As Fareed Zakaria sees it, the remedy for America's ailing and expensive health system is clear.

[eridani]

Kenneth J. Arrow, “Uncertainty and the Welfare Economics of Medical Care,” The American Economic Review, December 1963:

https://www.aeaweb.org/aer/top20/53.5.941-973.pdf

It might be hard for some to swallow, but, in his view, it is sure and proven.

"There's absolutely no question that when we look at the ability to provide good healthcare at an affordable price, lower levels of massive inequality in healthcare outcomes or provision, a single government payer and multiple private providers is the answer. It's absolutely clear that is the only way you can achieve that goal," Zakaria said. "The revolution that's needed here is not an information revolution, it's a political revolution."

<snip>

As Zakaria sees it, the answer does not lie in technology – at least not in technology alone, but rather in the structure of the health system itself and leaders should be prepared to unravel the structure.

Comment by Don McCanne of PNHP: Although Fareed Zakaria has wavered in the past on what we need to do to improve the health care system in the United States, he has now come to the firm conclusion that we need single payer.

As he states, “There's absolutely no question that when we look at the ability to provide good healthcare at an affordable price, lower levels of massive inequality in healthcare outcomes or provision, a single government payer and multiple private providers is the answer. It's absolutely clear that is the only way you can achieve that goal.”

He cites the 1963 landmark article by Nobel laureate Kenneth Arrow, “Uncertainty and the Welfare Economics of Medical Care,” (link below)) explaining why health care cannot achieve a competitive equilibrium in the marketplace. In today’s terms, Arrow’s work explains why it is foolish to continue to rely on a marketplace of private health plans plus various public programs to try to manage spending in our $3 trillion health care industry.

As Nobel laureate Paul Krugman states, “health care can't be marketed like bread or TVs.”

Imagine marketing fire or police or disaster relief services like bread or TVs. Those services should be there, ready for any of us whenever we need them. The same is true for health care. That would work just fine if we made our government the single payer.

[think]

1. Fareed Zakaria chooses the logical solution /nt

[Beowulf42]

8. Yes, but

If he expects common sense to resonate in the political mess we call government, he's going to be sadly disapointed.

[think]

9. True. That's why I'm glad Bernie is out there promoting single payer to the American people

It may not be enough to get him elected or single payer in place any time soon but he's at least making the effort.

I can't say that about the other candidates.

[secondwind]

2. kickety-kick!

[daleanime]

3. K&R....

[Yorktown]

4. Zakaria is spot on. Two caveats though

to provide good healthcare at an affordable price, lower levels of massive inequality in healthcare outcomes or provision, a single government payer and multiple private providers is the answer.

sums up most of what's needed.

Caveats:

- a small fraction of the cost must be paid by the patient, lest the system be abused.

- medicines must be vetted by some public health org, and its members must be FBI style, uncorruptible by big labs (to keep high cost/low efficiency medicine)

[annabanana]

6. "lest the system be abused"

You mean like people getting surgery just because they can?

[magical thyme]

10. No. Like a group of giggling young women coming to the ED with "syncope"

to get out of work.

Like someone coming to the ED 2 days in a row with a headache, clean labs, but won't give up until the doctor breaks down and does a spinal tap which is also, not surprisingly, clean.

Like someone (on Medicare) coming to the ED because they haven't eaten in 5 weeks.

In my neck of the woods, there are many, many, many who abuse the system. They run up huge $$ worth of diagnostic tests because they don't know the difference between an ordinary bug and something that requires attention, they don't know the difference between a medical emergency and something that can wait for an appointment, or they're attention-seeking.

The majority of people I've seen in the ED simply don't belong in a hospital at all. A high percentage don't even belong in a clinic.

There is a lot of abuse of the system all around. Glad to have left it.

[Vincardog]

13. Do those people have a co-pay now? IF so how does it stop them?

[magical thyme]

15. I don't know the specifics of their insurance.

I ran the lab tests, not the paperwork.

I do know that from what I've seen, insurance companies are not the only ones that abuse the health care system. And I don't know how to stop them, but co-pays may help slow them down.

[Vincardog]

16. Insurance companies cost us all a LOT more than "abusive" patients ever could.

[magical thyme]

17. not necessarily. again, I don't know the specifics but I do know that a majority

of the patients I saw in our ED were not sick, or had days or weeks to schedule an appointment with a doctor or visit a walk-in clinic.

And I suspect that if a lot of them had to pay for their care out of pocket, they wouldn't be there.

[Vincardog]

19. You are free to suspect anything you want to. I don't share your concern. Adding cost to

Health CARE doesn't add VALUE to my way of thinking

[Yorktown]

12. Nah. I'm talking about benign visits (the bulk by number)

[-none]

7. First off, define abuse.

- a small fraction of the cost must be paid by the patient, lest the system be abused.

Not really. Those wanting to abuse the system, will find a way to do it regardless of the cost. People are doing that now. What you are proposing will eventually end up denying too many people health care again and pricing people out of needed health care. Money being the motivator.
Those that actually abuse the system can be weeded out up front by the system itself, without raising the cost for anyone.

[JayhawkSD]

11. Second of all, prove abuse.

"- a small fraction of the cost must be paid by the patient, lest the system be abused."

If that were true, then health care would be heavily abused in France, Denmark, Sweden... Please show evidence that such is the case. Hard to do, isn't it, given that those countries spend one-third per capita of what we do on health care, and a far lower portion of their GDP, and the patient pays zero.

The patient, that is to say the taxpayer, pays the entire cost, of course, just as we do in the United States. Only here we filter that cost through insurance companies and, now that Obamacare is in place, through government and insurance companies. We pay the government, the government pays the insurance company, and the insurance company pays the medical provider. Obamacare made it a three step payment system rather than the former two step system.

Those countries have socialized the entire cost of health care and are saving a lot of money. We require the user to pay an ever increasing portion of the cost in copays and deductivles, so we have socialized only a portion of the cost in order to be able to say that we have free enterprise, which is a system where part of the cost enriches the capitalists and the other part enslaves the consumer. It may be enterprise, but it sure as hell isn't free enterprise.

[dreamnightwind]

20. Thanks, excellent post

Seems to work well in other countries. The abuse meme sounds like a RW talking point to me.

Also so much of the covrage of any single payer discussion in the MSM (pretty much all of it) misrepresents it as being something that will cost a lot ($15 trillion?) and must be paid for somehow.

How can they get away with that? I've seen this BS spread by Democratic sources too.

Single payer will SAVE money, a LOT of it.

The difference is the money will come from the general tax fund, not from individuals making direct payments to insurers/practitioners. But it is far far cheaper once the profit is remove from the system, and there are many other countries' systems out there to prove it.

[jwirr]

14. If you research abuse of the existing medical health care

systems you will find that it is seldom the patient that abuses the system. It is a provider padding the bill. Look it up.

[Enthusiast]

5. Kicked and recommended!

[KamaAina]

18. The Fareed Zakaria who was in the Party of the Right in the Yale Political Union?

That Fareed Zakaria?!