The Corner

Politics & Policy

The Single-Payer ‘Cost-Effectiveness’ Mystery

If universal coverage is the sine qua non of health-care reform, then I can understand the appeal of a single-payer system, such as the one Bernie Sanders recently proposed. Single-payer is a conceptually simple way to ensure that every American receives the same coverage. Advocates are on much shakier ground, however, when they claim that single-payer is not merely more equitable, but more cost-effective as well.

Robert Frank made the familiar cost-effectiveness case in the New York Times earlier this summer, and, as usual, it left me with more questions than answers. Frank made three points. First, administrative costs are lower in single-payer systems. Second, single-payer systems save money by not having to advertise. Third, the government can use its monopoly on demand to negotiate lower fees paid to providers.

Even if all three points are true, it is unclear why they are unique to health care. Someone arguing for single-payer plumbing or single-payer automotive maintenance would probably make the same points. To what extent is the case for single-payer health care different from the case for government financing of all goods and services? Frank doesn’t say.

As for whether costs are indeed lower, “you get what you pay for” would seem to apply regardless of whether the payer is the government or a private insurance plan. Want better fraud detection? Administrative costs have to go up. Want more program utilization? Increase advertising costs. Want better doctors? Compensate them more. How a single-payer system is supposed to change this basic relationship between cost and quality is not clear.

Compare health care with education. Public schools are essentially single-payer education systems within the areas they cover. When was the last time we heard anyone argue that public schools are a great tool for containing education costs? When has Bernie Sanders or any Democrat called for the government to push down teacher salaries in order to save money? Any suggestion that teachers should be paid less is met with the obvious counter-argument that teaching quality would suffer. And yet single-payer health care, which comes with the explicit promise to pay doctors less, is supposed to reduce costs without reducing quality. By what magic?

Jason Richwine is a public-policy analyst and a contributor to National Review Online.

Most Popular

Elections

Vote Your Conscience

At the 2016 Republican convention, Senator Ted Cruz spoke a controversial phrase: “vote your conscience.” I think about this phrase, this idea, fairly often. I’m not one to give advice on voting (or much else). But when asked for advice, I usually say, “Vote your conscience.” Sweet conscience! One of ... Read More
Elections

Vote Your Conscience

At the 2016 Republican convention, Senator Ted Cruz spoke a controversial phrase: “vote your conscience.” I think about this phrase, this idea, fairly often. I’m not one to give advice on voting (or much else). But when asked for advice, I usually say, “Vote your conscience.” Sweet conscience! One of ... Read More
Music

Stevie Nicks, Like Springsteen, Preaches and Preens

In the 1970s, Stevie Nicks and Bruce Springsteen made impressions on pop-music culture with romantic rock landmarks, Fleetwood Mac’s Rumours album and Springsteen’s Born to Run. But their new 2020 releases, Nicks’s single “Show Them the Way” and Springsteen’s Letter to You film and album, make the ... Read More
Music

Stevie Nicks, Like Springsteen, Preaches and Preens

In the 1970s, Stevie Nicks and Bruce Springsteen made impressions on pop-music culture with romantic rock landmarks, Fleetwood Mac’s Rumours album and Springsteen’s Born to Run. But their new 2020 releases, Nicks’s single “Show Them the Way” and Springsteen’s Letter to You film and album, make the ... Read More

The Pollster Who Thinks Trump Is Ahead

The polling aggregator on the website RealClearPolitics shows the margin in polls led by Joe Biden in a blue font and the ones led by Donald Trump in red. For a while, the battleground states have tended to be uniformly blue, except for polls conducted by the Trafalgar Group. If you are a firm believer only in ... Read More

The Pollster Who Thinks Trump Is Ahead

The polling aggregator on the website RealClearPolitics shows the margin in polls led by Joe Biden in a blue font and the ones led by Donald Trump in red. For a while, the battleground states have tended to be uniformly blue, except for polls conducted by the Trafalgar Group. If you are a firm believer only in ... Read More
Law & the Courts

The Kavanaugh Court

If Justice Barrett votes as her mentor Justice Scalia did, she will be part of an ascendant conservative majority on the Supreme Court. What kinds of decisions can we expect from this majority? Short answer: Ask Brett Kavanaugh. Contrary to how journalists frame each seat change on the Court, comparing the new ... Read More
Law & the Courts

The Kavanaugh Court

If Justice Barrett votes as her mentor Justice Scalia did, she will be part of an ascendant conservative majority on the Supreme Court. What kinds of decisions can we expect from this majority? Short answer: Ask Brett Kavanaugh. Contrary to how journalists frame each seat change on the Court, comparing the new ... Read More