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April 08, 2009

Single-payer health care pitfall

There are three aspects to health care: quality, access, and price. Only two of the three can be controlled. If we choose to keep quality and access, then price cannot be controlled. If we want price controlled, then quality, access or both will be sacrificed.

Every merchant realizes that the lower the price of an item, the greater the demand. For example, in Austin, Texas, nine individuals used emergency room services 2,678 times within six years. The average emergency room visit costs $1,000. But why not? There was no cost to the patients.

Universal, single-payer health care will improve our health system how? How can access and quality be maintained when there would no longer be an apparent cost to the patient for going to the doctor?

Jerry P. Murray
Centerview, Mo.


Mark Robertson

You are exactly right, Medicare is a disaster. The "brilliant" LBJ said that Medicare would cost 9 billion in 1990. It cost 67 billion that year and is now approaching a half trillion annually. And, unfortunately, President Bush added a prescription drug benefit that will end up costing in the trillions.
Government should get out of health care. The main reason that it cost do much is third party payments, both government and private, and the involvement of government in general.
Free market forces are all but gone from U.S. health care. The only way to bring health care costs down is free market forces. It works in all other businesses. A return to direct payment for health care with health savings accounts is an answer.
Private charity is an answer for the poor. Virtually all pharmaceutical companies already have programs set up for poor an others who can't pay. Thankyou.

Mark Robertson


Yeah right Medicare is really a good system. You pay for it all your working life then you get to pay for it again when you need it. It's called double dipping.
More failed crooked government.
Why should health insurance be any different than say auto insurance?
Let me geuess, that will be the next big problem and entitlement.


Gosh if we go to the Single payer system where will our Canadain friends go for health care?


"...a single-payer system such as Medicare is the most prudent, fair and cost-effective."

We've had lots of talk and references to "fair" in the letters for the last few days. Discussion of the high percentage of total taxes paid by high earners, Obama's policies as an "economic leveling in the name of fairness", and now, universal access to health care without cost to the user have all been identified as "fair", or lacking "fairness".

The problem is, there's no acceptable or workable definition of "fair". What's just to one person may be wholly unjust to another. It's like trying to define the "middle class ", everyone thinks THEY belong and others don't.


From an economic standpoint, Jerry's assertion is correct. When cost of a service decreases (or is eliminated), demand for that service should increase. What Jerry doesn't address is the true capacity for service in our current system. Is it being fully utilized? Do we have service capacity to spare? Are there other incentives to increase our service capacity while increasing demand for services?

I don't know the answer to these questions either, but any "sky is falling" discussion about the explosion in demand is dishonest without considering these things.


From the original story (or one of them) in the Austin American-Statesman about an ICC report ...

"... In six years, eight people from Austin and one from Luling racked up 2,678 emergency room visits in Central Texas, costing hospitals, taxpayers and others $3 million. One of the patients spent more than a third of last year in the ER: 145 days. That same patient totaled 554 ER visits from 2003 to 2008.

The report didn’t include details about the reasons for all those ER visits or identify the patients (because of privacy laws). Ann Kitchen, executive director of the ICC — a nonprofit that works with hospitals and other providers that care for the uninsured and low-income people in the region — said all nine speak English and three are homeless. Five are women whose average age is 40 and four are men whose average age is 50. Seven have a mental health diagnosis and eight have a drug abuse diagnosis. ..."


Jerry's "nine individuals" were hardly typical and they didn't go to the ER "in Austin". The ER visits were across "central Texas". The cared for were druggies and mentally ill, homeless, street people. But, hey, it made a better story with Jerry's "artistic license" and it "proved" his point.

The point of the ICC report/A-S article was that "preventative care" taken before the ER visits would have been cheaper and better. Preventative care was denied only to see Jerry's friends dumped on the doorstep of the ER where they finally couldn't legally be turned away.

Rather than prove his point, Jerry's only proved how expensive our current health insurance scheme really is.

Sharon Lee

Mr. Murray and others seem to have a true lack of understanding about the current health "system" which controls some of the demand by costing health care so high that many literally die rather than access services priced beyond their means. THe majority of doctors and about two thirds of the population have come to realize a
single-payer system such as Medicare is the most prudent, fair and cost-effective.

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