From: andy@SAIL.Stanford.EDU (Andy Freeman)
Subject: Re: Bush/Quayle's Health Plan -- vouchers?
Organization: Computer Science Department,  Stanford University.
Date: Fri, 11 Sep 1992 19:23:29 GMT

In article <1992Sep9.200546.2045@alchemy.chem.utoronto.ca> golchowy@alchemy.chem.utoronto.ca (Gerald Olchowy) writes:
>In article <1992Sep9.180602.24891@CSD-NewsHost.Stanford.EDU> andy@SAIL.Stanford.EDU (Andy Freeman) writes:
>>In article <1992Sep9.134621.19407@alchemy.chem.utoronto.ca> golchowy@alchemy.chem.utoronto.ca (Gerald Olchowy) writes:
>>>Real reform would ultimately not cost anything since the elimination
>>>of the waste in the system would pay for the increased coverage for
>>>the poor.
>>
>>Not so fast.  There's no guarantee that a single-payer system will, in
>>fact, have less waste.  (There's also no guarantee that a single payer
>>system will have lower malpractice costs.)  The expense problems with
>>the US system have little to do with the payer system.
>>
>>I note that any provider can basically decide on how much it wants to
>>spend on overhead (read "waste").  People who think that a much lower
>>overhead system is possible in the US without changes that have
>>nothing to do with payer systems can prove that any time they want.
>>
>>Such a proof consists of establishing a health care payer that does
>>things "right".  That will drive the evil wasteful companies out of
>>biz, lower health care costs (the savings can be spent on the poor or
>>returned to the customers), and make a lot of money (which can be
>>spent on other good acts) for the people who do it.  That sure looks
>>like a moral obligation, so I really doubt people who insist that its
>>possible yet are unwilling to risk their money to prove it.
>
>Health care has a non-market component if one has a goal of insuring
>everyone including the poor and the sick.

So?  The promise was that the "unnecessary" overhead would pay for that.
If it's true globally, it is true locally in that the overhead saved
can be used to provide some for-free coverage.

>Even the current so-called private American system has huge tax
>subsidies for the well-off for their health care insurance.

Those subsidies, paying for health care with pre-tax dollars, are
available to any private payer, so they're not an obstacle.

We get lots of excuses, but there don't seem to be any people who are
confident enough in their health care theories to risk their money.
Heck; I'm willing to invest in such an experiment, so the preference
for systems that take my money by force is "curious".

>check and balances can be put in place to control costs and that

Hold it.  We were told that overhead savings ALONE would pay the poor's
health care costs.  What are these other costs that must be controlled?

>Most every other Western Capitalist democracy has demonstrate that such
>systems are possible at enormous cost savings.

With different populations.

Let's try the obvious experiment.  We'll let the experts from Canada
run health care in NYC, DC, Chicago, and/or LA.  They get to pay for
it using whatever money they can extract from the region covered,
which won't kick in for health care costs for other regions.  (If the
Canadian system doesn't allow tax deductions for medical payments,
they disappear in the region, but if the system uses taxes, so can
they.  In other words, they can set up the same paying system.)  We're
promised savings, so let's see the system pay for itself in the US.
Note that the experts don't get to change the malpractice system
and have to do it with the populations in those regions.

Since those regions have more people than many of the countries that
are so successful, they're obviously big enough.

-andy
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