What is Single Payer?

What is Single Payer?

It is a national health program. The government taxes earnings. The people go to doctors. Doctors bill the government. The government health agency pays the doctors with the money they took from the earners. The government is the “single payer”, the only way for doctors to get paid. Government is the big cahuna, the only game in town. Australia, Canada and Taiwan have it. Other nations have other versions of socialized medicine.

Is it socialized medicine? Yes. Margarita McLarty denies it. She wrote a letter to the editor in the Bozeman Daily Chronicle. It appeared May 25 or 26. She wrote: “What is ‘single-payer health care’? It is not ‘socialized medicine’. You get to choose your health care providers.” In doing so, she parrots the Physicians for a National Health Plan (PNHP) statement.

I disagree. It is socialized medicine. Whenever the government takes money from you, pools it with other peoples’ money, and spends it according to their choices, that is socialized medicine. Imagine a similar system in the provision of food. The government takes $400 a month out of your paycheck. You go to the grocery store. You walk out with food. The government pays the grocery store for what you took. When taxes collected are not enough, what you’ll be allowed to carry out will be determined by the government. This system is not voluntary. It does not empower individuals. It is a collective system. Thus, it is socialized medicine. Collective systems are socialized systems.

McLarty and PNHP claims people will be able to “choose your own health care providers.” Pick your doctor. Stand in line. If he or she is too busy, what then? Stand in line. No, that will not work. The doctor will say, “Not accepting new patients.” This happens in Canada all the time. So you go to another doctor. But he or she is busy. You get to choose any doctor who is not overwhelmed by the huge new demand created by people not paying their own bills. Good luck finding one.

Image a cine-plex. You have a movie voucher. You can choose any movie you want as long as there are seats. When all the seats are full, how much choice do you have? Unlimited “access” to the movie theaters will cause demand to burgeon. Good luck getting in. Get in line. That will be the nature of single-payer. Get in line. Try to find services. Wait. Take a number. Some person with a sniffle takes the doctor’s time, while you need a tourniquet.

The government will have to step in. They will decide how this scare resource, doctor’s time, will be fairly apportioned. They will limit what doctors can treat, so as to put some constraints on demand. They will figure out ways of getting people in lines and waiting lists. This is rationing. It’s the way they did it with meat and cheese during WWII. If voluntary market-based systems are not employed, someone has to ration to satisfy the amplified demand. That falls to the single-payer, the blessed, all-wise government.

The American Medical Student Association, AMSA, definition for single payer is: “Where both the collection of funds and the reimbursement are the responsibility of one entity: the government”. Comforting isn’t it? The government does everything. A few clarifications are needed. “Collection of funds” means taxes. Taxes are taken from workers. One way not to pay is not to work, a course some will take. “Reimbursement” means payments to doctors, hospitals and pharmacies. The government sets the amount. If the amount is set low, doctors will become farmers and researchers will not invent new drugs. “Responsibility” is a strange word to invoke in a system which shifts responsibility so radically away from individuals, families and providers, to an enormous, politically vulnerable entity. Government will make life and death decisions based on the politics of the moment.

Government sets the tax rates workers pay. Can workers opt out? No. If you want a service the single payer doesn’t cover, and if it is still legal to choose it, you will pay for it directly, in addition to the taxes taken from you.

How much will the tax be? No one knows. Advocates say it will be a modest increase in expense so that the presently “uninsured” will get coverage.  How much will single payer cost? Since $2 trillion was spent on medical services in 2006 (Kaiser Foundation), and there are 120 million private, non-farm employees, the cost per employee would be $16,666 each. Promoters of single payer are talking much lower tax rates. That’s promotion. Don’t believe them. Do some long division yourself.

Who pays? Workers. That leaves out youth, the unemployed, the very old, retirees. The incentive to choose unemployment increases.

Is it fair? Unemployed people will love it. A fat smoker will cost the system four times as much as an exercising non-smoker. They will pay the same tax. Fat people will think it’s fair; fastidious people will not. Fatness will pay.

How much will doctors be paid? Much less than nw. No one knows how much less. Bureaucrats will decide. They will frequently change their minds. Fewer people will choose medicine as a career.

Who loses their jobs? 3.2 million people in the health insurance industry. Also hurt are workers throughout the economy as economic activity slows down.

Are all Democrats in favor? No. Senator Max Baucus’ proposal is not a single payer plan, though it is socialized medicine of another flavor. It allows private insurance companies a role, at least until government decisions make them uncompetitive. Single payer advocates are livid. They want the whole enchilada. They attack Obama, too. He promised single payer but now supports the Baucus plan. Advocates are even mad at their comrades in the unions, the SEIU, Service Employees International Union. (The word International in their name signals their solidarity with international workers. Recall the Comintern, which was shorthand for Communist International. To know the enormity of communism’s crimes, consult The Black Book of Communism.) SEIU workers are going door-to-door drumming up support for the Baucus plan.

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Universal Health Care

Nine Myths About Universal Health Care

Myth 1: The uninsured get no care.

Fact: Many of the uninsured could afford insurance but choose not to buy it. Hospitals and doctors frequently serve the uninsured without charge. Medicaid pays. The uninsured get care.

Myth 2: Single payer advocates know how much America’s health bill is “to take care of everybody”, and how much it will be in the future.

Fact: This figure cannot be known by any one person or entity. Planners are not omniscient. What the government would cover is not known. How demographics, health technology and politics will change is not known. Would the plan cover- • Hip replacement? Cornea transplants? Organ transplants past 80? Sex change operations are included in Brazil’s plan. Would the US plan cover them? • Dentistry? Orthodontics? Only once per lifetime? • Eyeglasses? Lost eyeglasses? • Abortion? HIV? • Stomach stapling? Weight loss drugs? • Physical Therapy? Chiropractic? • Home care provided by a family member? • Hearing aids? • School sports physicals? Boy Scout camp physicals? • Addiction treatment? Smoking cessation? • Seasonal allergy relief? • Fertility treatments and IVF? • Bicycle helmets? Medicare and Medicaid do not cover everything. For example, hearing aids are not paid for. Medicare and Medicaid constantly revise the list of covered services and drugs. “Medicare for all”, as advocates for single payer prefer their plan be known, would not supply all demands. The impression held by many supporters of social medicine is that budgets would be unlimited. Bob Putsch, a member of PNHP, Physicians for a National Health Plan, says that by reducing administrative costs, “we can take care of everybody”. The marketing slogan for PNHP is, “Everybody In. Nobody Out.” Does this sound ominously like herding people into rail cars like cattle, with no right of exit? Like captivity? Funding all health needs without exclusion will short something that tax revenues presently pay. What are single payer advocates willing to give up? National security? Schools? The real world is not static. Basing program decisions on present spending is vain.

Myth 3: The US health care system is a free market system. (And that’s why “it is so bad”.)

Fact: the US system is 60% socialized. John Nordwick, CEO of Bozeman Deaconess Hospital, stated that 60% of all medical bills are paid by government agencies; Medicare, Medicaid, Indian Health Service and the Veteran’s Administration. Bob Putsch concurred. These programs’ large presence distorts decisions and incentives, raises costs for some participants, creates billing nightmares, and creates moral hazard. 60% of our system’s problems must be attributable to socialized health care. The free market remains untried.

Myth 4: The administrative costs of dealing with private insurance and government programs are 31% of system-wide costs, money better spent on providing care.

Fact: Considerable disagreement exists about this figure. “The General Accounting Office projects an administrative savings of 10 percent” (PNHP website.) Bureaucracies such as those envisioned by a single payer plan entail significant costs. If those costs could be diverted to care, they would still fall short of matching the likely increased demand. No one knows how much, if any, administrative cost would be saved by seizing the entire US health care system.

Myth 5: The government is good at cost containment.

Fact: Government program spending escalates. Medicaid is breaking state budgets. When Medicare began in 1965 its planners estimated that in 1990 it would cost $9 billion. Instead, it cost $66 billion, seven times as much. Consider Amtrak, the United States Postal Service and military procurement. MassCare, the recently adopted Massachusetts “everybody in” plan, is over budget 85% in its very first year.

Myth 6: European social health systems are universally admired.

Fact: Citizens of countries with social medicine are not entirely satisfied. The cost of their programs swells unsustainably. The tax burden inhibits economic growth, and increases unemployment. Germany’s unemployment rate averaged 9% over a recent 9 year period; the US employment rate averaged 5% over the same 9 year period. Maurice Williams, a 55-year-old construction business owner, said he turned to an Internet company called Treatment Choices because he faced a wait in England for heart bypass surgery, which his doctor said he needed immediately to live. The company gave him a list of places where he could get the surgery right away. “I felt pretty let down,” he said while convalescing at a cardiac center in Lahr, Germany. “Living in England all those years, paying all that money into the system … Now I’m sick, knocking at death’s door, and I can’t get help.” “50,000 surgeries closed as GPs threaten to desert Germany and head for Britain, reports our correspondent THOUSANDS of German doctors threatened yesterday to desert Europe’s most modern health system and work in Britain, rather than put up with declining wages and longer hours.” People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either “fundamental change” or “complete rebuilding.” It is ironic that US citizens are preparing to adopt more social medicine programs while Canada and European countries are backing away due to exploding costs. But Bob Putsch asks, “Why be afraid of single payer when it works so well all over the world?” Because who wants to live in Western Europe’s moribund economies or under the heavy hand as in Cuba or North Korea?

Self-portrait of a young, obese male. Wikimedia.

Self-portrait of a young, obese male. Wikimedia.

Myth 7: US health care costs are higher than other countries’ primarily due to the administrative costs of private insurance companies.

Fact: Many differences exist between the US and other countries. The US is not Switzerland. We have large high-cost populations such as African-Americans, Native Americans and at least 13 million illegal aliens. Our citizens’ obesity radically increases costs. Our tort system forces defensive medicine, doctors performing duplicate and unnecessary tests to protect themselves from lawsuits. This adds perhaps 20%. Our pharmaceutical research benefits the whole world. European nations free-load; the US pays. The US is not like Iceland, Sweden, or Taiwan.

Myth 8: Universal coverage is universal.

Fact: Even universal coverage nations have people who lack “access” to medicine. In Brazil, health care is free, but “most of Brazil’s hospitals are considered substandard, with long waits for procedures.” I personally know a Brazilian woman who was told to wait 8 months for cancer treatment. A Sao Paulo newspaper reported that 14% of Sao Paulo residents lack access.

Myth 9: Health problems are accidental things that befall people unawares.

Fact: Most health problems are self-inflicted and predictable. When people bring upon themselves health problems, should they not pay? Why should others pay? Deepak Chopra wrote in the Wall Street Journal, “Heart disease, diabetes, prostate cancer, breast cancer and obesity account for 75% of health-care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle.” The costs of over-eating, slothful inattention to exercise, sexual promiscuity, smoking, drinking, drug use, and partaking of high-fat and high-calorie foods, are costs that should be borne by the person himself or herself. Why should a thin exerciser have the same taxes taken out for the National Health Service as an inactive glutton that is 200 pounds overweight? Why should Coloradans, of which 16% are obese, send money to heal Mississippians, of whom 29% are obese?

Why should virgin young adults pay the same taxes as sexual profligates with Chlamydia rates eight times as high?

Proponents of a single payer system are operating under false assumptions and myths.

Single Payer Presentation

Single Payer Presentation

Old Naval Hospital

Old Naval Hospital

Last night, Melani and I went to an event sponsored by Bozeman for Change, a vestige of the Obama campaign, a clot of Democrats. A doctor, Bob Putsch, spoke in favor of a single payer, government coercion health plan that could take the place of Medicare, Medicaid, Veteran’s Administration, SCHIP, and possibly the Indian Health Service. (Ask about the IHS.) Putsch is a member of Physicians for a National Health Plan, PNHP. They prefer the term “Medicare for all” rather than “single payer”. They found public resistance to the latter.

Putsch’s main points were:

  • 46 million Americans have no formal health insurance
  • Health costs bankrupt some people
  • Health costs are higher in the US than other industrialized nations
  • Infant mortality and maternal mortality is higher in the US than some nations
  • Money is wasted on administration, doctors billing hundreds of private insurance companies
  • These high administrative costs could be used to provide medical services if billing was simplified as under a government single payer plan

I remember all these complaints. Hillary Clinton made them in 1990. She and her husband tried a massive overhaul of health care in which the government would dominate. Putsch’s points have a long history.

One of the most surprising observations I made was dissent within the Democratic club. Max Baucus has a bill socializing health care to a large extent. But because it allows a role for private insurers, single payer advocates oppose it. Obama is with Baucus, though they remember him advocating for a single payer plan at one time. A far-left union, the Service Employees International Union, SEIU, also supports the Baucus bill. References to Baucus, Obama and SEIU drew snickers and discontent from the crowd on Friday night. They are going to picket Baucus’ listening tour coming up. And I thought Democrats were unified.

Park downtown for only $75.53! (Daily)

Bozeman’s new parking garage is now open. How many people use it? Is it a good deal? Who pays the cost of parking? Who benefits?

parking garage

parking garage

Bozeman’s new parking garage is now open. How many people use it? Is it a good deal? Who pays the cost of parking? Who benefits?

On April 22, 2009, at 4:45 p.m., there were 27 regular parkers and 18 vehicles in the $1 per day area, the “permit” parking area. If we assume that the 27 cars were there all day, paying $.50 per hour, or $4.00 per day,  total revenue was $126.00 for April 22.

What is the cost? The capital cost, the cost of financing the building is $3,050 per day, 365 days per year, including Sundays when few parkers will visit. Operating costs could run as high as $500.00 per day. On April 22nd there were three employees at work. Other days there were fewer. Let’s use an employee cost of $300 per day and other operating costs such as maintenance on the computer system, lights, cleaning, security, accounting, repairs and maintenance, promotion, insurance, and depreciation that total $200, for a total operating cost dailyof $500.00.

Add capital and operating costs for a total of $3,550 daily.

On April 22nd revenue was $126.00. The loss was $3,424. For one day.

If each parker was paying their full cost for parking on April 22nd, the charge would have been $3,550/ 47, or $75.53. Any takers? That would be an curious promotion: “Park downtown for only $75.53!”

So if parkers are  paying $4.00, not $75.53, who pays the other $71.53? Taypayers. Taxpayers might be pardoned for objecting.

On April 22, 2009, at 4:45 p.m., there were 27 regular parkers and 18 vehicles in the $1 per day area, the “permit” parking area. If we assume that the 27 cars were there all day, paying $.50 per hour, or $4.00 per day,  total revenue was $126.00 for April 22.

What is the cost? The capital cost, the cost of financing the building is $3,050 per day, 365 days per year, including Sundays when few parkers will visit. Operating costs could run as high as $500.00 per day. On April 22nd there were three employees at work. Other days there were fewer. Let’s use an employee cost of $300 per day and other operating costs such as maintenance on the computer system, lights, cleaning, security, accounting, repairs and maintenance, promotion, insurance, and depreciation that total $200, for a total operating cost dailyof $500.00.

Add capital and operating costs for a total of $3,550 daily.

On April 22nd revenue was $126.00. The loss was $3,424. For one day.

If each parker was paying their full cost for parking on April 22nd, the charge would have been $3,550/ 47, or $75.53. Any takers? That would be an curious promotion: “Park downtown for only $75.53!”

So if parkers are  paying $4.00, not $75.53, who pays the other $71.53? Taypayers. Taxpayers might be pardoned for objecting.

Questioning Stimulus Spending

Natalie Meyer: Grants and Climate Protection Coordinator

City of Bozeman

34 N. Rouse

Bozeman, MT 59715

Dear Natalie:

I read the article about $175,000 in stimulus (taxpayer) funds to be spent on “eco-friendly improvements” in city buildings.

Will you please provide the Return On Investment expected for each of the following:

Boiler in downtown fire station                          $48,400

Charging stations for electric vehicles

in new parking garage                                       $5,000

Solar panels in under-construction

fire station on west side                         $20,000

Heater replacement at city shops                                   $16,500

Hot water pumps at City Hall                                        $12,000

Low-flush toilets at Senior Center                                 $10,000

Please provide the assumptions underlying your ROI projections, and any spreadsheets or worksheets that generated your figures.

Please provide a cost breakdown for the toilet replacement project. Low-flush toilets should cost under $224 each. Doesn’t the already-subsidized Toilet Tradeout Program cover this? Don’t its promoters claim that the cost per traded-out toilet, after taxpayer subsidy, is $74 plus $150 labor, or $224? Does the Senior Center really have 45 toilets?

Will any of these projects “pay for themselves” in less than 25 years?

Thank you kindly,

Tom Burnett