Slow and Steady

David Brooks thinks single-payer is worth considering, but has no clue how we would make the transition.

He cites bunch of reasons.

Jobs will be lost in the health system; jobs will be lost in the insurance industry; patients will have to switch from private insurance they generally like to coverage provided by the government; doctors’ salaries will go down; the Federal government will have to spend ~$3.26 trillion more a year; taxes will go up; time between needing an appointment and seeing a doctor will increase.

These are hurdles worth considering. One of the scariest statistics he cites is that support for Medicare-for-all drops 23% if people hear we would need to pay more taxes.


It’s clear political support for Medicare-for-all will be difficult once the fervor clears and the extent of the changes/costs become apparent. As the diagram suggests, nobody wants to cut out private health insurance, endanger medicare, pay more taxes, and on top of that have additional delays in treatment.

Here is my question to David Brooks: how slow can we go? If we were hell-bent on getting universal healthcare with as little growing pain as possible, what’s the best way to go about it? Doing it as slow as possible (perhaps over a century) would do a lot alleviate the economic impacts, the strain on budgets, and the sticker shock of having to pay more taxes. By the time everyone got universal healthcare, all of its critics/anyone who remembers an alternative would be dead.

In fact, the same study claims support for marginal changes in the system is high.

Larger majorities of the public favor more incremental changes to the health care system such as a Medicare buy-in plan for adults between the ages of 50 and 64 (77 percent), a Medicaid buy-in plan for individuals who don’t receive health coverage through their employer (75 percent), and an optional program similar to Medicare for those who want it (74 percent).

I’m not an expert, but I’d really like to know what a molasses-like plan for healthcare reform would look like. How would we phase out private insurance? Is it reasonable to expand things like Medicare and Medicaid in search of incremental change and then cut/transform them later? Would a slow, drawn-out process be messier and more bureaucratic than a clean cut?

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