That dastardly duo, Trent and Galen , have some questions about single-payer. Good for them. Keepin’ me honest.

On the 45 million uninsured statistic:
Our two camps will never, ever, agree on this number. Folks on my side see the number big, folks on the other side see it smaller. Galen has a valid critique if his numbers are correct–that some of the uninsured could potentially purchase their own health insurance. However, I’m not sure where his souce is getting his data (Googled it, couldn’t find the BCBS report): the Census itself reports (PDF) that 8% of the uninsured make $75,000 or more per year, and 12.5% make more than $50,000 but less than $75,000. Even if Galen’s argument holds water, that’s only 20% of the uninsured, not the 50% Galen would have you believe.

Galen’s right. Basic, mediocre coverage could probably be afforded by some of these families. Let’s ignore the fact that many probably locked in mortgages assuming that their employers would continue to provide health insurance, or that they would continue having a job. Let’s also ignore the fact that these plans require physicals and approval and come with pre-existing conditions: if your child has asthma, you dislocated your shoulder in a car accident 10 years ago, or anything else, these conditions will probably not be covered (I speak from experience, a classmate was trying to buy health insurance for himself and his two kids, and they were rejected for the two reasons I just gave). So if you have any sort of medical condition, how worth it does it really seem if your diabetes, Crohn’s disease, or any other illness isn’t covered?

I’m assuming Galen’s never worked in community health centers or with uninsured patients, because if he has, he’d realize that it’s no easy task to get people that qualify for government programs enrollled, and to keep them enrolled. (I’m skeptical about his claim, I’d really like to what “government programs” are that empty.) Most clinics have full-time benefits analysts that work their asses off trying to get people into any programs they qualify for–not just for good nature, but because the clinic needs someone to bill so it can keep afloat. There are numerous steps, income qualifications, and follow-ups involved; your child can go to the ER and get signed up for your state’s CHIP program, but some states have short re-enrollment periods, so that parents have to constantly be re-enrolling their kids.

Besides *all* of this, the point is, even if they *could* have health insurance, they don’t. There’s still 45 million people in the country without health insurance. And even if they could afford it and don’t buy it, we still *ALL* pay more for it. There are externalities and social costs involved. Galen and Trent can’t deny that.

On Galen’s other points (sorry guys, school starts tomorrow, and I’ve got to speak at orientation soon):

* A single-payer system is needed because it will control costs better, and will save us a ton of money, allowing us to provide health insurance to everyone.
* A government-run entity, like the NIH, for example, runs the Prom Committee.
* Health care demand will temporarily go up, as the people that are sick and need a primary care physician will (surprise!) get to see a doctor. Crazy, I know, as it seems, but I’d argue that illness and disease costs our economy billions, if not trillions, and if more people can get better, and better faster, it’s good for all of us. Once everyone has health insurance however, demand will stabilize. There’s a term for overusers of medical services: hypochondriacs, and it’s a psychological condition.
* Health care providers are not required to stay in the system, if they don’t want. In Canada, however, you’re not allowed to offer health insurance for services the government currently pays for. In other countries, it’s different. Google and read up. And if they want to stay in the system, you get your representatives to argue for a pay increase for you. Just as they did in Saskatchawan last year.
* The Prom Committee rations care based on need for medical services. Currently we ration it on ability to pay. You decide what’s better. “Over your own judgment?” On the snarky side, I didn’t realize that patients currently get the option to ration their own health care, or generally know enough about medicine to make an informed, educated economic decision about their care.

On “Savings From Reduced Paperwork”
Trent, it’s a pretty big argument when some estimates find that we could save all most $300 billion (BILLION, not million) on paperwork . And yes, I realize who my source is. So say they’re way off on their estimate. Say they doubled their estimate. That’s still $150 billion (BILLION, not million) in savings. Independent analyses by many consulting firms agree: single-payer is the only approach that both saves money AND provides universal coverage. Argue with The Lewin Group or Mathematica Consulting if you don’t agree. They’re not exactly flaming liberals.

On “A Free Lunch”
It wasn’t my intention to imply that anyone’s lunch is free. I thought I made it pretty clear in both the Prom analogy as well as in the single-payer animation that everyone pays into the system. If you didn’t take that away from it, sorry.

On “Medicare”
I’ve never gotten the sense from anyone in Medicare that it “trap(s) many elderly into poverty.” The elderly, when polled, *love* Medicare. That’s why you can’t touch it politically–the 65+ crowd you hang you out to dry. And I’d love to know how Medicare provides “substandard insurance.”

I’d love to go on, but I’ve got an orientation session in 45 minutes and I still have yet to shower. Too much information, I know.

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