Keith: I agree with most of what you say. I would just add some nuances.

With regard to unpaid medical bills: You say that as a civilized nation, we will not let life-or-death decisions depend on ability to pay. That is not quite true. We do provide emergency treatment regardless of ability to pay but not other treatment. If a person with diabetes or cancer goes to an emergency room, they are “stabilized” without paying, but they don’t get a year’s supply of insulin or the chemotherapy they need, so they are still sick and may quite possibly die. So in that regard, the current system, which you rightly criticize, is even worse than you say.

With regard to single payer, I would say this about UCC compared to a Sanders-type system. Both systems (rightly in my view) require higher income people to pay a greater share of total cost. That is because we are talking here about social insurance, which simultaneously pools risks across health status and across income status. The difference is that under Sanders, the rich pay via higher taxes, whereas under UCC they pay via higher deductibles. Arguably, the latter is more efficient, for two reasons. First, taxation is a “leaky bucket;” When you consider both administrative costs and deadweight losses, the government collects less than $1 for each $1 of tax burden. Second, making people who can afford it responsible for at least some part of their own medical bills puts pressure on them to think twice about whether they are getting their money’s worth. That leads to less spending (a well established effect) and (this part is more controversial, I realize) potentially to better choices.

Written by

Economist, Senior Fellow at Niskanen Center, Yale Ph.D. Interests include environment, health care policy, social safety net, economic freedom.

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store