Okay, I wan't to talk about Ralph Nader for a moment. I know I know. He cost Gore the election in 2000, which led to the horrendous presidency of George W. Bush. Let's leave that aside for the moment. The fact of the matter is that Ralph Nader is a very progressive candidate.
In this post I'm going to focus on healthcare. Now, admittedly, Barack Obama's healthcare plan is vastly superior to John McCain's. But in my opinion, both miss the mark.
The Nader plan would would create what's called a single payer healthcare system. As the name implies, a single entity is responsible for the payment of healthcare costs (as apposed to the cost being split up between you and your employer). In this case, the single payer would be the government, and for-profit insurance companies would no longer be necessary.
There are a lot of advantages of a single payer healthcare system. First, and foremost, every single American would receive high quality healthcare. Second, a single payer system would lower costs through simplicity and efficiency. It is estimated that 24% of our healthcare costs are due to administrative and other non-clinical expenses. If the federal government were solely responsible for paying healthcare costs, the current healthcare bureaucracy that coordinates between patients, employers, and insurance companies would no longer be necessary.
Let's make this a little more concrete. The World Health Organization ranks France number one in overall quality and access. The United States is ranked 37th. Yet, France spends 11.2% of its gdp on healthcare, while the U.S. spends 15.2% of gdp. So what's the deal? France has a single payer system, and the U.S. has a market based system.
So, how would Nader pay for his plan? Employers would simply pay a 7% payroll tax. For larger employers, this actually turns out to be less than what they currently spend on healthcare for their employees. This payroll tax would also level the playing field because companies that currently do not provide benefits would not have a competitive advantage. The rest of the money would come from a 2% income tax. Now, this might sound like your taxes are being raised, but when you consider the fact that you are no longer paying premiums, deductables, or copays, they actually aren't.
The bottom line is that we could be providing quality healthcare to every single American at an equal or lower cost. Let's do it.
5 comments:
I think that Obama gets this one right. One aspect of (real) conservatism that I respect is its healthy suspicion of centralized power. I think it's important that the system doesn't coalesce into a single point of failure, so that there's not the possibility of a FEMA-like institutional collapse if we ever elect another horrible president.
I also believe in the power of competition, as long as the incentives are correct. Obama's plan focuses on correcting the incentives of the current system, so that instead of having their financial success depend on providing less coverage, it depends on providing more effective coverage.
It also has the advantage of being politically viable. I think we're a long ways away from being able to pass a single-payer system.
I agree that a healthy dose of suspicion is always desirable. I don't think our democracy would survive without it.
The point you make about redundancy in an interesting one. Although, I would say that it seems to be more of an argument for competent leaders, rather than an argument against a single payer system.
On the issue of competition, I guess I am of the belief that there are some aspects of our lives that the private sector ought not be involved in. As long as an insurance company stands to make a profit by denying care, we run the risk of limiting equal access to facilities that affect our ability to be productive members of society.
I totally agree that a single payer system is not politically viable at the moment. Especially when John McCain is calling Barack Obama of being a socialist just for being a proponent of the progressive income tax.
If I felt like we could make any meaningful promise about what kinds of leaders we would end up with, then yes, it would be an argument for effective leadership. But we have 8 years under our belts showing us that Americans can manage to screw that one up, so it makes more sense to me to try to make the system as robust against bad leadership as possible.
One of the things that I like about the Obama plan is that it tries to reduce incentives for denying care, focusing on preventative health and paying based on outcome rather than procedures. The other part about his plan is the backdoor de facto single-payer system that comes from making the health insurance plan available to federal employees available to everyone.
And yeah, McCain has crossed into whole new territories of ridiculousness. It's amazing.
I'm going to make a somewhat provocative argument here. I think a single payer system may be more robust to bad leadership than Barack Obama's. Here's why. It is generally believed that social security, medicare, and medicaid have become third rails in American politics. I would argue that a single payer system has the potential to be put into the same category. Barack Obama's plan, however, leaves much of the current healthcare system in tact. Hence, it could be easily rolled back by a future congress or president.
Now, I'm not really stating this as an argument for a single payer system. I believe a single payer healthcare system is what's best for America. I just think that the above statements may be true.
Social Security might be a third rail in the sense that it could never be explicitly killed, but it's not like anyone has been willing to go to bat to save it yet. I certainly don't expect to get Social Security benefits, at least not anywhere near their current level.
Also, if the system is under the control of the executive branch, all the executive needs to do to undermine it is appoint a Michael Brown or Alberto Gonzalez to run it. Rolling back the Obama plan would at least require legislative involvement.
Single payer is more efficient and can benefit from greater economies of scale, but redundancy and competition are positive features, as well. I think I just value the latter more than the former, personally.
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