a favored public plan would probably doom today’s private insurance. Although some congressional proposals limit enrollment eligibility in the public plan, pressures to liberalize would be overwhelming. Why should only some under-65 Americans enjoy lower premiums? In one study that assumed widespread eligibility, the Lewin Group estimated that 103 million people—half the number with private insurance—would switch to the public plan. Private insurance might become a specialty product.
Many would say: Whoopee! Get rid of the sinister insurers. Bring on a single-payer system. But if that’s the agenda, why not debate it directly? It’s not insurers that cause high health costs; they’re simply the middlemen. It’s the fragmented delivery system and open-ended reimbursement. Would strict regulation of doctors, hospitals and patients under a single-payer system provide control? Or would genuine competition among health plans over price and quality work better?
That’s the debate we need, but in truth, doctors, hospitals and patients don’t want to be limited, whether by government or markets. Congress reflects public opinion. Fearing a real debate, we fake it.
That’s exactly true. Who pays for healthcare is not the real issue. The real issue is the business model of healthcare. The cost of healthcare in America depends upon:
- the regular rate of increasing disease
- the rate of new diseases that can be invented
- the rate of new therapies that can be invented to treat either invented diseases or old diseases
- the rate of new tests that can be invented to treat new or old diseases
- the maximum volume of patients a doctor can see in a given year (increasing every year)
Changing who pays for this money pit will do nothing. People fighting for single payer or “The Public Option” don’t understand the root cause of our healthcare problem. It’s like trying to treat ever-increasing symptoms without curing the disease.