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It’s Surprising How Few Countries Have National, Single Payer, Health Care Systems

"The details of last week's fiasco about American health care are for my colleagues over on that desk to deal with. My purpose here is just to point out that the economic structure of health care in other places just isn't what all too many people think it is. There's a large part of the American political class insisting that this is just obvious. We should have a national, single payer, health care financing system. And the amazing thing about this is that so few countries actually do that. And most of those countries who are thought to have better health care systems than the US don't do that either.

There are indeed national health care systems out there--but they tend not to be single payer. And there are single payer systems out there, or close enough at least--but they tend not to be national. Which is something that we really ought to be thinking about, no?

Take it as read that the US system isn't as good as it could be. And also that we might want to propose something to make it better. So, we're agreeing that something must be done. My point here is just that the economics of what we should do might well not be the same as the economics of that national single payer system we're urged to implement."

Uninsured Rate, 2008-2015

This chart shows the uninsured rate for the United States, California, Texas, New York and Florida from 2008-2015. Thanks for the Affordable Care Act, many more families are able to afford health insurance, especially in the states that expanded Medicaid.

Data Source: US Census Bureau, Health Insurance Coverage Status and Type of Coverage by State--All Persons: 2008 to 2015.

The Health-Care Debacle Was a Failure of Conservatism

"The fact is that the health-care industry, which makes up about a sixth of the American economy, isn’t like the market for apples or iPhones. For a number of reasons (which economists understand pretty well), it is riven with problems. Serious illnesses can be enormously costly to treat; people don’t know when they will get ill; the buyers of health insurance know more about their health than the sellers; and insurers have a strong incentive to avoid providing their product to the sick people who need it the most.

Since the days of Otto von Bismarck, most developed countries have dealt with these problems by setting up a system in which the state provides medical insurance directly, or else mandates and subsidizes the purchase of private insurance, setting strict rules for what sorts of policies can be sold. Obamacare amounts to a hybrid model. It supplements employer-provided insurance, the traditional American way of obtaining health care, with a heavily regulated (and subsidized) individual insurance market and an expanded Medicaid system.

It is far from perfect. But, in combining mandates with subsidies, regulation, and access to a state-administered system for the poverty-stricken and low-paid, it is intellectually coherent. (Many of the problems it has encountered arose because the mandate to purchase insurance hasn’t been effectively enforced, and not enough young and healthy individuals have signed up.) Since it leaves in place the basic structure of private insurance and private provision, Obamacare is also conservative. As is well known, parts of it resemble a proposal that the Heritage Foundation put forward in 1992."

Replacement healthcare plan would cost poor and older people the most

"The proposal introduced by Republicans would allow insurance companies to charge older adults five times what they charge the young. Analysts call this an “age band”. At the same time, the bill would reduce subsidies to all Americans, distributing them by age to everyone who earns less than $75,000 a year individually or $150,000 for a couple."

"That may sound like a philosophical difference, until you get into the arithmetic. Young Americans would be eligible for up to $2,000 in tax credits, and older Americans would get double, topping out at $4,000. But with just twice the tax credit, and up to five times the charges from insurance companies, older adults could be left to foot the bill."

(In other words prime voters. Seems like a turkey of a proposal.)

Change in Median Healthcare Worker in New York’s Wages, compared to a Year Ago

While Healthcare and Social Services Workers in New York enjoy regular increases in their median wage every year, the yearly increases in median wages in New York have decreased somewhat since the passage of the Affordable Healthcare Act, along with a lower inflation rate, causing somewhat stagnating wages. Simply said, it's not as lucrative to work in the Healthcare industry as it once was in New York -- despite a growing number of jobs. This is calculated by the total wages of Healthcare and Social Services Industry, divided by the median wage, then looking at difference compared to the previous year. One upside of the Healthcare and Social Service Industry was it does not see the dip in wages that other industries during recessions -- it's a largely recession-proof industry.

Data Sources:
U.S. Bureau of Economic Analysis, Health Care and Social Assistance Wages and Salaries in New York [NYWHEA], retrieved from FRED, Federal Reserve Bank of St. Louis;, March 6, 2017.

U.S. Bureau of Economic Analysis, Health Care and Social Assistance Wages and Salaries in New York [NYWHEA], retrieved from FRED, Federal Reserve Bank of St. Louis;, March 6, 2017.

Google Maps: Rate Of Preventable Hospital Admissions By County

The Dartmouth Atlas of Healthcare calculates preventable hospital admissions by considering the discharges for ambulatory care sensitive conditions per 1,000 medicare enrollees.

See for more information.

Data Source: Dartmouth Atlas of Healthcare, Rate of Preventable Hospital Admissions in by County, retrieved from FRED, Federal Reserve Bank of St. Louis;, March 7, 2017.

All Employees: Health Care and Social Assistance in New York

Healthcare and Social Assistance continues to be a rapidly growing industry in New York State, especially as our state's population grows and there is a growing demand for healthcare workers.

Data Source: Federal Reserve Bank of St. Louis and U.S. Bureau of Labor Statistics, All Employees: Health Care and Social Assistance in New York [SMS36000006562000001], retrieved from FRED, Federal Reserve Bank of St. Louis;, March 6, 2017.

Obamacare Rollback Bill Would Replace Subsidies With Tax Credits

"The Feb. 10 document follows the broad policy outline released by Republicans last week just before they went home for a Congressional recess. It proposes cuts to federal payments to states that have expanded Medicaid and offers tax credits for people to buy health insurance."

"This would mean fewer people could afford health insurance and that the health insurance would likely cover less," says Larry Levitt, senior vice president at the Kaiser Family Foundation.

Cancer Rates Compared, Several States

Comparison of cancer rate for common cancers in New York, Pennsylvania, New Jersey, Vermont, New Hampshire, and National Averages. Rates are per 100,000 persons.

Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2013 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2016. Available at: