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'Single-payer by attrition'

The Economist follows up on my argument that ruling the individual mandate -- and thus a hybrid universal health-care system -- unconstitutional would be a disaster for conservatism.

The clearest way to explain it is that right now, what we have already is a system that's getting ripped apart in a vortex of adverse selection. Health spending is rising at 8% per year. PriceWaterhouseCooper says medical costs will grow 9% in 2010; health insurance premiums generally rise even faster than costs. Premiums now amount to 18% of the average household's income, up from 11% in 1999. As insurance costs rise far faster than wages, unsurprisingly, the number of uninsured keeps rising too, to 46.3m in 2008. And those who aren't uninsured are increasingly insured by the government. Medicaid added 3m people to its rolls in 2008. The Children's Health Insurance Program (CHIP) picked up another 1.5m. As this process continues, federal spending on health insurance keeps climbing; it grew 10.4% in 2008. Sick people, poor people, and older people are increasingly unable to afford insurance, and many are winding up on the government's dime. As premiums rise, people at higher and higher income strata find they cannot afford them, drop out of private insurance, and end up being covered by the government or not covered at all.

This is single-payer by attrition.

By Ezra Klein  |  January 15, 2010; 3:11 PM ET
Categories:  Health Reform  
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and single payer by attrition is painful for those going through it. I would expect its like those that go into a nursing home and have to go through all their money before they are picked up by the government. Also, don't forget though that this is during the worst recession on record and millions lost their jobs in the last couple years. Increases in employment would slow that pace significantly but we'll eventually be forced to single payer (likely kicking and screaming). The question is when we get there will it be the British model or one of the private models available for copying across the globe. My bet is the private models as the level of government distrust is at an all time high although the level of private distrust is pretty maxed out too.

Posted by: visionbrkr | January 15, 2010 3:29 PM | Report abuse

I don't know if your uncited Economist author did, but once again, you have conflate single-payer with universal coverage and insurance with health care.

There is no such thing as a "hybrid universal system" -- a health care financing model is either universal, meaning that the same financing model applies to everyone, or it is not. The one under consideration here is not.

Also, it is simply untrue that the only alternative to requiring those who do not have an employer to foot their premium costs to purchase individual policies from profit making companies (with after-tax dollars) is single-payer. As France and Germany demonstrate, it is entirely possible to fund a privately managed system through *universal* payroll deductions.

Posted by: Athena_news | January 15, 2010 3:33 PM | Report abuse

In essence George Will was saying the real conservatives value strict constructionism over all else. He's saying if that means single payer health care, so be it. I agree.

As an aside, I was a long-time subscriber to The Economist and I am confused by the editorials that now appear on its blogs. The magazine used to have a very strong editorial voice, and they *never* would have called for a universal mandate as means of heading off single payer. The inmates are running the asylum.

Posted by: bmull | January 15, 2010 3:40 PM | Report abuse

Right and unless the conservatives want to allow hospitals and doctors to toss people out onto the curb this trend will keep picking up steam.

Posted by: luko | January 15, 2010 3:44 PM | Report abuse

good point to bring up the basics.

This whole thing about health costs simply rising up to the point equal to all disposable ability to pay is the basic reality from which I derived what kinds of reforms would be most useful.

Posted by: HalHorvath | January 15, 2010 7:09 PM | Report abuse

Now why do you suppose it is that health care costs continue their inexorable rise? Magic? Nope. It's because of the existence of taxpayer subsidized gold plated insurance plans with no or very low copays, low deductibles, low annual out of pocket costs, and no caps. Exactly the sort of coverage that Nancy Pelosi has promised to everybody. Only now they won't even have to hold down a job to obtain it. Regarding out of control health care ain't seen nothing yet.

Posted by: bgmma50 | January 15, 2010 11:25 PM | Report abuse

Ezra, as a proponent of single payer government run healthcare and a avid supporter of Obamacare surely know Obamacare is for all intents and purposes single payer government run healthcare. Sure private insurance companies will still be around but they will function like public utilities with the type of health coverage you can get and how much you pay being determined by the government. There will be gigantic new government bureacacies to administer the gigantic amounts of new taxes and fees going to the government to pay for Obmacare and the IRS will come after you if you don't sign up for Obamacare. Tell me how that's any differnt than single payer healthcare.

Posted by: RobT1 | January 16, 2010 12:28 PM | Report abuse

"Tell me how that's any differnt than single payer healthcare."

For one thing, in single-payer systems,care is funded by general taxes and the government pays for the same level of coverage for everyone.

Only someone who has never seen any kind of universal health care would consider what has been proposed as "government run", single-payer, or even universal.

If you need more information about the differences between what is being proposed and "government run" or "single-payer", talkd to someone who who will be required to purchase their own insurance without any kind of tax support whatsoever those with employer-paid benefits get a free ride.

Posted by: Athena_news | January 16, 2010 12:43 PM | Report abuse

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