Being a Canadian living in the US, I have first hand experience with both a single payer system, and the completely dysfunctional US approach, which is caught in the nether-land between Government support and market driven forces - as a result it has none of the advantages of either.
Proponents of a single payer system want, appropriately, to make basic health care a human right - we have a moral duty to help those less fortunate than us. Other single payer systems have better outcomes at lower cost. Proponents of a pure market driven system believe we would enable bad behavior by giving healthcare to all, and that if the system was truly driven by market forces we would end up with solutions for both the low and high end. They also, with at least some support, claim that innovation is higher in a market driven system than in a government run one. If you put a system completely under government control, innovation grinds to a halt. Of course, both are right and wrong. The best solutions are a combination of both, as outlined in an article from a few years ago in The Atlantic.
Before we look at that, I have to highlight how disappointed I am in the positioning of Bernie's proposal. The messaging seems to go out of its way to be partisan. "Democrats this", and "Democrats that" - as if no independents or Republicans would support his moral argument and that all Democrats would. It is just another example of how a duopoly operates (which is what the US system is). Imagine how nice the proposal would be if it was presented as a 'human proposal' as opposed to a 'Democrat' one. By presenting it this way, he makes conversion of almost any Republican more difficult. Not smart.
Back to The Atlantic. What the US should do is simply take either Switzerland's or Signapore's system and work towards implementation of it. There is no need, at this point, to architect a new model - simply take the best one that has evolved to date, and adopt it. I will not re-articulate those systems here.
Getting to one of those systems is hard, so here is what I would propose.
We need a two phase approach:
Further, this approach should satisfy both Republican and Democratic goals. The Swiss and Signapore systems have (close to) the right balance of Government and market driven forces. There is no need to develop a new model; just take the best that has evolved outside the US. Both the moral and market needs are met.
Before we look at that, I have to highlight how disappointed I am in the positioning of Bernie's proposal. The messaging seems to go out of its way to be partisan. "Democrats this", and "Democrats that" - as if no independents or Republicans would support his moral argument and that all Democrats would. It is just another example of how a duopoly operates (which is what the US system is). Imagine how nice the proposal would be if it was presented as a 'human proposal' as opposed to a 'Democrat' one. By presenting it this way, he makes conversion of almost any Republican more difficult. Not smart.
Back to The Atlantic. What the US should do is simply take either Switzerland's or Signapore's system and work towards implementation of it. There is no need, at this point, to architect a new model - simply take the best one that has evolved to date, and adopt it. I will not re-articulate those systems here.
Getting to one of those systems is hard, so here is what I would propose.
We need a two phase approach:
- In phase 1, we move to a Government run single payer system. We use this phase to bring radical transparency, full outcome measurements, and reasonable profit profiles to the system. This should be run by an independent group, who can not receive pressure, payments, or spiffs from existing health care companies. Their only mandate is to simplify how health care is delivered, and to bring costs to a reasonable place (not minimize costs; simply make them reasonable - we don't want to break the innovation cycle, simply make it transparent). Individuals should be able to research, choose, and hold accountable all aspects of their health care experience - from insurance to optional procedures.
During this phase, standards for transparency are developed and adopted. Companies are given time frames in which to respect those standards, and if they don't comply, they are dropped from the system. Also during this phase, the basic health care structure - savings accounts, opt-outs, multi-tier service - are put in place.
It is possible, during this phase, that the Government has to step into some elements of the system and provide those services - this is an assumption based on how broken the current system is. As it is pulled apart and as light is shone on the innards, some services may be so convoluted or so broken that providing a Government run component is the only way to go. - In phase 2, we re-privatize as much as we can, under an architectural model like Switzerland or Singapore. The Government function becomes enforcing the standards developed in phase 1, as opposed to providing any services. Much like the SEC oversees public companies, a regulatory body would oversee all health ecosystem providers. Unlike the SEC, the goal is to improve outcomes, not support short term profit taking.
Further, this approach should satisfy both Republican and Democratic goals. The Swiss and Signapore systems have (close to) the right balance of Government and market driven forces. There is no need to develop a new model; just take the best that has evolved outside the US. Both the moral and market needs are met.