Dylan Scott tells the tale of Taiwan's successful implementation of single payer national health care. If you read the whole article you'll find a strange ambivalence. He seems to feel compelled to practice both-sideism and find a downside, but he fails to put it in context.
The purported downside is that health care costs keep rising so they have to choose between raising more revenues and restricting services. But that has nothing to do with the single payer system. That's true everywhere, no matter what kind of payment system, including in the U.S. In the UK, the Conservative governments have failed to provide enough revenue for the National Health Service for many years now, which has resulted in some problems with quality and waits for elective procedures, as well as physician burnout. But that's no an indictment of the concept, it's an indictment of the execution. Both the UK and Taiwanese systems are much more efficient than the U.S. system, by not squandering 20% or more on administration, marketing and profit; and they cover everybody.
Another problem in Taiwan is a shortage of doctors. Basically, the production of new physicians didn't keep up with the increased demand once everybody got coverage. But this is also a solvable problem. It is expensive and does take a long time to make new M.D.s, but a lot of routine health care can be provided by professionals who are a lot cheaper and faster to produce -- physician assistants and nurse practitioners. If the Taiwanese would make that investment, they could solve that problem in a few years I would think.
Those issues aside, the program is extremely popular. Everybody's covered, out of pocket expenses are largely trivial, and the taxes that pay for it are less than the insurance premiums Americans have to pay -- whether they know it or not because they may be hidden in payroll deductions.
But, the bad news is that the system was created before Taiwan became a democracy. The unelected leadership implemented it based on recommendations from American policy specialist Uwe Reinhardt, and they didn't have to worry that it was unpopular at the time. But once it actually happened, it became extremely popular and has continued full strength under subsequent elected governments. And that's the problem we face. Medicare for All loses support when people realize that it will mean a big change from the status quo, which may be okay for many of them; and of course it is opposed by the insurance industry and many providers and suppliers who expect their own incomes will be squeezed, and probably rightly so.
So it's a daunting problem politically. But it's the right thing to do.
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8 comments:
What's to keep future US Congresses from under-funding any single payer government system implemented and having to experience the same problems as the UK?
Well yes but people would still be better off than they are now. In the UK if you can afford it you can buy supplemental insurance or pay for services out of pocket. At least everybody has the NHS to fall back on. Sure, it's a political problem to keep it high quality, but it's still better than nothing.
The push back on government single-payer healthcare is, in part, fear of concentrating power.
What better government control of the population can there be than holding the purse strings of healthcare? Should this be a concern?
No, not at all. Point to the totalitarian dungeons in western Europe, Canada, Taiwan -- all prosperous, stable democracies. If government deprives people of health care to "control" them, the result will of course be the opposite -- loss of popularity and control of government.
I think the public in the US will be a tough sell. This is, in the end, a representative government and they'll have to be on board.
Even in a famine, you have to "SELL" the bread.
Hi Cervantes,
Off topic, but very interesting...maybe you'd like to post something about this. This is something that we've discussed somewhat earlier.
https://newrepublic.com/article/156207/plot-level-administrative-state
This is a basic argument about the nature of democratic governance in the modern era. But the U.S. is no different from every complex society in this regard: the legislature has to delegate rulemaking powers to executive agencies or government could not function. Certainly plenty to argue at the margins about how extensive that delegation ought to be and how specifically Congress should write its mandates. Where is the line between legislating and governing to be drawn? That can only be answered on a case-by-case basis, it's very difficult to write general principles.
The status quo of congress delegating authority to bureaus has transferred and continues to transfer congressional power to the executive branch. This is only accelerating. It's great when your guy is in there and it's not when the other camp's guy is in there(Obama, Trump).
If this practice is held to be constitutional, what's to stop other branches from delegating their power to some other branch such as the judicial branch letting an executive branch bureau decide court cases? Or, the executive branch delegating enforcement to the judicial branch?
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