“Keep adding mass to that black hole and it will suck less.”

Probably because I used to be a member of the ACLU, I often get mailings from far-left causes, such as Public Citizen. I usually read them, too: I can be convinced that I’m wrong, and sometimes they’re so out of step with reality that they make a good blog post.

This mailing, from Public Citizen President Robert Weissman calling for single-payer health care, falls into the latter category.

At the start, Weissman claims that 45,000 Americans every year die due to lack of health insurance. Now, on the face of it, this doesn’t sound like a good argument for single-payer or anything else. Today, everyone has health insurance: they either have it under the ACA or they have it under Medicaid. Even if they are eligible for the ACA and forego it, the sign-up periods are both ubiquitous and often extended. This means that they can acquire insurance for long-term issues. Single-payer can’t improve on that.

And, of course, hospitals are still required to accept short-term issues regardless of ability to pay.

Even with long-term issues prevention providers don’t seem to ask about ability to pay. They provide the service and then ask for payment, and some don’t even hound you for inability to pay. I know this from personal experience.

There is even further evidence that health insurance, or lack thereof, doesn’t change mortality rates here. Medicare doesn’t improve outcomes, and virtually everyone at 65 gets it—and “Medicare-for-All” is what Public Citizen is calling their single-payer system.

The 45,000 number comes from political advocates for… a single-payer system. So the argument is a bit circular here.

The left is predictably fond of the study which got the largest number, 45,000 a year. Unfortunately, its authors are political advocates for a single-payer system, who also helped author the notorious studies on medical bankruptcies. Those studies are very shoddily done, with parameters that somehow always conspire to produce the maximum possible number. In the first study, they set an absurdly low threshold for what constituted a “medical bankruptcy”. In the second, they chose 2006, the year after the 2005 bankruptcy reform act had driven an unprecedented spike in filings. It seems pretty likely that medical bankruptcies were bound to be overrepresented in 2006, since most financial events are easier to see coming than illnesses. But even if you disagree–and the authors offered an incredibly wan explanation of why they did–it’s very clear that the people who filed in 2006 were not going to be a representative sample of bankruptcies in a normal year. I can’t imagine why you would choose to study 2006 unless you were looking for biased results. I have to conclude that their political beliefs are affecting their work, which means I wouldn’t touch that 45,000 number with a bargepole–I wouldn’t cite anything they authored even if it offered to prove beyond a shadow of a doubt that I was right about everything.

Out of 321 million people in the United States, 45,000 people is one one hundredth of a percent. Even if the number were valid, we could easily cover their health care needs without taking over the health care of the other 321 million Americans.

That, however, is a mere quibble compared to the rest of the letter.

They claim that, for example, single-payer is not government run health care.

That would be the Veterans Administration. Or the British health care system. Where the government pays for the doctors and hospitals. Under single payer, you get a health care card and you can go to any doctor or hospital in the United States. Doctors are not employees of the government. Hospitals remain in private hands. You get free choice of doctor and hospital.

If government isn’t paying the doctors and hospitals, who is backing up that card with cash? Because the standard definition of single-payer is “a system in which the government, rather than private insurers, pays for all health care costs.”

When you go into a doctor’s office and you negotiate what they charge and then pay it, the doctor is working for you.

When you go into the doctor’s office and the government has already negotiated the charge, and the government either pays it or pays nothing, in which case you are denied that service, then the doctor is working for the government.

The same is true of hospitals. The person that cuts the checks is the person in charge.

Think of it. If “the government” paid all costs, but you got to negotiate the costs and services, you could ask your doctor to sell you a house, call it a medical expense, and the government would pay for it. That doesn’t happen. You could also ask your doctor to overcharge you by, say, $1,000, and then give you half of the overcharge, pocketing the rest themselves. That doesn’t happen either.

Well, the latter isn’t exactly true. It does happen: but the overcharge goes to the politician. What single-payer is, is cronyism. When their only source of income is politicians, hospitals will give money to politicians to influence what they get paid. That money, of course, will have to come out of what the politicians set their fees at. Since it isn’t the politician’s money, it’s in their best interest to increase the fees. Both sides of the negotiating table want the fees to be higher: the hospital so that they make more profit, and the politicians so that the hospital will give them more donations or political support.

Private doctors cannot compete with hospital chains when it comes to political donations, which is why private doctors were shafted the most under the ACA, and would be shafted even more under single-payer.

You can see this under another “myth” on the same page. It’s a myth, they write, that “costs will skyrocket under single-payer”, because

By eliminating the health insurance industry, we save $350 billion a year or more in administrative costs and profits.

But eliminating the health insurance industry means there is only one organization handling the transfer of funds to doctors and hospitals. It’s either a single “private” organization, or it’s the government. That’s a monopoly, and monopolies have no interest in keeping costs down. Why should they? If you don’t like what they’re doing, where do you go?

Weissman really needs to read and understand David Goldhill’s Catastrophic Care. Goldhill explains in detail how single-payer or other monopolistic systems where taxpayers aren’t part of the negotiating process end up causing very high costs. Single-payer takes the part of our current system that causes costs to rise and makes it the whole system. Of course, costs will rise catastrophically for the same level of service and procedures.

Really, the ACA is for all practical purposes single-payer. Everyone has either heavily-restricted private insurance or Medicaid or some other government program. Your only choice as a consumer is who handles the paperwork for you—whether it’s the government or some insurance company.

The insurance company themselves have their hands heavily tied by the government’s ACA regulators so there isn’t a lot of leeway in what they cover and how they cover it.

What single-payer does is take away that choice, too, so that the single-payer monopoly is the only choice you have.

If Weissman read Catastrophic Care or any other basic primer on health insurance, he would also avoid whoppers like saying that the United States allows “health insurance corporations to profit off the sick”.

Now, ignoring for the moment the gratuitous use of the word corporation reminiscent of Team America,¹ this is the exact opposite of how health insurance works in a free market. When someone sells you health insurance, they make money when you are healthy. If you’re sick, they have to pay out. Health insurance companies profit off the healthy, not the sick. And that’s the way you want it—it is in your insurance company’s best interest that you be healthy.

Unless, of course, they’re part of a cronyist system such as single-payer or the ACA, in which they can get kickbacks such as through the ACA’s risk corridor. Health insurance companies only profit off the sick when the government gets too heavily involved.

In a have pity on me because I’m an orphan sort of way, Weissman also uses the skyrocketing costs of health insurance under the ACA to argue, not for restoring sanity to the health care market, but rather for taking the mistakes of the ACA and doubling down on them. Yes, that’s right, he acknowledges that under the ACA, costs are still “spinning out of control”:

We can’t wait because we know that health insurance costs are going to continue to spin out of control. Health insurance premiums are doubling every six years, and are likely to jump again this year.

Of course they are. Because the ACA brought us closer to single-payer than we were before.

The Public Citizen pitch gets all corporationy when talking about their vision of the future outside what we normally consider health care, too. They have to be, because they’re really talking about setting up not just a government-run health care system, but a system that controls all aspects of our health choices:

An enlightened Medicare-for-All system would also be a powerful voice against the junk food, tobacco, alcohol and drug corporations that prey on the most vulnerable in our society.

Weissman doesn’t explain how single-payer would be such a powerful voice against junk food, beer, and the over-the counter drug market, but the obvious reason is that when taxpayers are on the hook for everyone’s poor health choices, the government has a good reason to start regulating what we eat, what we drink, and how we medicate common illnesses.