People arguing both sides of the health care reform issue keep hammering on the idea of a single-payer-based health system. The left wants it and the right thinks it would be the end of the world. Yet not only is it the wrong thing to be worried about, but it is mostly conspicuous for its absence from the current proposals being considered by Congress.
Critics on the right keep claiming that health care reform will lead inevitably to a single-payer system as if that's the worst that could come of these proposals, and for his part President Obama seems bizarrely defensive about the idea, denying any intention of creating a single-payer system in a way which is entirely out of proportion to the significance of the issue. It almost makes me wonder if single-payer is being thrown out as a stalking horse to scare us into accepting other potentially more radical ideas.
The argument is that a public option and even coops are steps which will inevitably lead to government paying for health care. The belief is that the socialist impetus of the administration is to get its hands on as much tax money and redistribute as much private income as possible, and that single-payer health care would be a great way to do that.
Yet this is not inherently the way that a single-payer system has to work. There are single-payer systems in other countries like Australia and Singapore which work perfectly well with private insurance and leave most control and most health care choices in the hands of the consumer. When it comes to threats to capitalism and individual liberty, the idea of a public option where the government competes directly with private insurers is far more of a threat than a single-payer system if that system were to be implemented sensibly.
If you want insurance companies to reduce prices and be more competitive, you don't need to have a "public option" you just need to actually let them compete with each other. Past policy has insulated insurers from having to compete and effectively created monopolies. Let insurers compete on a nationwide basis on a level playing field, selling to individual consumers rather than through group plans. Then you would see prices going down and quality improve without any kind of artificial interference or the tax burden of a public option. Let the government set standards and apply some reasonable requirements to protect the public and then leave insurers free to find ways to satisfy them and make money.
But going back to the idea of a single-payer system, maybe it's an idea which can be turned to positive purposes. If you accept the premise that everyone must have health care, then why not let the government be the collector and repository of the funds to pay for that health care? Establish a simple percentage tax for health care, either added onto the income tax or as part of a national flat tax like the FairTax. Then take that money and distribute it equally to citizens in the form of vouchers which can only be spent on heath insurance. The insurance companies will respond by offering basic plans at the price of the voucher and people who want policies with extra features can pay more out of their pockets.
This approach would assure that basic health coverage is available to all Americans while at the same time preserving the free market and leaving the power of choice in the hands of individuals. The key thing about a single-payer system is that it does not have to involve the government directly in health care. They can play an entirely passive role as payer and distributor of funds, guaranteeing equal access to a basic level of care while not taking away options from health care consumers. This is why the basic concept of a single-payer system can be turned into a net positive, while other ideas which are being pushed like a public option in competition with private insurers will just continue the pattern of destructive meddling in the health care marketplace.
Single-payer only becomes a problem if the single payer is also the single provider. Then choice and competition and quality of care really will be taken away. So in the debate on health care, let's put the focus in the right place and fight for free market solutions and against more of the same government meddling and unintended consequences which created the current mess and which current proposals in Congress are loaded with. Powered by Sidelines