and ED visits in the first place), or that many honestly consider waiting out an appendicitis because they lack insurance and know their financial lives will be ruined by a $50,000 hospital bill. The mess that fragmented care complicates care so greatly. The mess that other countries can apparently do it”“and for cheaper”“and we apparently can’t. I could go on.

Why do I think we can do it? Because we’re America, god damn it. We’re the land of opportunity. Innovation. Creativity.

There are countless horror stories on both sides, so let’s get past the hospital bill anecdotes.

In theory, a single-payer system may result in less administrative waste, reimburse and focus on primary care, and provide universal coverage. It may look good on paper. And in a utopia where a government was knowledgeable about health care and had limitless dollars, it may work.

I’m sad to say we don’t live in that world. Medicare given countless examples why the government is inept in managing health, ranging from their inane coding rules, misguided emphasis on documentation, to their short-sighted and damaging cuts in physician reimbursement.

Yes, this is indeed America. A country where its government has turned a blind eye to Native Americans and Veterans, by critically underfunding their health care systems to the point of uselessness. I would not have tremendous confidence in that track record.

And yet, people are still willing to give them the keys. Call me a cynic, but be careful what you wish for. Forgive me if I don’t think these are the right guys for the job.