So, this is just a blurb, but I did see a discussion on healthcare today and the different options, and I just wanted to explain why, as someone who is more hard line and on the progressive side of the aisle, am not for a full on NHS style healthcare system.
Ironically, it's not because I don't LIKE such a system, or the idea of it. I think the NHS is one of the envies of the world in terms of healthcare. I just don't think it's a good model....for America. And here's why.
First of all, cost. It kind of runs into the same issue single payer does, super high costs. And while a normal progressive who does NOT support a $4 trillion UBI can go crazy on healthcare, I'm kinda pinching our pennies after funding UBI, designing systems that work around UBI, without compromising UBI. I still nominally support single payer in principle, and I would support NHS as an option in principle, but I understand a fully paid model of healthcare by the government is going to be expensive, and it's possible we can't fund both. So that's reason #1, even though any single payer program I come up with could be used to fund the NHS in the same way.
So what makes NHS so further beyond the pale for me than even single payer? Well, it's because of this. On top of everything else, the NHS type system wouldnt just be fully government funded healthcare, but fully government RUN healthcare. Single payer has the government be the single payer for healthcare. Healthcare is still run privately, it's just that providers now have to negotiate with the government, as a single payer and monopsony on healthcare. If we ran the healthcare ourselves, we'd have to design all of this bureaucracy ON TOP OF just funding the healthcare, and that's a bit out of my expertise, and I'm not sure if it can be done.
The US government seems notoriously bad at bureaucracy. It's one of the reasons I have my own approach to government, which isn't all that different from Yang's idea of "modern and effective government". The government isnt necessarily good at running things, the government is good at moving large sums of money to where they need to go. Just as I dont want a welfare system where the government determines what in kind aid people need instead of cash, I'd rather have the government...just fund things with cash. That's what it's good at. If the government ran healthcare directly, it would have to figure out what services it provides, what limitations there would be, etc. They effectively run into the problems of command economies. They have to adequately centrally plan all of this crap out and account for every item they need, and if they miscalculate, we could have shortages.I'd much rather just have the government pay for things and let the actual healthcare market figure things out. Let the government pay the bill, and let people get what they need.
Also, because NHS style healthcare is so dependent on bureaucracy, and that's what the US is bad at, it's also open to sabotage. The right could just implement literal death panels limiting what services people can get, and then go "SEE WE WERE RIGHT ABOUT DEATH PANELS AFTER ALL". We kinda gotta worry about that in the US. Any system we set up can be sabotaged through underfunding.
Meanwhile what would sabotage look like with UBI? Well, you'd get less UBI. Or you'd get inflation if the right decides to pump tons of money into the economy without paying for it first. With single payer, they could try to refuse services to pay money, but in both cases, if sabotage occurs, the left could clearly say, much like with social security and its fiscal crisis today, that hey, this is underfunded, we need to raise taxes on the rich to pay for this. I mean, because the system is simpler, there's more accountability. The US has a habit of just making things intentionally difficult to sabotage things, and then we say government doesnt work. And because the success of NHS depends on its bureaucracy, and that's what the US system is particularly bad at, I'm not sure we can 1) set up a good system in the first place, 2) maintain it, or 3) reform it properly if broken.
It's a great idea on paper, and if it works it works. I'm just not sure the US could make it work.
Either way, I think either single payer or a robust public option would get the job done. Philosophically I like single payer more as I AM progressive, but if I need to develop an alternate framework based on a public option instead, I know how we can make it work, and how we can scale it to different funding levels. obviously more money is better, since more tax money put into the system reduces the private costs on people, and the private costs are what's the killer in the current system, but yeah, we can make it work.
As such, I'd rather just focus on getting people insured, and getting the government to pick up the tab. Whether we have a public option free for low income people and that scales with income, or a single payer system funded purely with taxes, I think we could make that work. I just think an NHS system goes a bit too far, and there's too many moving parts where we're at risk of making something that just doesn't logistically work. I'd rather just fund single payer if we can, and a public option scaled up to the affordability levels we can afford if we can't.
No comments:
Post a Comment