HR-676 is an improved and expanded Medicare for ALL system.
Lorraine Heth

Okay, now I have examined the details, and can comment.

It is a fine idea to take care of everyone. It is in fact necessary for any kind of system to work: Since the risk of disease is wildly variable on an individual basis, yet is equally spread across the whole population (with exactly one body per person), any rational system will have to have a way to spread the risk across the whole population. One way to do that is through taxes supporting a single payer system.

But of savings claimed, only the smallest part, the administrative expense, shows a real mechanism. The claim is $350 billion/yr. I suspect that may be low, as such estimates do not account for the massive costs on the provider side of trying to deal with all these different insurance systems trying to dodge paying for what they have a contract to pay for.

$350 billion sounds large. But the whole system costs about $3.5 trilloin. So this is about 10%.

The far larger savings are to be had in 1) waste (the approximately 1/3 of all the costs that go to treatments and tests that the medical specialties themselves consider unnecessary) and 2) prevention and management of chronic disease. Waste doesn’t go away until you stop paying for it. And nobody launches huge and expensive prevention and management programs unless they are paid specifically to do that. This is not speculation, this is hard evidence from years and decades of pilot programs and other attempts.

The bill includes a commission to study cost effectiveness. Will that commission have the power to say, “We will not pay for somplex back fusion surgery for a diagnosis of simple back pain”? Or, “No more mammograms as first-line mass screening for breast cancer”? (Yes, that has been proven ineffective compared to manual examination in massive studies). Every attempt to do anything like this in the past, even without coercive power, just for research findings, has been specifically outlawed and destroyed. So assuming that it would work this time around is no more than a naive hope.

The same thing can be said of giving the government the ability to negotiate prices across healthcare. It already exercises that power for people over 65. The prices it pays are somewhat lower than what private insurance pays, not half as expensive.

What has true coercive power in any economic system is true customers who can walk away from a deal, who have alternatives, who have information, who have multiple providers competing for their business on price and quality, and who have a real stake, both personal and financial, in getting the best deal. The true customers in healthcare can be the individuals, organizations whose incentives are aligned the individuals (self-funded employers, unions, and pension plans), and aggregations of individuals for the purpose of bargaining with providers. All that goes away under a single-payer plan.

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