Let’s see, if I do a review of research on single-payer plans for the US and the research I am reviewing was all done by proponents of single-payer plans, I wonder if the results of my review will suggest that such a plan would reduce spending in the US. Oh, and did I mention that I myself, as the author of this review am funded by an organization that is lobbying for a single-payer plan. But don’t worry, my results are completely believable and trustworthy, and just like the last reform effort, everything will turn out just like all the mis-information I put out said it would. What I am describing is literally what a review of supposed economic analyses of single-payer proposals does. That is how desperate advocates are to try to justify the Medicare for All and other proposals in the wake of the public’s growing rejection of the concept because people are figuring out the true cost. (PLOS Study) They did include a couple of studies that weren’t done by proponents, but treat them as outliers. Interestingly these analyses are the only ones that have realistic assumptions about the increase in utilization that occurs when you remove cost-sharing and about the lack of feasibility of reducing provider payments. Those analyses all show a dramatic uptick in spending. And the authors intentionally excluded other analyses which showed cost increases on the pretext that those studies weren’t realistic.
And you can get a clue about how clueless the people doing most of these analyses are by looking at the range of estimates for increased utilization and net savings. When you see that much variance, it tells you that the “experts” don’t really have any idea what will happen. The only possible way the current proposed single-payer plans reduce health spending, especially since most of them remove all cost-sharing, is by massive reduction of payments to health care providers and product companies. Theoretically, you can do that, but what do you really think the consequences would be for both quality and access. It is absurd to pretend that there would not be severe dislocations, that many providers would not simply go out of business, that patients would not have great difficulty finding clinicians to treat them. And the harm to the economy just from attempting to shut down the private health insurance system and all the vendors and suppliers who depend on that system is also massive. That is literally hundreds of thousands of very well-paying jobs lost. Our current system is not great in terms of how it is administered and financed, but don’t for one second think that some government-run bureaucracy won’t be ten times worse. As The Who so lyrically warned us long ago, don’t get fooled again.