[March 31, 2008 @ 3:36 pm] David Catron

Single-payer activists tell us that Medicare-for-All would be nothing like socialized medicine because health care providers would not be directly owned and operated by our masters in D.C.  In the real world, however, the golden rule (He who has the gold, rules.) applies to health care just as it does to everything else.

If government bureaucrats control who gets paid and how much, they may as well employ the doctors and own the hospitals. Anyone doubting this should read Jerry Cromwell’s post at Health Affairs, in which he describes how Medicare’s clumsy cost control strategies have destabilized acute care hospitals:

Stability reigned until Medicare’s per case bundled payment arrived, reinforced by aggressive government denials of inpatient coverage for simpler procedures (e.g., laser eye surgery). Stays became shorter, and less complex surgery migrated to ambulatory settings …


Acute inpatient surgery became far more complex and much more costly, on average. It also involved a higher proportion of uninsured patients as ASCs siphoned off better-paying patients … the industry was hemorrhaging inpatient cases that left many fixed costs of operating a full service facility uncovered.

All of this disruption might have been worth it if the goal of saving money had been reached. But health care inflation continues apace, Medicare is in serious financial trouble, and the patients are coughing up more out-of-pocket money than ever before. Moreover, it has created a whole new problem—-physician-owned ASCs and specialty hospitals:

ASC and specialty hospital physician-owners refer uninsured and Medicaid patients to acute hospitals more often … ASCs and specialty hospitals reap the benefits of physicians referring more complex, costly patients to acute general hospitals while focusing on less complex, more profitable patients …

This has, of course, done considerable damage to acute care hospitals. And the vicious cycle of meddling continues as various interested parties request (you guessed it) more government intervention. Cromwell himself, apparently missing the larger significance of his own analysis, thinks the solution is government-imposed “universal coverage.”

The real solution is, however, less rather than more government. There’s a lesson here for anyone capable of thinking outside of the ideological box: When government controls the purse strings, it can and will control the health care delivery system. Thus, there would be no practical difference between Medicare-for-All and socialized medicine.


  1. W Horter Says:

    Once more you overlook the obvious. Our healthcare system now chews up 17% of GDP. That isn’t some figure I have made up, it’s a cold hard fact. This “system” is insuring 83% of the people. Most other modern countries spend no more than 11%, in fact average 10% of GDP, and cover everyone! There are no bankruptcies because of healthcare bills in any of those countries, none at all. 33% of every healthcare dollar in this private for profit system is used for administrative costs. Fully one third! In “Socialized Systems”, are you scared?, those costs are less than 10%, as a matter of fact, in Medicare, less than 4%. Last but certainly not least, the people in those countries served by single payer healthcare, those “socialist systems”, outlive Americans! Isn’t that the ultimate teast of healthcare?

  2. Stuart Browning Says:

    We have an excellent FAQ on this site “The Myths of Single-Payer Health Care” that easily refute W. Horter’s socialist propaganda about overhead and life expectancy averages.

  3. W Horter Says:

    ” Socialist propaganda “?? I hardly think so. You can find my facts on the net easily Mr Browning. Pick out the above statements that you find untrue? The only propaganda, is the stuff you have on here. One person summed it all up, he said,”socialized healthcare, is a moral and economic imperitive”. That was all that needed said. What this site has, is simply balderdash. I do appreciate the chance to refute your absurd assertions though.

  4. W Horter Says:

    Myth No. 1: Everyone has access to health care a single-payer system. This is absolutely true. Read some of the blogs from Canadians posted in this website. The American system is the real “rationer”, asmany as 47 million are simply left out.

    Myth No. 2: Claims of rationing are exaggerated. Yes they are, as I said, read the blogs following some of your own stories, blogs by Canadians themselves.

    Myth No. 3: A single-payer system would save money on administrative costs. This is another true statement, not a myth at all. The US system uses 33% for administrative costs. Most other single payer systems use less than 10% for the same costs, and as a matter of fact, Medicare, uses less than 4%.
    Myth No. 4: Single-payer will provide fair and quality care for everyone. True again. The ultimate teast of any healthcare system, is lifespan. All those countries you say have “inferior” systems, their people live longer than Americans.

    Myth No. 5: Single-payer leaves medical decisions to patients & doctors. Here again, the answer is yes. In the American system, decisions are made by Insurance Companies, not Doctors.

    Myth No. 6: Single-payer systems achieve better health outcomes. A correct statement. Most other countries with single payer not for profit healthcare, their people outlive Americans. That is , after all, the ultimate test.

    Myth No. 7: The U.S. systems also engages in rationing. Yes, it is limited to the “haves”, the poor are simply priced out of the system. Some 17% of the people at this writing.

    Myth No. 8: A single-payer system will not hamper medical research. I must admit, I have no research in this area. Perhaps someone else reading this could comment.

    Myth No. 9: Single-payer will save money as patients seek care earlier. Yes, a single payer not for profit system would have better results as far as diagnosis earlier, simply by excluding those cases that are caused by hesitant patients because of cost. Perhaps this is the greatest reason their systems allow the people to live longer?

    Myth No. 10: The free market in health care has failed in the U.S. Yes, when you are spending the most, by far and away the most, and getting the least coverage, the shortest lifespan, you can say it is failing. Why would anyone but the most expensive system when it covers the least, and is rated 37th in the world?

  5. Gasper Says:

    Hey Horter,

    When DC cuts my paycheck in half, I’ll be coming after you for your great ideas.

    Why don’t you just say what every socialist thinks?…Why should I pay for it when someone else can take the hit? I deserve to live long ON SOMEONE ELSE’S MONEY.

    Life isn’t fair. Not everyone survives from cancer. Not every baby lives.

    And those WHO numbers balance out the relatively homogenized, anti-immigrant countries from ours? I never saw that part analyzed. We are not Europe.

    Before you setup entitlements, you’ll need to kick out all the illegals so they don’t take your very much deserved benefits.

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