In Marion, North Carolina, the Buchanan family decided to go without health insurance for the first time in their lives, rather than pay $1800 per month. Although their income puts them in the top fifth of households, their insurance premium was three times the price of their mortgage. In addition, their high deductible meant having and using their health coverage would cost over $30,000 annually. Instead, they now pay about $200 per month for membership in a local doctors’ practice that allows them unlimited office visits and discounts on medications and lab testing
In Phoenix, Arizona, the Bobbies and their son will remain uninsured, hoping this savings will help them pay for the special heart treatments their nine-year-old daughter needs. Their daughter qualified for Arizona’s Medicaid program, but the family was later told they made too much money to get low-cost state coverage. Before their daughter had turned three, medical costs amounted to over $1 million, and caused the Bobbies to lose their house and car. When coverage through the Affordable Care Act became available to them in 2014, the Bobbies were able to buy a policy for Sophia that costs just over $200 per month, but this did not solve their problems by any means; it is only affordable if the rest of the family remains uninsured (Bloomberg).
Why It Matters
The Constitution does not address healthcare as a specific right, but it promotes life, liberty and the pursuit of happiness, of which health is a crucial part. Evidence shows that, in comparison to people without health coverage, people with health insurance have fewer out of pocket medical costs, see the doctor more often, get more preventative care, and report that they feel healthier and less depressed. It is helpful to take a look at our current healthcare issues — specifically the rising cost of medical insurance — to understand where we are and what can be done to improve access to healthcare and health insurance for all Americans.
Putting it in Context
History: The Origins of Health Insurance
According to author John Steele Gordon, modern medicine has been practiced for a very short amount of time: “More than 90 percent of the medicine being practiced today did not exist in 1950.” The ancient Greeks were the first to recognize disease had natural, not supernatural, causes, but great innovations in medicine were still centuries away. Tools such as the stethoscope, ideas such as germ theory, and medicines such as anesthesia paved the way for great advancements in the 1800s.
The 19th century was a turning point for hospitals; originally for the poor, hospitals gradually became treatment centers as better sanitary procedures were introduced. With more use, however, came more costs, and hospitals quickly suffered financial problems. A way to finance running hospitals was through hospital insurance, a precursor to modern health insurance. Groups of hospitals quickly joined together to offer plans, and this became the model for the first health insurance company, Blue Cross, which opened in 1932.
During World War II, another healthcare development emerged: employer-paid health insurance, when the federal government instituted wage controls and companies began looking to provide non-cash benefits to compensate their employees. The IRS ruled employer-paid health insurance was a tax-deductible business expense, which made it attractive for employers to offer. Working Americans began to take the plans their employers provided, which sometimes meant Americans did not search for the most cost-effective plan. Additionally, subsidies for employers often destabilize the individual market.
Government became involved in healthcare during the 1960s, when President Johnson signed the bill that led to the introduction of Medicare and Medicaid; these programs were structured in much the same way as Blue Cross, but since the government was making the payments, healthcare providers were pleased because even more people could afford medical care. This also gave state governments the ability to influence policy decisions at hospitals, many of which were political rather than economic.
The highly controversial 2010 Affordable Care Act (also known as the “ACA” or “Obamacare”) resulted in even greater government involvement in the healthcare system. The ACA allowed millions of Americans to purchase health insurance via new government exchanges or obtain coverage through Medicaid. Through the act, the government also introduced subsidies for people with annual incomes below 400 percent of the poverty line to offset the costs of insurance premiums for plans available on the state exchanges.
All of these developments in healthcare came with a price tag: In 1930, Americans spent $2.8 billion on healthcare, approximately $23 per person and 3.5% of GDP. In 2018, that figure was $3.6 trillion —$11,172 per person and 17.7% of GDP. Adjusted for inflation, per capita medical costs in the U.S. are now 30 times higher than they were 90 years ago.
See this timeline from PBS for more on the history of U.S. healthcare.
Where do Americans get insurance?
For the most part, the U.S. has a third-party payer system, meaning health insurance plans (third parties) reimburse doctors for costs of services provided to patients. There are both public and private programs available to Americans.
Medicaid includes coverage by Medicaid, Medical Assistance, and Children’s Health Insurance Plan (CHIP). Medicaid is a state-run program, jointly financed by state and federal funds, that serves lower-income U.S. residents. CHIP is similar to Medicaid in structure but is specifically for children. Medicare includes coverage by Medicare and Medicare Advantage and is the largest federal health care program that serves almost 60 million elderly and disabled people in the U.S. There are four parts of Medicare:
- Part A (Hospital) pays for your care in a hospital, skilled nursing facility, nursing home (as long as it’s not just for custodial care), hospice and certain types of home health services.
- Part B (Medical) covers medically necessary services or supplies needed to diagnose and treat a medical condition. It also covers preventive services for illnesses such as the flu, including inpatient and outpatient physician services and some limited outpatient prescription drugs.
- Part C (Medicare Advantage), also known as MA plans, is sold by private companies. MA plans come in two varieties – HMO plans and PPO plans – and take the place of Medicare Part A, Part B and, often, Part D coverage. Many offer extras such as vision, dental, hearing aids and wellness services.
- Part D (Prescription Drugs) provides prescription drugs from a list (called a formulary). Each Medicare prescription drug plan has its own list. Most plans place drugs into different “tiers,” with each tier having a different cost.
Other public insurance sources include coverage for military service members and coverage from the Veterans Administration.
Employer-paid insurance includes coverage through a current or former employer or union, as a policyholder or dependent. In 1943 the IRS ruled that employees do not have to pay taxes on group health insurance premiums paid on their behalf by their corporate employers. This tax exclusion meant that the value of the healthcare benefit to the employee was greater than if a company offered the employee the same amount of cash, which would have been taxable. Thus, more and more employers began offering health insurance plans as part of attractive compensation packages for their employees.
For individuals whose employers do not offer insurance or who are self-employed, there is also the option to purchase private insurance. Non-group insurance includes coverage by policies purchased directly from a private insurance company.
Approximately 49% of Americans get their health insurance through their employers as of 2017, according to health care nonprofit Kaiser Family Foundation.
The Role of Government
Federal and state government is currently deeply involved in healthcare. Its spending, regulations, and its tax code all play a large role in structuring the current market. Much of government involvement in the healthcare system comes from the Department of Health & Human Services (HSS), which includes agencies such as the Centers for Medicare & Medicaid Services (CMS), the Center for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH).
At the state level in particular, states provide health insurance coverage for their respective state employees. In terms of the ACA marketplaces, 23 states have at least some control over their exchanges with either state-based, federally-supported, or partnership exchanges.
Of the $3.5 trillion spent on healthcare in 2017, the U.S. government contributed about $1.5 trillion, mainly through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP). Medicare cost about $600 billion and Medicaid and CHIP cost just under $400 billion in 2017. Other spending by the federal government includes veterans’ and active-duty military health care as well as health insurance subsidies created by the ACA (CRFB).
Healthcare reform is a top issue going into the 2020 election. Proponents of centrally-planned government believe that the government should guarantee and subsidize universal coverage, consolidate providers into large organizations, and have experts manage federal spending in a way that drives efficiency throughout the healthcare system. Calls for “Medicare for All,” which would involve complete or majority control of the healthcare system by the government, have been making headlines in recent years. See more on Medicare for All below.
Free-market advocates favor increasing competition to make insurance more affordable so that people will voluntarily buy it and introduce more market-based approach to consumption. They believe centralization does not improve efficiency, and that government should take a more modest role and allow a functioning market to emerge. This creates a closer relationship between the consumption and payment of health services, and empowers consumers within that market. The Department of Health and Human Services under the Trump Administration released a report in December 2018 detailing efforts to reform the healthcare system by expanding choice and competition for American citizens, including effort that revises an ACA guideline to give states more leeway over their individual insurance markets.
For more on the history of the role of government in the healthcare system, see this CMS report.
Current Challenges and Areas for Reform
A frequently cited statistic is that the U.S. spends significantly more on healthcare than other developed countries but does not report much better health outcomes in areas such as infant mortality and life expectancy. These statistics, however, need to be understood in context to truly grasp the challenges the U.S. healthcare system faces and how to best fix them. For example, as Sally Pipes of the Pacific Research Institute points out, different countries have different definitions of infant mortality, and “America’s seemingly poor performance is largely attributable to lifestyle and social factors – not the quality of the institutions that make up its healthcare system.”
Author John Steele Gordon explains that the U.S. healthcare system was originally designed around temporary treatment in hospitals. Today, however, the “serious, long-term, expensive-to-control illness” is the new normal. The design of the healthcare system has not changed to meet this new challenge of managing chronic disease, which leaves room for improvement: current barriers to health services in the U.S. include high costs and lack of coverage, and uneven distribution of services.
In 2018, the U.S. spent almost 18% of its GDP on healthcare. Costs also vary widely within the U.S.: an MRI of the lower back costs about $140 at an imaging center in Louisiana but costs over $7600 at a center in California. Some experts speculate price differences result from differences in demand for healthcare services or supply of providers, provider and insurer market power, and even health characteristics of the populations. You can compare healthcare prices and use levels across the country with Health Cost Institute’s interactive Healthy Marketplace Index.
Author John Steele Gordon also recommends reforming the present system to be more transparent by requiring providers to make their prices public. “Once prices are known and can be compared, competition…will immediately drive prices towards the low end,” he says. “Posting prices will also force hospitals to become more efficient and innovative, in order to stay competitive.” In November 2019, President Trump announced a new rule that would require hospitals to disclose prices for services and treatments such as x-rays, outpatient visits, and lab tests, arguing it would help patients “obtain an estimate and understanding of the individual’s out-of-pocket expenses and effectively shop for items and services.”
Some medical organizations including the Federation of American Hospitals and the American Hospital Association warn that revealing costs could cause confusion, and “undercut the way insurers pay for hospital services” because there are large differences in how services are reimbursed by Medicare and private insurance. Industry groups also argue that such a requirement is beyond the executive branch’s authority. For example, a federal judge stated the Trump administration “overstepped its regulatory authority” and blocked a Trump administration rule in June 2019 that would have required drug makers to post list prices on television (WSJ).
In 2017, the government, consumers, and insurers spent $333 billion on prescription drugs (NPR). Insurance plans handle negotiations for drug pricing in the U.S., but this does little to lower costs. Some of these drugs, like intravenous solutions, are used by hospitals and have been identified by the FDA to be in short supply, which greatly affects prices. Between 2008 and 2016, costs for generic oral prescription drugs rose almost 10% annually, and injectable drug prices rose over 15% annually.
The House and Senate have both prepared bills that would address drug pricing, specifically in Medicare and Medicaid. It is important to remember that while the U.S.’s high drug pricing is an issue that garners a lot of attention, it’s also a contributing factor to U.S. scientific innovation. One study found about $2.5 billion in revenue is required to “support the invention of one new chemical entity.” Additionally, the U.S. has more clinical trials than anywhere else in the world, accounting for almost half of the world’s total.
The Wall Street Journal explains how drug prices in the U.S. work:
Doctors and Patients
The Trump Administration revealed a plan in April 2019 that would restructure how primary-care doctors are paid in order to reduce the high costs of Medicare. According to Seema Verma, administrator of the Centers for Medicare & Medicaid Services, the current fee-for-service method creates “perverse incentives to offer more care” (WSJ).
Most experts agree that patients in the U.S. are frequently overtreated, although one Johns Hopkins’s study also found overtreatment was not usually due to high incomes for doctors and hospitals; the two most common reasons cited for overtreatment were patient demand and fear of malpractice. Medical practices and treatments pursued to avoid malpractice litigation are called defensive medicine, and can cost somewhere in the realm of $50 billion annually. Addressing medical malpractice reform with the costs of defensive medicine in mind may help lower excess healthcare spending.
The Affordable Care Act
The 2010 Affordable Care Act was introduced as a solution to many of the pressing problems of cost and access. The objective of the ACA was to offer access to health insurance to the nearly 48 million people in 2010 unable to get health insurance — or good health insurance — through employers. The following are a few main features of the law:
- Millions could purchase health insurance via new government exchanges or obtain coverage through Medicaid, the government-run health-care program intended for the poor, which many states dramatically expanded via incentives in the ACA.
- For those who qualify, the government provides subsidies to offset the costs of insurance premiums for plans available on the exchanges.
- Insurance companies are required to offer health insurance to people with pre-existing conditions on the same terms as to others.
- All would be required to purchase health insurance; those who did not would have to pay a fine (effective 2019, this tax was eliminated when Congress passed the 2017 Tax Cuts and Jobs Act.)
- A new tax on expensive employer-provided policies was instituted to control costs.
Although uninsured rates are still at all-time lows, the number of uninsured Americans rose for the first time in a decade between 2017 and 2018. This is due declines in Medicaid coverage as rising wages leave fewer people eligible for Medicaid, and due to the fact that more people are foregoing insurance since the individual mandate tax was reduced to zero. What’s more, the ACA is just not working for many Americans as the cost of healthcare continues to rise faster than Americans’ incomes: “the cost for many people to buy a health plan – if they don’t get it from a job or the government – is higher than ever” (Bloomberg).
More people than ever are underinsured thanks to high out-of-pocket expenses and deductibles. An estimated 44 million people were underinsured in 2018, up from 29 million in 2010. Compared to insured adults with adequate coverage, underinsured adults are more than twice as likely to not fill a prescription, to skip a recommended test, treatment, or follow-up appointment, and have medical debt.
While opponents of the ACA have not reached a consensus on a replacement plan, several policy prescriptions have attracted widespread support:
- The ability to buy health insurance across state lines to create more market competition and choice in policies;
- Secure renewal of health insurance that is guaranteed so people who have health insurance can keep it and not see premiums soar if they get sick;
- Cost transparency so people can know the price of their insurance and medical services
For more on the ACA, see The Policy Circle’s Affordable Care Act Deep Dive.
Medicare for All
Medicare for All is the plan for universal health care that expands Medicare coverage to everyone and would be funded through taxes. It is referred to as the single-payer healthcare system. In a single-payer healthcare system, everyone is covered by one government-run health plan that pays for all services. In some cases, as in the bill presented by Sen. Bernie Sanders (I-VT) private insurance would be outlawed. Other ideas involve giving more people access to government-funded healthcare by lowering the eligibility age for Medicare or offering a public option through Medicare or Medicaid buy-in. In these cases, private insurance would remain, as would Medicare Advantage, through which the government pays private companies to run Medicare plans. In all cases, the government insurance plan competes with private-insurance.
Realities of a Single-Payer System
The most widely-cited Medicare for All plan is Senator Sanders’s bill. Mercatus and the Urban Institute both estimate the costs of this plan over the next 10 years would add about $30-$34 trillion to the federal budget – this would be on top of the estimated $17 trillion in federal government spending on health care over the next decade, projected by the Congressional Budget Office. Federal government spending on healthcare makes up about 28% of all healthcare spending, amounting to just over $1 trillion annually.
But runaway costs are frequently a problem in healthcare, as Sally Pipes of the Pacific Research Institute notes in her book, False Premise, False Promise: The Disastrous Reality of Medicare for All (p. 32). When Medicare added dialysis coverage in 1972, the actual cost ended up being more than twice the estimated amount of $209 million, and that was only for one small piece of coverage. Additionally, Medicare made almost $50 billion worth of improper payments in both 2018 and 2019.
This means the single-payer system may cost much more than the projections estimate, which means more taxes will be needed to fund the system. The Rand Corporation estimates a single payer plan in New York would require about $140 billion in new state tax revenue, approximately double what New York currently collects in taxes.
The Washington Post Fact Checker takes a closer look at the costs of a single-payer system:
Quality of Care
In a healthcare system, there are limited numbers of doctors, hospitals, services, and amenities, from treatments to testing to hospital beds, but there is a potentially unlimited demand from patients. This will inevitably lead to longer wait times. In her analysis of the UK’s and Canada’s single-payer systems, Sally Pipes, a Canadian, found the quality of care available in these countries is very different than in the US (p. 64). For example, average wait times in Canada for a CT scan are 4-5 weeks, mainly because there are fewer than 20 machines for every million people. For an MRI, of which there are about 10 per million people, waiting times are 10-11 weeks. Between hospitals and outpatient care facilities, the U.S. has 44 CT scanners per million people and almost 40 MRI machines per million people.
In the Fall of 2019, only 74.5% of patients seeking care in Accident and Emergency (A&E) units in the UK were seen within four hours, marking the lowest percentage since the target of 95% was set in 2004. In the U.S., average emergency department waiting time is an hour and a half. For non-emergency treatment, as of June 2019, over 4 million people across the UK were waiting due to a lack of available hospital beds and available staff. Meanwhile, the UK’s National Health System doctors and nurses work an average of 3-4 hours of unpaid overtime per week.
This doesn’t even begin to touch on the procedures and prescription drugs that are not offered by other countries’ health systems. For example, in countries such as Canada, Germany, and Japan, governments engage in negotiations with drug manufacturers to keep prices low, but Sally Pipes notes this also means these health systems choose to limit the drugs they offer because they are too expensive to begin with (p. 107). In the U.S., consumers spend about three times as much on drugs as European consumers do, but much of that spending is because American patients have more access to newer and more expensive treatment options. Additionally, that spending contributes to innovation and research that leads to widespread development of procedures and prescription drugs, and explains the U.S.’s low mortality rates for breast, colorectal, and cervical cancers in comparison to other countries.
While average prices for medical procedures, hospital costs per day, and prescription drugs are higher in the U.S. than elsewhere, patients in the U.S. actually have greater, easier, and faster access to these treatment options and services. Sally Pipes outlines how these services can be improved through other means. For example, short-term health insurance plans and Health Savings Accounts are options that could allow more people to get coverage that fits their specific health and budgetary needs. On the supply side, expanding licensing reciprocity so professionals can practice around the country without needing to seek state-specific license can ensure there is no shortage of physicians in the U.S.
Employer-based and Private Insurance
The tax exclusion that gave employers the incentive to offer employees health insurance has created a number of problems over the past 60 years. According to healthcare policy expert Tom Miller at the American Enterprise Institute, the tax exclusion “has been criticized for raising – and hiding – the overall costs of health insurance and health care.” It also limits choices for individuals, and “dispenses its rewards disproportionately to higher-income workers in larger companies with better-paying jobs.”
This is mainly because large companies have the most leverage when negotiating with insurance companies. Whereas only 40% of small companies with fewer than 25 employees offer health insurance, 97% of companies with over 100 employees offer coverage. For all companies, however, average health care prices for employer-sponsored coverage rose over 17% between 2013 and 2017, according to a Wall Street Journal report. In 2019, the average total cost of employer-provided health coverage rose to over $20,000 for a family plan (a 5% increase from 2018) and to about $7200 for individual plans (a 4% increase from 2018). On average, employers bore 71% of the costs. Individuals who are self-employed, unemployed, or not offered insurance by an employer have additional difficulties facing rising prices, steep premiums, and meager benefits.
You can look at hospital price comparisons with the Employer Hospital Price Transparency Project, from the Employers’ Forum of Indiana and the Rand Corporation. The project gives employers access to information on hospital prices, from which many employers have seen unexplained and unsustainable health care cost increases over the past few years. For example, one of the studies found employers in Indiana were paying hospitals anywhere from two times to over three times the amount that Medicare was paying. For all medical services, Medicare rates average about 40% lower than private insurance rates, well below the costs of providing these services.
According to Gloria Sachdev of the Employer’s Forum, health plan contracts frequently include clauses that prohibit parties within the network from disclosing what the prices are, which prevents employers from being able to shop for health care for their employees. To find the best quality for the best price, one option is to address these clauses so employers can hold hospital systems and health plans accountable for price negotiations.
Another difficulty is that health insurance is regulated differently by each state. This patchwork regulation dramatically limits competition in the insurance market, causing high prices. employers and individuals alike must purchase plans that comply with state mandates–-creating monopolies of one or two insurance companies in many states. For those who suffer from pre-existing health conditions that are serious and costly, the individual market is rarely an affordable option.
The Trump administration has addressed monopolization and competition through issuing a 2018 Department of Labor rule that “expanded access to affordable health coverage options for America’s small businesses and their employees through Association Health Plans” which work “by allowing small businesses, including self-employed workers, to band together by geography or industry to obtain healthcare coverage as if they were a single large employer.” The larger risk pools and economies of scale created by Association Health Plans give smaller businesses stronger negotiating power with providers.
Another option is to give states a more prominent role in reforming their health insurance markets since states have a better understanding of local needs and are having trouble offering their own plans given current mandates. Idaho’s Blue Cross insurer, for example, tried to implement a plan that would help the state financially but would charge higher premiums for sick people or people with preexisting conditions. Federal officials struck the plan down but “encouraged Idaho to explore offering similar policies as short-term plans…” The problem with short term plans is that, although they tend to be less-expensive options, they lack the consumer protections that come with ACA plans.
State budgets have been in trouble for at least a decade due to healthcare expenditures like Medicaid and retiree healthcare benefits. States pay for a portion of healthcare bills for retired public workers, promising hundreds of billions of dollars in retiree health benefits that have resulted in a nation-wide $600 billion dollar gap. This has prompted a number of states to start “testing how far they can reduce health benefits…as a way of coping with mounting liabilities and balancing budgets.” For example, In 2017, Kansas began charging retirees the full cost of health coverage in 2017. After this, 75% of former beneficiaries dropped out, and Kansas saw its health care liability fall from over $6 million to just over $500,000.
The Role of Technology
Telehealth is an area for opportunity that could help improve healthcare delivery and reduce costs. According to the Health Resources Services Administration, “telehealth” is defined as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”
Telehealth includes clinical (e.g., a virtual exam) and non-clinical applications (e.g. training on how to use equipment or holding administrative meetings). Seema Verma has noted key ways that telehealth “is changing the very face of healthcare. Telehealth innovations could help usher in a new world of healthcare that is embraced by both patients and providers, that identifies new avenues of care delivery, and that improves the value of care by increasing its quality while lowering its cost.” Telehealth can be a long-term solution that allows patients to more quickly and easily access the services of specialists without the imposition of travel.
For example, Amazon’s Alexa “can track blood glucose levels, describe symptoms, access post-surgical care instructions, monitor home prescription deliveries and make same-day appointments at the nearest urgent care center.” The Apple Heart Study, a combined effort between Apple and Stanford University, uses data from Apple watches to improve technology detecting irregular heart conditions. Developments in telehealth could also reduce the burden on doctors, nurses, and medical practitioners, who often complain that entering medical information into electronic health records is currently time-consuming and takes away from interactions with patients.
Another example of digitization in practice is the Australian health system’s remote care coordination for Type 2 diabetes patients, which saw a drop in patients’ blood glucose levels by a full percentage point when managed remotely compared to only seeing a traditional doctor. Additionally, the annual cost of care per individual dropped by $900. Digital and pharmaceutical technologies “can move most chronic care from centralized hospitals, surgery centers and clinics into patients’ homes,” turning healthcare from a “high-cost destination” to a “low-cost delivery system” focused on value and empowering patients.
You can read more about telehealth in The Policy Circle’s Digital Landscape Brief.
Healthcare reform is one of the most contested issues in U.S. politics: costs are high, access is limited, and current laws and mandates do not work for everyone. Reform is inevitable, and will affect all Americans. It is important for lawmakers, businesses and employers, and individual citizens to be aware of the current state of healthcare and the reforms under consideration to come up with the best solution for Americans.
What You Can Do/Ways to Get Involved
Many options for healthcare reform are being considered. It is essential that American citizens remain aware of the options so they can contribute to dialogue and make their voices heard. Here are some resources to explore:
- Research your elected representatives’ positions on healthcare law and his or her vision for how to tackle the healthcare challenges facing Americans at large and your community specifically.
- Make your voice heard
- Committee on Finance
- Committee on Health, Education, Labor & Pensions (HELP)
- Committee on Appropriations
- Committee on Ways and Means
- Committee on Energy and Commerce
- Committee on Appropriations
- Committee on the Budget
- Network for Regional Healthcare Improvement is an organization representing other state and regional affiliated partners working to collaborate healthcare improvement across regions.
- The Kaiser Family Foundation is a nonprofit organization that focuses on national health issues.
- The RAND Corporation is a nonpartisan, nonprofit organization that does research and analysis on areas including security, health, education, sustainability.
- The Galen Institute is a non-profit public policy research organization that focuses on policies to create a patient-centered health sector that offers greater freedom and more affordable health care choices.
The Galen Institute President Grace-Marie Turner testified before Congress about the path to universal coverage in the U.S. Read the full transcript here.
The Pacific Research Institute’s CEO and health care expert Sally Pipes discussed the future of health care and how single payer systems actually function. Listen to the podcast here.
Education and Healthcare face similar debates, centered around what role the government and individuals should each play in making decisions and controlling resources in these service industries. First, both face “rising prices, consumer criticism,” and questions of quality. Additionally, both are subsidized by the government, who is not the consumer, which means consumers have little power over producers and producers have little incentives to cut costs.
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