Obamacare is in a death spiral.
Trump promised to repeal and replace Obamacare, but then ran dead on it, allowing Ryancare to fail and washing his hands of it.
Trump then announces he has to compromise with the Democrats on medicine.
Single payer for everyone, as in Britain and Canada, is a horrible disaster, but despite being a disaster, once in place it seems impossible to remove. If we get single payer, we are screwed.
The key problem of US healthcare is absurdly high and completely unpredictable health costs – you stroll into hospital for something trivial, and if you are white and male, get hit for three hundred thousand dollars for no apparent reason. Routine and standard health care procedures like a colonoscopy typically cost twenty times what they cost in the rest of the world, and even though they are absolutely routine and standard no one will tell you what they are going to cost.
So, America has to copy from countries that have attained low and predictable health costs, and most importantly, up front health costs, where you know what you are going to be charged: These are Singapore, India, and Thailand, which have single payer for poor people. Which means that when some bum shows up at the rich people’s hospital, they send him over to the poor people’s hospital.
The reason America has no market in healthcare is cross subsidies – white males pay for everyone, and this requires opaque prices. The government decrees that hospitals will take care of the poor and female, that insurance companies will take care of the poor and female, which in practice winds up as cross subsidies, white males taking care of the poor and female, which results in a system with no prices and no markets.
To get health costs down you need a market and prices. Singapore and similar countries have a market and prices, and they can get away with this politically because there is a safety net for the poor, the feckless, and the unlucky.
If you have clear up front prices, someone has to pay for the poor people. If explicit up front prices then you need an explicit overt handout in place of the hidden handout paid for through hidden prices.
The trouble with single payer for poor people is that it is apt to grow into single payer for everyone, as has more or less happened in France and is happening in Germany. But Singapore has kept single payer under control, and single payer has not swallowed up the entire medical industry in Australia.
What I would really like is a system where you can just turn the poor and the sick away, but we cannot have that when we pretend to democracy, so some kind of single payer for poor people it has to be.
The trouble is, of course, the Democrats are going to demand single payer for everyone. But as the Obamacare crisis ripens, and the mid term elections approach …