Part 3—Our long-standing bungled discussion: It's a relatively minor point. But we've never understood why Medicare is described as "single-payer."
If by the word "payer" we refer to the sources of payment for the services of a program, Medicare wouldn't seem to be a "single-payer" program. Let's compare the Medicare program to the public schools.
When Parent A moves into Community X, he is allowed to send his children to his community's public school or schools.
No "co-pay" will be involved. The child shows up and gets enrolled. Parent A pays no monthly fee. Government moneys finance the school. Attendance is free to the parent's children—even if he has several!
You might call that system "single-payer," though no one ever does. It's true that public schools are financed by moneys drawn from several levels of government. But the "recipient" isn't charged a fee when he and his children receive the services of the public schools.
Medicare isn't like that. As the leading authority clearly explains, the federal government picks up the tab for some of the Medicare program's services. The Medicare "beneficiary" is stuck with the bill for the rest.
On Monday, we quoted that leading authority. We've never understood why you'd want to call this arrangement "single-payer:"
"No part of Medicare pays for all of a beneficiary's covered medical costs and many costs and services are not covered at all...On average, Medicare covers about half of the health care charges for those enrolled. The enrollees must then cover their remaining costs either with supplemental insurance, separate insurance, or out-of-pocket."
Why do we call that "single-payer?" (Why don't we call public schools "single-payer?") We don't know how to answer that question.
But then, our health care discussion, like all our discussion, is marked by our constant cluelessness. This isn't just true of the Okies, the hillbillies, and the rest of Those People, the ones who are found Over There.
We liberals are constantly massively clueless too! We've maintained our liberal cluelessness down through the recent generations, even as we mock the dumbness of The Others.
How clueless does the health care discussion remain in the face of our self-admitted liberal brilliance? Just consider one part of the health care discussion in last Friday's Washington Post.
In last Friday's Washington Post, three major columnists discussed our nation's clownish health care system. Charles Krauthammer and Fareed Zakaria actually flirted with the idea that Donald J. Trump may come around to supporting "single-payer" in the form of "Medicare for all."
Citing our current system's high costs and mediocre outcomes, Zakaria seemed to say that this would be a good idea. David Ignatius took that theme even farther as he discussed the lunacy of our prevailing arrangements.
Much of what Ignatius said was basically correct. As he started, he railed against our nation's twin health care demons—high costs joined to weak results:
IGNATIUS (3/31/17): Here’s a radical idea for reframing the health-care debate on the ruins of the GOP’s half-baked plan: Let’s listen to doctors rather than politicians. And let’s begin with a simple formula offered last week by the National Academy of Medicine: “Better health at lower cost.”As he started, Ignatius endorsed a proposal that's hard to reject. He suggested that we should receive better results at less cost.
Better and cheaper. It’s hard to argue with that prescription. Because the real health-care crisis in America is about delivery of care, more than the insurance schemes that pay the bills. Costs are continuing to rise, even as public health in America declines. We’re getting less for more. And the GOP’s proposal to starve Obamacare will make that downward spiral worse.
Americans don’t realize just how bad our system is. Health-care costs are far higher in the United States than in other developed countries, but our health is worse. That’s especially true among older whites without a college education—Trump’s core demographic—whose mortality rates are rising alarmingly.
Soon, though, the rubber was meeting the road. We Americans "don’t realize just how bad our system is," the columnist provocatively said. "Health-care costs are far higher in the United States than in other developed countries, but our health is worse."
According to Ignatius, we're paying much more than comparable nations, but we're getting worse health outcomes. Provocatively, Ignatius said we Americans don't understand how bad this actually is.
In our view, he then went on to prove his provocative point. In the following passage, Ignatius seemed to explain how bad the situation actually is. Unfortunately, this passage suggests that Ignatius himself may not grasp the apparent scope of the problem:
IGNATIUS: The problem certainly isn’t that America doesn’t spend enough. The United States now pays $3.4 trillion annually. But the Academy of Medicine study estimates that 30 percent of this money is wasted on unnecessary services, high prices, inefficient delivery, excess administration and fraud.Are we spending more than other nations while getting less? That passage represents Ignatius' only attempt to quantify the problem.
These problems long pre-date Obamacare. Health-care expenditures rose as a percentage of GDP from 5 percent in 1960 to 17.8 percent in 2015. The cost of government health programs has increased an astounding 63-fold since 1974, according to the Congressional Budget Office.
America’s problem is that it squanders money on the wrong things— expensive procedures and tests rather than preventive care and social programs. A study of premature deaths estimated that just 10 percent were the result of poor medical treatment, while 40 percent came from behavioral issues, such as obesity and alcoholism.
To what extent are we spending too much? That passage suggests an over-spending rate resembling 30 percent. Post subscribers trembled with rage as they considered that figure.
They weren't exposed to these basic data, which seem to suggest a substantially larger problem:
Per capita spending, health care, 2015According to those basic OECD data, U.S. spending exceeded that of France by almost 115 percent! By way of contrast, Ignatius had described a possible solution on the order of thirty percent.
United States: $9451
United Kingdom: $4003
Dreaming an ambitious dream, Ignatius suggested that we should eliminate all sorts of bad medical practice. But uh-oh! This is how those numbers would have looked if we had eliminated all the "unnecessary services, high prices, inefficient delivery, excess administration and fraud" his formulation describes:
ADJUSTED FOR PERFECTION: Per capita spending, health care, 2015On a per capita basis, we still would have been outspending the French by almost exactly 50 percent! That's how the numbers would have looked after the pundit's solution.
United States: $6616
United Kingdom: $4003
Ignatius was working from an old official prescription. Years ago, we discussed the way that 30 percent estimate compares to the actual levels of spending described in the OECD data.
Years later, a bright and decent American journalist continues to work from that framework. To this day, we've never seen anyone try to explain the massive level of overspending which seems to be described in those startling OECD figures.
A few weeks ago, we published an award-winning series, "In Search of the USA 9400." In this report, we noted the fact that Paul Krugman called attention to this massive level of apparent overspending way back in 2005, in a series of New York Times columns.
That was almost twelve years ago. From then till now, our liberal world has piddled along in our standard state of outrage mixed with stupor. We know of no one who has tried to extend the critique Krugman offered back then.
We know of no one who has tried to explain those remarkable spending figures. We know of no one who has discussed the way those remarkable data relate to our country's constant failed attempts to provide universal care, even to the lesser breed, who voted for Donald J. Trump.
Might we mention the truth just once? We liberals are about as dumb as any such group has ever been. On balance, we're lazy, clueless, unkind and not real smart, but reliably self-impressed.
We also enjoy kicking down, quite hard, at the undeserving and stupid white underclass. We love to kick down at the massive dumbness of Them, the dumb breed found Over There.
We love kicking down at the dumbness of Them. Tomorrow, more on the constant, gobsmack-inducing, world-class dumbness of Us.
Tomorrow: Good for one thing only
Coming—progressives explain things to us: Progressive icon condescends to visit a "bleak little suburb"