(The Part Two in the Series)

People seem to be taking sides in our little medblogger health care debates; I hear a lot of people that would be unhappy with a single-payer solution, but not a whole lot of other ideas to fix our health care system (ie: more negative ads than positive ones). The fundamental thing I don’t understand from libertarians is this: what’s a better option? Libertarians would have you believe that if we all just were responsible for our own health care costs, we would decrease our spending and la la la everything would be okay. But that’s not going to happen.

We have a law on the books saying that any ER has to screen patients who walk through the door. Now, you can take this law and do one of two things with it:

1) Keep it, and deal with the consequences that it creates.
2) Repeal it. (But let’s be honest, people, no one but wealthy crazies actually believes that this is reasonable policy.) So we repeal it, and ERs are allowed to turn away emergency patients (or patients who think they might be emergencies). We’re going to let people die on the streets? This would never, ever happen, and if it did–talk about health care revolution.

So here we are. We as a society have agreed that we will take care of the acutely ill, no matter the cost.

From where I’m standing, then, if we’re going to take care of the acutely ill, we might as well keep societal costs lower by preventing people from becoming acutely ill (or from developing the consequences of chronic illness). Am I crazy? Am I missing something here? You can’t tell me that our system makes sense in this way. We will allow an uninsured diabetic to go years without any preventive care, because lack of ability to pay, but once his foot becomes necrotic and he needs an amputation, and gets an ICU stay for becoming septic–oh well, let’s definitely pay for that!?

So here are the facts: single-payer would not cost us any more in ABSOLUTE dollars than we are paying today (as evaluated in the California Health Care Options Project , The Vermont Single-Payer Study , The Maryland Single-Payer Study , Massachusetts Health Care Studies , and Maine’s Single-Payer Microsimulation . Just to be clear, these analyses were done by The Lewin Group and Mathematica Consulting , two economic analyst groups. Not single-payer supporters.

(A note: single-payer critics will say that single-payer causes tax increases; while this is technically true, as money would be directed to the government, it would not be new money, it would essentially be the same money that employers are already paying for health insurance to HMOs right now.)

Single-payer would cover everyone.

Single-payer would slow costs.

Single-payer would allow people true choice–to see any doctor they wanted, provided that the doctor was available to see them.

Single-payer would allow for lower prescription drug costs.

Single-payer would not “cherry pick” healthy people; single-payer would eliminate the American concept of “pre-existing conditions.”

Look, if you have a problem with the “political feasibility” of single-payer, that’s fine, we can debate that. If you’re weary of allowing a government entity to set all health care reimbursement, that’s fine, we can debate that. But to stick your thumbs in your ears and ignore that we’re already ready to pay for emergency care, because of the consequences of the alternative is just stupid, plain and simple.

So, what’s your better solution?

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