Improved Medicare for All (USA)

IntroductionLet me start by introducing my case. I am in opposition to the idea that we should have a single payer health care system in the USAThis idea is not a new one. Other nations have single payer health care systems, in various forms. The model that is being proposed by my opponent is not the exact same as the model of any other nation. After all, no two nations are the exact same so it would make sense that no two health care models are the exact same. This does not mean that the experience of these nations are not relevant. They are. However, we must be very careful in remembering that different nations have different cultures and different populations. Some nations are more different than others. This means that the experience of some nations is more relevant than others to the USA.Having said this, I will begin my arguments.The Current USA Health Care SystemI do not deny, or even attempt to deny, that the current USA health care system has many flaws. The system, to be modest, is very, very bad. This is a view that is shared by advocates of single payer. However, our view of the cause of the problem and the solution are very different.First, it should be noted that it is very difficult to blame the failings of the current USA health care system on the free market. Indeed, 48% of health care spending in the USA is public spending from the government [1]. In fact, the USA health care system isn't a free market at all. On top of nearly half of health care spending coming from the public sector, the USA system is dominated by what are called third party payers. What this means is that individuals pay for virtually none of their health care costs directly. In fact, to quantify this, only 12% of USA health care costs are out of pocket in 2010, which means that only 12% of health care costs are paid for directly by individuals [1].The other 88% is picked up by either the government or insurance companies. This is important, because it means that individuals have no incentive to be sensitive to prices. In other words, they have no reason to look at cost when choosing health providers.The kinds of reforms I advocate would greatly increase the share of health care costs that consumers would directly pay. However, the reforms I advocate are not part of this debate. Instead, I am arguing against reforms proposed by my opponent. To that end, I will simply stop by pointing out that the current USA system is far from a free market, and that most of it's problems are, in my view, the result of lack of market forces, not too many of them.The Drivers of USA Health InflationIn 1960, according to the OECD, USA health spending was $148 per capita and 5.1% of GDP. In 2010, the most recent year for which we have data, health spending was $8233 per capita and 17.6% of GDP [1]. So, the real question is: what is driving health inflation?I'm sure advocates of single payer, like my opponent, would blame private health insurance and "free market" health care. However, if that were true, we would expect private health spending per capita to have risen at a faster pace than public health spending per capita. However, the opposite has happened. From 1960 to 2010, public health spending per capita grew at an annual average rate of 10% compared to 7.5% for private health spending per capita. Over a 50 year period, this is quite a large difference indeed. If public health spending had grown the same speed as private health spending over this period, we would be spending $2082 less per capita on health care in 2010. That means we would be spending $6151 per capita as opposed to the $8233 per capita that we are spending [1].In terms of health spending as a percentage of GDP, we would be spending 13.1% of GDP on health care as opposed to the 17.6% of GDP we are spending [1]. In other words, public health spending, or government health spending, has been a much larger driver of health inflation than private health spending. In fact, if public health spending had grown at the same speed as private health spending over the past 50 years, we would not be the outlier in terms of health spending's share of GDP that we are among nations, a point that will be expanded upon this round.The Economics of Single PayerBasic economic principles apply in health care just as they do in every sector. Supply and demand determine prices, incentives matter, and other basic principles are very much alive in health care.Unfortunatley, the whole idea of single payer health care runs totally contrary to these principles. As far as prices go, a single payer system would have a central bureacracy, not supply and demand, determine prices. Of course, the central planners do not have access to the type of information needed to set prices in health care, so disaster follows.In terms of incentives, single payer has no incentives to stop consumers from overusing health care. Of course, the central planners don't have access to an infinite supply of medical care, so choices must be made. They must either accept rising costs and the people must accept higher and higher taxes or they must ration care and have long waiting times. This is what happens in a system with price controls and central planning, especially when there is no incentive for individuals to control their own costs.It is amazing that this kind of system is so popular. After all, if we have learned anything in the last 100 years of history or if we just paid attention to simple logic, we would see that systems that ignore incentives, impose price controls, and rely on central planning inherently fail [2].Single Payer in ActionWe do see single payer health care systems in action in various other nations. However, as I pointed out earlier, we must be careful in comparisons. Th USA is, by comparison, a very large, unhealthy, diverse, and individualistic nation. So, it would not be fair to compare us to a small, healthy, homogeneous, and collectivistic nation when looking at health care comparisons.In my view, there are two nations with single payer that are somewhat relevant to the USA. These would be Canada and the UK. Both of these nations are somewhat large, although not anywhere near as large as the USA, somewhat unhealthy, although not as unhealthy as the USA, somewhat diverse, although not as diverse as the USA, and somewhat individualistic, although not as individualistic as the USA.So, it must be remembered, that however single payer works in the UK and Canada, it would likely be even worse in the USA, due to factors mentioned above.As far as costs goes, both of these systems appear to compare favorably. Canada and UK spend 11.4% and 9.6% of GDP, respectively, on health care. That compares to 17.6% of GDP in the USA [1]. However, a closer look reveals that, while they are spending less in these nations, they actually have higher cost growth in both of these nations. From 2000 to 2010, real health spending per capita grew 72% in the USA. That is compared to 76% and 87% in Canada and the UK, respectively [1]. So, health inflation has actually been even higher in these nations with single payer than in the USA.Outside of costs, these systems also fall short. In the UK, there are 6 MRIs and 9 CT scanners per million people. In Canada, there are 9 MRIs and 15 CT scanners per million people. In the USA, by contrast, there are 32 MRIs and 41 CT scanners per million people [1]. In other words, we have much more medical technology in the USA.I am running low on space, but I will expand further on failings of these systems and respond to my opponent in the next round."If you think health care is expensive now, just wait until it is free"-PJ O RourkeSources:[1] http://www.oecd.org... (Must look at excel document for data, many of the figures I got from this source was based on calculations I made using these figures)[2] http://www.thefreemanonline.org...