David Brooks Wouldn't Mind a Single-Payer System

Maybe he has said this in the past but if so, I've missed it. His comments come around the two minute mark right after Paul Krugman notes all the flaws in the bill.

It's somewhat exasperating for me because I think I've made the argument that spending 17 percent of our GDP on healthcare is unsustainable and that most other advanced industrial nations that make up the OECD are spending on average around 10 percent of their GDP achieving universal coverage and obtaining better results in terms of socio-economic metrics such as life expectancy, infant mortality etc. So while it is refreshing to hear David Brooks admit that our current system is untenable, why didn't he write on the merits of a single payer system considering he has a national podium at the New York Times? And he's right, a single payer system would control costs and I am not convinced that this bill will accomplish that.

Paul Krugman has some thoughts on polling at the end that are also illuminating.

Update [2009-12-28 3:40:1 by Charles Lemos]: After a little research, I found this exchange between Gail Collins and David Brooks in the New York Times back on July 29, 2009 discussing the question "What's Wrong with the Single-Payer?"

I’m not crazy about the public plan. I dislike the idea of the government competing in a marketplace it regulates. I think the temptation to subsidize the public entity will be overwhelming. But I’m not vociferously against it either. That’s because:

A.) I’m not that thrilled with the insurance companies.

B.) I think it will save money, but not that much (the C.B.O. agrees).

C.) (!) I think it will produce small administrative efficiencies.

Democratic politicians throw around statistics claiming that Medicare has much, much lower administrative costs than private insurers. I’ve been told by various economists that this claim is three-quarters trickery. It’s a lot cheaper to administer a targeted population that uses a lot of care than it is to administer a large population that uses little care per capita. Plus you can save a lot of administrative costs if you don’t actually regulate treatments that much.

Tags: David Brooks, Paul Krugman, Single Payer Systems, US Healthcare Reform (all tags)



Re: David Brooks Wouldn't Mind a Single-Payer Syst

As a Brit, with 60 years of a free universal health service, I could sing the merits of a 'single payer' system - but I find the name an odd characterisation: there are actually multiple payers  (through taxations) and multiple arrangements for employment of medical staff,

However, the key thing about Krugman and Brook's exchange is that this is now happening, and should constitute the next phase of debate and reform. Quite frankly, having followed the primaries and the GE avidly, the main thing that the incoming president promised was reform to cover the 40 million uninsured, and close some of the loopholes in the insurance. Debate about single payers and public options developed on liberal blogs, but I never had any sense that this would be the immediate focus of any reform, though maybe a more long term objective.

So that would be  my advice to progressives who want socialised medicine like most of Europe. Instead of calling the current administration sell-outs and traitors, celebrate the more universal coverage that you have gain, and then start persuading the rest of the country that single payer healthcare isn't communism.

by brit 2009-12-28 12:36AM | 0 recs
My hopes for more widespread coverage

and incremental change are the only things currently allowing me to swallow my bile about the health care bills as they currently stand, and my nightmares about what the final bill may ultimately become. The Senate bill is worse than the House bill, of course, but the House bill is no progressive prize. Still, there is more potential to be found there than in the Senate bill. Realistically, we weren't going to get any sort of progressive prize out of either chamber, but I had hoped for better than this.

I would like to think that eventually we will work our way toward a system more like yours, and that we have found a decent starting point. Still... the idea of a mandate without the availability of a public plan makes my hair stand on end, and despite the new restrictions and stipulations being placed on insurance companies, a little voice in the back of my head keeps telling me they're getting a handout...

by sricki 2009-12-28 01:32AM | 0 recs
Re: My hopes for more widespread coverage

To get reform, sometimes you have to buy out vested interests.

It's not beautiful, nor edifying - it's just politics.

In the case of the NHS, the only way the National Health Care system was passed was to give Doctors the vital concession that they were self employed, and could work in private as well as public medicine.

This was seen as a huge betrayal of principles, but it got reform through.

Maybe the Obama administration has had to appease the insurance companies. Short of not passing any kind of bill though, I'm not sure what the strategy should be. Improve things bit by bit, with some ugly compromises with blue dems and obstructionists. Or pull down the whole system?

That's why republicans fought this tooth and nail. HRC was the big test of Obama's ability to get things done, and having defeated Bill and Hillary a decade ago, the republicans probably thought they were onto a good Alamo.

Given what was at stake, for 40 million uninsured, and the next 3 years of administration, Obama made the calculated decision to ditch the PO in order to get it through.

Not pretty, not principled, but politics. And I hazard to guess more good will be done by having a partial and tarnished compromise here, rather than heroic defeat, in terms of other legislation. I might be wrong. But the very fact people are talking already about the deeper deficiencies in US healthcare and looking at more long term reform is all to the good.

by brit 2009-12-28 02:39AM | 0 recs
Re: My hopes for more widespread coverage

You will notice the Doctor Lobby is a lot stronger in the US. The NHS and Canadian systems took on the doctors and won sort of, there is no way the US government can hope to do the same.

by vecky 2009-12-28 11:23AM | 0 recs
Re: David Brooks Single-Payer System

And now we are hearing that the House Dems are ready to give up the public option in order to merge with the Senate bill. It seems to be case of universal health care at all costs, even if in the end the country goes bankrupt just to prop up the health insurance industry. It seems to have already happened with the pharmaceutical industry, about which the barring of imported drugs is forbidden. It irks me everytime a see a TV ad for some magic drug and they seem to come one after the other at the cost of billions each year.

by MainStreet 2009-12-28 03:07AM | 0 recs
Re: David Brooks Single-Payer System

Sorry looks like a double negative. Pl delete "forbidden."

by MainStreet 2009-12-28 03:09AM | 0 recs
Er, ah, ahem. Sorry, OT, but...

Charles... unless you would REALLY like the women of MyDD to learn to tighten their vaginas and increase their breast size, I think some deletions are in order....

http://www.mydd.com/story/2009/12/28/916 28/279#1

http://www.mydd.com/story/2009/12/28/953 3/7462#1

by sricki 2009-12-28 04:58AM | 0 recs
Re: Er, ah, ahem. Sorry, OT, but...

The tighter vaginas diary was deleted.

Guess he only wants ya'll with bigger breasts.

Far be it for me to argue with Admin.  ; )

by Kysen 2009-12-28 06:02AM | 0 recs
Re: Er, ah, ahem. Sorry, OT, but...

Alas, it seems as though the MyDD women will now never know how to increase their breast size.....or how to prevent their bodies from becoming filters. 'tis a sad day indeed.

All kidding aside, those spam diaries are far more entertaining that the shoe store ones!

by Kysen 2009-12-28 06:07AM | 0 recs
Ben Nelson Expands Medicaid or Jeopardizes HCR

So the Senate passes their HCR reform on Christmas eve with Ben Nelson's "Federalizing Medicaid for Nebraska" amendment. This could be really good or really bad, as the other states wake up to the implications (NYT). Charles Lemos wrote about this the other day in "States React to the Nebraska Compromise".

The States are waking up to two things, (1) The HCR bill sticks them with a huge, unfunded mandate at a moment in time when they're facing a budget crisis due to the impact of the recession on tax receipts. (2) Why can't we all get the same deal as Nebraska?

I would like to see #2 for a number of good reasons:

(1) The Federal Tax code is more progressive than most states. Federalizing Medicaid shifts more of the tax burden to the wealthy taxpayers.

(2) Having the Feds regulate medicaid insurance helps define a guaranteed minimum to health care benefits, which will secure the floor of for all other plans. Presently, Medicaid benefits can be variable depending on each state's budget or opposition to providing welfare to its citizens.

(3) Yeah, there is the little thing of Taxes vs Debt, but the economy could certainly use additional stimulus money. Providing medical care to people has a very high stimulative effect. The recession is killing state budgets everywhere as they are prohibited from running debt. Federalizing Medicaid would provide a huge kick in the stimulus package.

(4) Medicaid doesn't have the famous 20-30% cost hit from private insurance. To the extent that more people are served by an insurance program with 5-10% overhead, national health expenditures will go down.

(5) Cost Control. Medicaid health delivery is frequently offered through FQHCs (Federally Qualified Health Centers) which are much more efficient at delivering cost effective health care than big, for-profit hospitals.

However, you can bet that the States are freaking out over #1.

I have no doubt that every governor in every State is on 24 hour lobbying to their Senators and Representatives. The unfunded Medicaid Mandate has a much higher impact on Blue States, which means that Democratic Caucus will be getting the highest pressure. As pointed out in the NYT article:

Existing Medicaid coverage varies widely. Arkansas, for example, extends Medicaid to working parents who earn up to 17 percent of the federal poverty level, and Alabama offers coverage for those making up to 24 percent of that level. Minnesota covers working parents making up to 215 percent of the federal poverty level, and New York, up to 150 percent. New York also covers childless adults up to 65 making up to 100 percent of the federal poverty level.
by MetaData 2009-12-28 05:01AM | 0 recs
Re: David Brooks Wouldn't Mind a Single-Payer Syst

This seems like absurdities on top of absurdities on top of absurdity

a) Absurdity : discussing single payer at this juncture

b) On top of absurdity: Asking why didn't a conservative columnist do the job that our team refused to do, and, in fact, despite all polling to the contrary, our team preordained as impossible.

c) On top of absurdity: Saying all of this while there is a great push to pass a bill that makes future government action less likely because of the personalities and partisanship involved in the first two absurdities.  Including by one of the panelists who says pass the bill.

by bruh3 2009-12-28 04:45PM | 0 recs


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