Article by Megan McArdle

This strikes me as a very compelling argument against Powerman and Tboy’s assertion that single payer healthcare is the golden goose to free us from the current shitshow.

I’m interested to hear their thoughts

quote:
Let’s return to national health care. It’s practically a mantra on the left that every other country in the developed world has a marvelous system that provides better outcomes at lower costs, so why would we want to stick with the obviously subpar American model?

In fact, it’s debatable whether the other countries’ systems get better outcomes: Once you’ve controlled for factors that have almost nothing to do with the health-care system, such as homicides and car accidents, it’s not clear people in other countries live any longer. But it is not debatable that they are cheaper; we are the only country in the world that spends a fifth of our gross domestic product on health care.

And why do we spend so much? Because everything is organized to make the system costly, from the cost of labor to the number of machines we use to the way we construct our hospitals. (Yes, we pay a lot for drugs, but drug spending is only a small fraction of total spending, so this cannot account for the difference — and neither, before you ask, can insurer profits or administrative costs).

It is possible that we could have controlled these costs, once, as other countries have done. But as any legislator, or parent, will tell you, it is a lot easier to not do something than to stop doing it. Some things we’ve done can’t be undone at all — our hospitals are now constructed around private- or semi-private rooms with intensive electronic monitoring of patient status, and we can’t convert them to space-saving, labor-economizing open wards without spending more than the project would save us.

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Other cost-saving measures are theoretically feasible but politically catastrophic. American health-care workers are very highly paid compared with their international counterparts, and we have a lot of them, all very well politically organized. Those people have planned their lives around their steady jobs and strong earnings – mortgages, car payments, college tuitions. Suddenly announce that you’re slashing everyone’s salary by a third to make national health care affordable, and you’ll have a modern-day Bonus Army marching on Washington, scalpels in hand.

This is why no nation in the world has managed to make sustainable cuts to their health-care system. They have kept costs from growing, yes, but except in the case of fiscal crises such as the Greek debt disaster, no country has actually slashed what they were already spending. If others can’t, then it’s probable we can’t either — at least, short of a Soviet-style revolution, which is a cure worse than the disease.

quote:
What we’re talking about is a phenomenon known as “path dependence”: What you can do now depends on what you’ve already done.

Long story short: American healthcare is expensive because we want it to be. Americans worship PPO plans that allow for easy access to specialists, while European systems control excessive specialist visits by requiring referrals (HMO).

Americans demand hospitals organized around private rooms caked in gadgets. In other nations, it’s communal.

Americans demand high pay for nurses, hospital staff, etc.

There is no way to “reset” these things. When we decided in the 50s and 60s to organize our healthcare in the most expensive way possible, we set it in stone. There is no political possibility to cut nurse pay, bulldoze hospitals, restrict specialist visits, etc.

And ultimately, Powerman and Tboy cannot answer this question:

With the exception of Greece during their solvency crisis, what nation has managed to outright reduce health expenditure outlays?

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Posted by Riverside

Member since Jul 2022

9424 posts

Posted on 12/6/25 at 2:00 pm to HailHailtoMichigan!

We can make things considerably cheaper and more affordable within the current system we have despite what the author claims.

Repealing Obamacare should be done next year. Speaker Johnson’s recent comments about not wanting to do that were deeply disturbing.

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