Why single-payer healthcare funding may not work in America

Of course Obamacare is failing.

Not quite as badly as No-Obamacare was failing, so I'm still glad it exists. It's a necessary stopgap until we find a system that actually works.

But you know what? Single-payer healthcare will fail just as badly.

In 2015, U.S. spending is projected to hit $10,000.

Yes, I know that single-payer healthcare systems succeed in other developed nations. I also know that competitive insurance-based healthcare systems succeed elsewhere. But neither system will succeed in the United States, because the U.S. is the only nation on earth that refuses to keep healthcare spending from spiraling out of control. If the cost remains the same, it doesn't matter who's paying. In the long run, we all are.

Many Americans believe that a free market would drive spending down, but the American healthcare mishmash (both before and after Obamacare) is definitely not a free market. Just try finding out what a procedure is going to cost so you can choose the least expensive provider. Even the providers have no idea until they've already signed you up and run your insurance numbers. If you're computer literate and have lots of time and patience, it's possible to get approximate prices for prescription drugs, but what can consumers do about profiteers like the infamous Martin Shrekli?

And anyway, when you're being rushed to Emergency is no time to comparative shop.

Many in the general public scream "Rationing!" whenever any limitation to healthcare is suggested, no matter how sensible it may be (refusing to fund drugs with no proven benefits, for example, or allowing futile, often painful, but expensive procedures for people in the last stages of dying). It's frustrating when we grow up and realize that we can't all have everything we want, but it's rational to make sure that, when something (like money for healthcare) is in short supply, it's apportioned wisely for the common good. Americans are not rational about rationing.

Congress, as the right arm of lobbyists, has no interest in keeping healthcare affordable. They would not pass either George W. Bush's Medicare prescription drug plan or Barack Obama's Affordable Care Act until all threat of price caps was removed. Medicare is not even allowed to negotiate drug prices.

Well, folks,

• if consumers are unable to do comparative shopping;
• if we all believe we have a divine right to any healthcare that's available, no matter how expensive or ineffective it may be;
• if we will not allow our healthcare payers to set price ceilings or negotiate lower prices;
• and if our lawmakers continue to favor the lobbies who fund them rather than the people who elect them;

of course our healthcare system will fail.

It will fail millions of people who cannot afford the treatment they need. It will fail millions who pay high prices for treatment they don't need. It is failing all of us, since we pay twice as much for healthcare as we would pay in other developed countries.

Until we find an effective way to limit healthcare spending, American healthcare will continue to fail--whether it is funded by private individuals, by competing insurance companies, or by a single payer.

Medicare Part D: Another year, another huge price increase

I signed up for Medicare last month. In addition to standard Medicare, I added Part D, the prescription drug benefit. My 2013  costs, if they had covered the entire year, would have come to $529 for insurance and $330 for prescription copays.

Today's mail brought the rates for 2014. The insurance premium has increased to $650, or by about 23%. Copays have also increased, to $616, or by nearly 87%. The total increase - assuming I won't need any additional medications - comes to 47%.

I was not happy when President Bush proposed and AARP supported Medicare Part D, the prescription drug benefit. The idea of insuring seniors' drugs was good. The resulting law, which specifically forbids the federal government from negotiating prices with pharmaceutical companies, was insane.

Well, "insane" is putting a good face on it. The financiers who supported the companies who bought the politicians who voted for the law were by no means insane. They were lining their own pockets, never mind the rest of us.

It's obvious, isn't it? If the government gives away money without limits and accountability, retail prices rise, insurance premiums rise, and consumers end up paying as much (or more) out-of-pocket than before the government stepped in.

Want proof? Take a look at this chart from the Kaiser Family Foundation. Notice that the U.S. government spends about as much of its GDP on healthcare as other developed countries (without, however, insuring everybody, as the other countries do). Notice that, unlike citizens of other countries, U.S. citizens spend a whopping amount in addition to what the government spends. The difference? Those other countries put strict limits on what pharmaceutical companies and other medical suppliers can charge.

Some Americans suggest that the government should just stop subsidizing things like health care and education. That doesn't make sense unless you think that only rich people should have access to schools and hospitals. But it makes more sense than subsidizing something without putting a ceiling on what the lucky recipients can charge for their goods and services.

I am going to look for a different Medicare Part D insurance company. I don't expect to find one that's much better, however, until our lawmakers learn to say Yes to middle-class and disadvantaged people and a loud, resounding No! to rich institutions and individuals who want to get even richer at our expense.