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Sunday, January 04, 2015 4:01 AM

US Doctor Comments on Single-Payer "Medicare for All" Proposal

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I received many interesting comments from readers on Single-Payer "Medicare for All" Proposal; Live and Let Die; Why Does Single-Payer "Work" in Europe?

This email is from a US M.D. named Ken. Ken writes ...

I agree with everything you wrote, but you omitted a discussion of the variation of demand in relation to the cost. It is approximately correct to state that when the perceived cost to the user approaches zero, the demand for services approaches infinity. This is the crucial flaw in all "government-funded" single-provider programs. The demand for "free" services is impossibly huge.

I have read extensively in the research literature on the details of the health care systems in most developed countries. To make a long story short, what goes on in most government-run single payer programs is that you are promised you may receive all conceivable medical care without limit, and then care is denied to you by a variety of rationing systems.

In England the General Practitioners are charged with broad authority to deny and ration care. Canada has a system in which care is rationed via a hard limit on the annual budget, which is funded by the provincial government. The fiscal year starts in July, and what happens is that clinics which provide elective services (e.g. hip replacement) exhaust their budget by the early spring, and so the clinics close for several months in the late spring and reopen in July after their next annual funding allotment is received. During the intervening months the bereft Canadians have to go to the U.S. for treatment paid out of their own pocket if they cannot wait. This is an amusing variant of "Rationing by Queue" which is a prevalent device in all such government programs in the developed nations.

The entire approach in all socialized medicine countries can be summarized as "Promise everyone everything, and then deny them when when they request delivery." This of course is the time-honored modus operandi of the welfare state.

Thank you for your courageous leadership in tackling a number of crucial issues in your blog. Your clear thinking and number-crunching acumen are in short supply. Please stay safe.

Ken is correct about unlimited demand for free services. I have talked about that issue before, just not in my recent post.

There is not one thing in Obamacare that increases competition or reduces overall costs. Obamacare did not even lift the ban on drug imports so US taxpayers effectively subsidize the entire rest of the world.

The government sets some prices but price setting and competition are certainly not the same thing. When prices are too low, shortages occur (or doctors drop out of the system), and the latter has happened. And nothing has been done about needless or repetitive tests.

A number of previously uninsured persons are now insured, but this comes at the expense of making many others pay far more. Those who pay less are happy, those who pay more aren't.

Obamacare is over 10,000 pages of legislation but did not fix a single problem with the "system". It  did create a new set of winners and losers. "Medicare for All" with unlimited free services would be veritable disaster.

I have a couple more emails to share, one from Europe and one from Canada.

Mike "Mish" Shedlock

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