Friday, August 24, 2007

Single Payer Insurance?

I'm continually amazed at the number of people who are clamoring for a 'single payer' health system in the United States.   I'm shocked that people would voluntarily want to give up control over their bodies to a bunch of politicians and bureaucrats.   Why on Earth would you want to cede control over your body to a single, monolithic insurance entity which only responds to lobbying and vote buying?  If you are in an HMO, you may have trouble getting certain health care options treated, but at least you have the possibility to switch insurance providers.  If we move to a single payer system, we will effectively have one very large HMO, run by the federal government.   If you are dissatisfied with what's covered by that HMO, what are you going to do?  Are you going to move to a new country?  Hope that in the next election 'your' people get elected and change the rules?  HMOs may be bad, but a single government monopoly HMO would be much worse.

The smarter choice is to go in the opposite direction, with more payers, not fewer.  Most people should pay for simple things out of pocket and use privately purchased insurance for big and unexpected expenses.  You, not your employer or government, would choose the insurance that best fits your family.  Insurance portability is a non-issue because you own your policy.   For those people who truly can't afford health care, there could be assistance programs, ideally through private charity, that could be established to help out.  Think about it, we have people who can't afford housing, but we don't require everyone to move into public housing.  We have people who can't afford food, yet we don't require everyone to go on food stamps.  Similarly, just because a segment of the population can't afford simple health care expenses doesn't mean we should throw everybody into one giant public system.  Certainly private health insurance is a mess right now because of years of government meddling, often at the behest of the insurance industry itself.  Cross-state purchasing restrictions and government mandates only reduce variety and drive up costs unnecessarily.  If you remove these restrictions, increased competition will bring new innovation, better service and lower prices.

Those who think single payer would be a good thing are living in a fools paradise.  Medicare, a smaller scale single-payer system, is facing financial difficulties.  Other countries are recognizing that their systems also have problems.   Really sick people are dying from being on wait lists.  There are quality of care issues as well.  However, in my mind, the biggest problem with single payer is the threat posed to individual freedom.  This aspect of the system is never mentioned by supporters.   The simple fact is that once taxpayers start paying the bills for health care, taxpayers are going to want to make sure their money is being well spent.  As such, there will be increased pressure to pass new nanny state laws to 'promote' good health and to control costs.  You can expect all sorts of new 'sin' taxes.  You can also bet that there will be increased pressure to ban or reduce controversial procedures such as abortion.  After all, a reasonable argument can be made that the government shouldn't be paying to kill unborn children.   The important thing here is that once taxpayers are responsible for paying the bills, taxpayers have a large amount of control over what you do with your body.