On the surface, the title of this article seems paradoxical. How can any conservative in the USA even contemplate the concept of the government creating a single-payer health insurance system covering all Americans and, in effect, ending private major medical health insurance?

In this post I hope to make the conservative case for a single payer incontrovertible for those occupying the centre-right politically.

Conservatives are supposed to be the defenders of business. Yet our current health care system works as an albatross around the neck of American business. Likewise, the piecemeal reforms of ObamaCare seem only to make some problems even worse. Hence it is only a matter of time before a single-payer becomes inevitable in this country. Therefore conservatives need to position themselves and come to terms with this eventual reality. And if history is a judge, many times it takes, say, a Nixon to go to China or a Clinton to do welfare reform. A Republican president may be the one who puts single-payer in place down the road.

According to the US Chamber of Commerce, group health insurance is the single most expensive benefit offered to employees. General Motors’ cost alone to offer health insurance yearly to employees is $5 billion dollars. To put it in perspective, health care insurance alone, adds $1,500-$2,000 to the price of each car that comes off the assembly line.

A RAND study from 2009 found that companies with higher levels of participation in employee health insurance benefits had much slower economic growth then those companies and industries which had lower health insurance costs or participation to deal with.

Let’s face it, health insurance is a drag on American competitiveness. Every major trading partner of the United States has some form of government-organized health care, so why do we continue to saddle American corporations like working donkeys with such expensive costs?

Americans pride ourselves on being the land of opportunity and of Horatio Alger. Yet the truth is social democratic Denmark now has higher levels of entrepreneurship than the USA. One primary difference between a Danish entrepreneur and his/her American counterpart is health care. Because of universal health care, a Danish worker with health problems can strike out on their own anytime and start up a business. Americans with health problems have to weigh the cost and benefit of leaving their jobs and decide if they can afford or even qualify for an individual health insurance policy.

Americans are more and more making working decisions based on health insurance. According to the Census Bureau, over 78 percent of all small business have no employees. Thus entrepreneurs in America are more likely to have to buy individual health insurance policies, which are usually more expensive and difficult to obtain than group health insurance.

It is no secret conservatives and libertarians in the USA ♥ Hong Kong. After all HK has Ricardian free trade, low levels of regulations, no capital gains tax and an individual flat tax. Every year when the Heritage Foundation releases its Index of Economic Freedom, HK always tops the list.

However, HK has a dirty little secret. It has a very good national health care system. HK citizens have some of the highest life expectancies in the world but their government health care system only costs about three percent of their GDP to operate (a sharp contrast to the 20 percent of GDP that USA health care costs are expected to be in the next decade).

The point of the HK example is that this beacon of capitalism manages to operate the freest economy in the world while offering and providing a British-style national health service. if one listens to rightwing shock radio or the rhetoric of the Tea Party, it is impossible for that to happen. After all government health care would turn America into a giant Gulag Archipelago.

American conservatives are free to believe that a single-payer system in America will lead to a road to serfdom. Just don’t tell the citizens of Hong Kong, OK? You may embarrass yourself.

In many areas of America, words like “free trade” and “globalization” are fighting words. Blue collar America lives everyday with the worry that they will show up at work and find a sign saying, “Moved to China: See ya, Don’t want to be ya.”

Those workers are then left to scramble to find a job, usually for less pay and lesser benefits. In the meantime they go on unemployment insurance and hope they can pay their COBRA premiums with their unemployment pay and their spouse’s salary. (COBRA allows Americans to keep their former employer-offered health insurance if they pay the full cost once they leave the company. Typically, employers pay 50% of an employees health insurance premiums.)

Let’s contrast this to the Danish workforce again. When leftwing journalist Bob Kuttner traveled to Denmark, he discovered something very interesting (and probably fascinating since Kuttner is an advocate of managed trade). What he found was the Danish labor movement is completely at ease with free trade and globalization. Part of this is because of Denmark’s very proactive labor retraining policies; but some of it has to do with the fact that a Danish worker’s health care is not tied to their employment. So if a Danish worker’s job is outsourced to Poland, at least some of the pain is mitigated by not having to worry about losing health insurance.

If conservatives would like to take the teeth out of the American labor movement, what better way than to eliminated their fears about free trade and the free market by supporting a single-payer?

The name Margaret Thatcher is said with much reverence in the USA by conservatives, almost with the same love as for Ronald Reagan. Yet Lady Thatcher always supported Britain’s National Health Service(NHS). In 1983, for example, as she geared up for her re-election campaign, Thatcher said, “The NHS is safe in our hands.”

Rather ironic that if Lady Thatcher were to change citizenship, move to the USA and try and run for office as a Republican, she probably could not win a GOP primary. She would be denounced as a crypto-commie by Tea Party activists for having once supported “socialized health care.”

Thatcher– much like the other iconic conservative statesmen of the 20th century in Europe, from Winston Churchill to Konrad Adenauer to Ludwig Erhard to Charles DeGaulle– made peace with their countries universal health care system. It is only in America where making peace with such an arrangement would be considered, “socialism” or “Marxism”.

The current system is unsustainable, a single-payer is coming– it’s only a matter of time. Conservatives forget that health care is not an example of a perfect market. It is not the same as shopping for a car, choosing an airline or deciding which brand of cereal to buy. Health care is the quintessential example of information asymmetry (PDF).

If conservatives and Republicans can’t talk about these things, they will cede the issue to liberals and Democrats.

"Hence it is only a matter of time before a single-payer becomes inevitable in this country. Therefore conservatives need to position themselves and come to terms with this eventual reality. And if history is a judge, many times it takes, say, a Nixon to go to China or a Clinton to do welfare reform. A Republican president may be the one who puts single-payer in place down the road.

Master Goebbels would be so proud!

"health care costs burden our private sector in ways that inhibit American competitiveness abroad. Our competitors in Europe and Asia don't have to worry about health insurance costs."

Yeah, I heard there's lots of other free shit over there too.

"We can continue to let escalating health care costs drag our economy down or we can have single payer health care."

They escalate, because of the particulars of govm't interference. They're designed to run up the costs deliberately to consolidate the monopoly. If you like single payer so much, why don't you just step up and volunteer to be that individual!

THE REAL DEAL:

Emergency room visits grow in Mass. New insurance law did not reduce number of users
The number of people visiting hospital emergency rooms has climbed in Massachusetts,
despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use."

Back to the ObamaCare Future (price controls in Massachusetts)
Natural experiments are rare in politics, but few are as instructive as the prototype for
ObamaCare that Massachusetts set in motion in 2006.
Last month, Democratic Governor Deval Patrick landed a neutron bomb, proposing hard
price controls across almost all Massachusetts health care. State regulators already have
the power to cap insurance premiums, which Mr. Patrick is activating. He also filed a bill
that would give state regulators the power to review the rates of hospitals, physician
groups and some specialty providers.

It doesn't even count as an irony that former Governor Mitt Romney (like President Obama) sold this plan as a way to control spending"

"The Huge Middle Class Tax Increase Coming Our Way With ObamaCare
The former CBO director, Douglas Holtz-Eakin, warns today on the effect ObamaCare
will have on our economy and health care. These facts should be painfully obvious to
those with even one iota of common sense. This bill will lead to a huge middle class tax increase:
Remember when health-care reform was supposed to make life better for the middle
class? That dream began to unravel this past summer when Congress proposed a bill that
failed to include any competition-based reforms that would actually bend the curve of
health-care costs. It fell apart completely when Democrats began papering over the
gaping holes their plan would rip in the federal budget.

As it now stands, the plan proposed by Democrats and the Obama administration would
not only fail to reduce the cost burden on middle-class families, it would make that burden significantly worse.

The bill creates a new health entitlement program that the Congressional Budget Office
(CBO) estimates will grow over the longer term at a rate of 8% annually, which is much
faster than the growth rate of the economy or tax revenues. This is the same growth rate
as the House bill that Sen. Kent Conrad (D., N.D.) deep-sixed by asking the CBO to tell
the truth about its impact on health-care costs.

To avoid the fate of the House bill and achieve a veneer of fiscal sensibility, the Senate
did three things: It omitted inconvenient truths, it promised that future Congresses will
make tough choices to slow entitlement spending, and it dropped the hammer on the middle class.

One inconvenient truth is the fact that Congress will not allow doctors to suffer a 24% cut in their Medicare reimbursements. "

"DEATH PANELS OPEN FOR BUSINESS IN MASSACHUSETTS
In August Sarah Palin wrote extensively about the incredible danger that ObamaCare
would lead to what amounts to "death panels." This of course caused great controversy
with many claiming Palin was either "crazy" or talking about the "end of life"
discussions that were provided for within House Resolution 3200, the prototype
ObamaCare bill.
As more Americans delve into the disturbing details of the nationalized health care plan
that the current administration is rushing through Congress, our collective jaw is
dropping, and we're saying not just no, but hell no!

The Democrats promise that a government health care system will reduce the cost of
health care, but as the economist Thomas Sowell has pointed out, government health care
will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the
most when they ration care? The sick, the elderly, and the disabled, of course. The
America I know and love is not one in which my parents or my baby with Down
Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can
decide, based on a subjective judgment of their "level of productivity in society," whether
they are worthy of health care. Such a system is downright evil. .
Now we have news from Massachusetts, the home of RomneyCare, which should be
looked at as a shining example of why ObamaCare will be an epic failure. Soaring costs
both to the taxpayers and patients was inevitable, and now the effects of these are coming home to roost.
You can't reap these savings without limiting patients' choices in some way,"

"You can't reap these savings without limiting patients' choices in some way," said Paul Levy, CEO of Beth Israel Deaconess.

The state's ambitious plan to shake up how providers are paid could have a hidden price
for patients: Controlling Massachusetts' soaring medical costs, many health care leaders
believe, may require residents to give up their nearly unlimited freedom to go to any
hospital and specialist they want.

Efforts to keep patients in a defined provider network, or direct them to lower-cost
hospitals could be unpopular, especially in a state where more than 40 percent of hospital
care is provided in expensive academic medical centers and where many insurance
policies allow patients access to large numbers of providers. ."

"State plan may place limits on patients' hospital options( Mass. RomneyCare )"

"Paying the Health Tax in Massachusetts [Romneycare]
My husband retired from IBM about a decade ago, and as we aren't old enough for
Medicare we still buy our health insurance through the company. But IBM, with its
typical courtesy, informed us recently that we will be fined by the state.
Why? Because Massachusetts requires every resident to have health insurance, and this
year, without informing us directly, the state had changed the rules in a way that made
our bare-bones policy no longer acceptable. Unless we ponied up for a pricier policy we
neither need nor want-or enrolled in a government-sponsored insurance plan-we
would have to pay $1,000 each year to the state.
My husband's response was muted; I was shaking mad. We hadn't imposed our health-
care costs on anyone else, yet we were being fined ("taxed" was the word the letter used).

We've spent much of our lives putting away what money we could for retirement. We
always intended to be self-sufficient. We've paid off the mortgage on our home, don't
carry credit-card debt, and have savings in case of an emergency. We also have a regular
monthly income of about $3,000, which includes an IBM pension. My husband, 61, earns
a little money on the side, sometimes working as an electronics consultant on renewable
energy projects. I'm 58 and make some money writing science books. We are not
wealthy, but we aren't a risk of becoming a burden on society either. How did we become outlaws? "

"National Health Preview - The Massachusetts debacle, coming soon to your neighborhood."
"Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country.
It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.
In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls.
As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget.
The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic.
The state's overall costs on health programs have increased by 42% (!) since 2006.

What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered.
But reducing costs while increasing access are irreconcilable issues.
Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional.
Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers."

A Very Sick Health Plan; Bay State's 'Grand Experiment' Fails [RomneyCare]
"The Daily News Record, Harrisonburg, Va. - 2009-03-31 "
"For folks increasingly leery of President Obama's plan to radically overhaul America's health-care system,
or 17 percent of the nation's economy, all this could hardly have come at a better time -
that is, fiscal troubles aplenty within Repubican Mitt Romney's brainchild, Massachusetts' "grand experiment" in "universal" health care."

"Initiated on Mr. Romney's gubernatorial watch in 2006, this "experiment" has fallen on hard times, and predictably so.
Even though the Bay State commenced its program with a far smaller percentage of uninsured residents than exists nationwide,
"RomneyCare" is threatening to bankrupt the state. Budgeted for Fiscal Year 2010 at $880 million,
or 7.3 percent more than a year ago, this plan, aimed at providing low- or no-cost health coverage to roughly 165,000 residents,
has caused Massachusetts' overall expenditures on all health-related programs to jump an astounding 42 percent since 2006.

So what does Mr. Romney's successor, Democratic Gov. Deval Patrick, propose as a remedy for these skyrocketing costs?
Well, whaddya think? The standard litany of prescriptions (no pun intended) - price controls and spending caps, for a start, and then, again predictably, waiting periods and limitations on coverage.
As in Europe and Canada, so too in Massachusetts. And, we feel certain, everyone from Mr. Romney to Mr. Patrick said, "It would never happen here."
But then, such things are inevitable when best-laid plans, with all their monstrous costs, run smack-dab into fiscal reality.

Health care in Massachusetts: a warning for America [Romney brings Mass. to its knees]
The Bay State's mandatory insurance law is raising costs, limiting access, and lowering care.
Sedalia, Colo. - In his recent speech to Congress, President Obama could have promoted
healthcare reforms that tapped the power of a truly free market to lower costs and
improve access. Instead, he chose to offer a national version of the failing
"Massachusetts plan" based on mandatory health insurance. This is a recipe for disaster.

Three years ago, Massachusetts adopted a plan requiring all residents to purchase health
insurance, with state subsidies for lower-income residents. But rather than creating a
utopia of high-quality affordable healthcare, the result has been the exact opposite -
skyrocketing costs, worsened access, and lower quality care.

Under any system of mandatory insurance, the government must necessarily define what
constitutes acceptable insurance. In Massachusetts, this has created a giant magnet for
special interest groups seeking to have their own pet benefits included in the required
package. Massachusetts residents are thus forced to purchase benefits they may neither
need nor want, such as in vitro fertilization, chiropractor services, and autism treatment -
raising insurance costs for everyone to reward a few with sufficient political "pull."

Although similar problems exist in other states, Massachusetts' system of mandatory
insurance delivers the entire state population to the special interests. ."

"'Severe' doc shortage seen hiking wait time The Boston Herald ^ | 9/15/09 | Christine McConville As the state's shortage of primary care doctors grows, people are waiting longer for medical care, according to a new survey by the Massachusetts Medical Society. "The shortage is getting more severe," said Dr. Mario Motta, the medical society's president. The state's health care dilemma can serve as a valuable lesson for a nation whose residents are locked in a frenzied debate about health care reform, he added."

"Health costs to rise again.( RomneyCare )
The state's major health insurers plan to raise premiums by about 10 percent next year,
prompting many employers to reduce benefits and shift additional costs to workers.
The higher insurance costs undermine a key tenet of the state's landmark health care law
passed two years ago, as well as President Obama's effort to overhaul health care. In
addition to mandating insurance for most residents, the Massachusetts bill sought to rein
in health care costs. With Washington looking to the Massachusetts experience, fears
about higher costs have become a stumbling block to passing a national health care bill."

"Nation's ill-advised to follow Mass. plan [Health plan a failure]
September 17, 2009 The canary is dead.
Massachusetts, the model for the ObamaCare universal insurance plan, is the canary in
the health care coal mine. Yesterday, its obit appeared on the front page of both The Wall
Street Journal and The Boston Globe-Democrat.

Both papers reported that our Commonwealth Care reform isn't working as planned. A
new law that was supposed to control costs and drive prices down (sound familiar?) has
instead sent costs soaring. "

"Bay State Insurance Premiums Highest in Country - Boston Globe August 22, 2009
Massachusetts has the most expensive family health insurance premiums in the country,
according to a new analysis that highlights the state's challenge in trying to rein in medical costs
after passage of a landmark 2006 law that mandated coverage for nearly everyone...
The report by the Commonwealth Fund, a nonprofit health care foundation,
showed that the average family premium for plans offered by employers in Massachusetts was $13,788 in 2008,
40 percent higher than in 2003. Over the same period, premiums nationwide rose an average of 33 percent..."

"Massachusetts: the laboratory for ObamaCare
Cato Institute looks a little farther down the coast to Massachusetts, where the state began its own health-care reform complete
with individual mandates and a government plan.
Cato calls it an "almost perfect" mirror of ObamaCare, complete with promises of reducing cost and extending care - that failed in both respects:
Massachusetts shows that such a mandate would oust millions from their low-cost health plans and force them to pay higher premiums. …

"Massachusetts' Obama-like reforms increase health costs, wait times [RomneyCare]
"If you are curious about how President Barack Obama's health plan would affect your health care, look no farther than Massachusetts.
In 2006, the Bay State enacted a slate of reforms that almost perfectly mirror the plan of Obama and congressional Democrats.
.... Premiums are growing 21 to 46 percent faster than the national average
in part because Massachusetts' individual mandate has effectively outlawed affordable health plans."

"Mass. Pushes Rationing to Control Universal Healthcare Costs (RomneyCare)
A 10-member Massachusetts state healthcare advisory board unanimously recommended
that the state begin rationing healthcare to keep the state's marquee universal health care program afloat financially.
The July 16 recommendations, the Boston Globe explained, would result in a situation where "patients could find it harder to get procedures they want but are of questionable benefit if doctors are operating within a budget.
And they might find it more difficult to get care wherever they want, if primary doctors push to keep patients within their accountable care organization."
The Globe stressed that the recommendations would "dramatically change how doctors and hospitals are paid, essentially putting providers on a budget as a way to control exploding healthcare costs and improve the quality of care."
"Budget" is a more politically acceptable word for rationing.
The Globe also noted that "consumer advocates said patients are going to have to be educated about the new system." Yes, apparently they will have to get used to having their healthcare rationed.

"Massachusetts Universal Healthcare System Breaking Down Already
When Governor Mitt Romney instituted a universal healthcare plan for Massachusetts in 2006 he proclaimed it a conservative idea.
But has it worked? Has it been successful?
For a time, many thought it might but cracks in the system are already being seen.
These cracks are instructive as a lesson on how Obamacare will crash and burn just like Romneycare is now in the process of doing.

One of the early claims that helped push Romneycare through to law was the insistence by its supporters that Emergency Room visits would fall as more and more citizens became covered under healthcare insurance.
Since ER care is far more expensive than a doctor's care, it was thought that more people with insurance would ease the overcrowding of ERs as well as lower the overall costs of healthcare.
However, a flaw in this logic has been seen throughout the state. As more people became insured, more people demanded the care of doctors. These doctors became overloaded with patients and waiting lists for doctors got longer and longer.
As a result, ERs in Massachusetts have not seen a downturn in visits. On the contrary, it seems that ER visits are actually on the upswing in the Bay State. In fact, in 2007 they were higher than the national average by 20 percent...

"National Health Preview - The Massachusetts debacle, coming soon to your neighborhood."
"Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country.
It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.
In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls.
As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget.
The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic.
The state's overall costs on health programs have increased by 42% (!) since 2006.

0What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered.
But reducing costs while increasing access are irreconcilable issues.
Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional.
Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers."

brbr/b

The problem is that all prescriptions which focus on health insurance, rather than actual health care, are certain to lead to bad outcomes. In some ways Obamacare managed to combine the worst features of single payer health insurance with the worst features of an imperfect market.

The problem with health care costs is that everyone seems to operate under the delusion that we have a free market in health care. Government regulation creates an economically artificial oligopoly (called the medical profession), which actually functions more like a monopoly (”reasonable and customary” is price-fixing).

Yes, such regulation is needed for the public good. We do not want quacks opening up medical offices. But, as in the case of utilities, the creation of a restriction of suppliers in the public interest should be combined with a regulation of prices in the public interest. (I would actually argue that rates charged by any profession the exercise of which is restricted to state-issued license-holders should be subject to regulation.)

Likewise, most advanced medical technology, including drugs, are sold under government grants of monopolies called “patents”. Yes, there is a socially useful purpose in granting such monopolies (on actual devices, or artificial substances, not on business plans, not on algorithms) enshrined in our Constitution— to encourage invention and discovery — but in the case of products for which there is inelastic demand (like the best available treatment for some disease), the grant of a monopoly should come with regulation of the price.

Fix these problems, and an insurance market, and folks paying for their own health care as they did before FDR’s wage freeze pushed companies into offering health insurance benefits and further distorted the imperfect market created by state-granted oligopolies, should be able to deliver good health care at reasonable cost.

There is already rationing in our health care system based on availability and price.

The distinction between 'rationing' by a free market and rationing by a government bureaucrat is that the free market responds (via the clear signal of profit spreads) where 'availability' (is this your word for scarcity?) indicates improvements can be made.

If low 'availability' generates high prices, the free market responds by entrepreneurial efforts to lower costs (which, by virtue of competition, drives down prices) or capitalist investment in increasing the 'availability' of the service or good.

The government's response to low 'availibilty' is to just lower the hospitals bandage allotment. There is no mechanism outside the bureaucrats whim to decide how many bandages are 'enough'.

The capitalist system, which is what conservatives support, identifies the need for increased production with the profits realized from the difference between costs of production and the price generated by supply and demand. Whether more wealth should go into creating bandages, or into creating entertainment, is the sum of countless individual decisions made in a relentless pursuit of happiness.

The federal government compels hospitals to provide goods and services to anyone who enters, irrespective of their ability or willingness to pay for them. Imagine if the same requirement were placed on restaurants. Would we be surprised to see meals become more expensive for those who actually paid their tab?

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