The conventional wisdom these days is that the major Democratic presidential candidates for 2020 will end up endorsing some version of single-payer health care. The senator Bernie Sanders is expected to introduce his Medicare for All bill this week, with a considerable number of co-sponsors.
This political posturing, however, is far from a practical proposal.
There is an obvious problem with moving Americans to a single-payer system: most people with private health insurance are pretty happy with their current arrangements. They are not looking to trade in that coverage for a new government programme of uncertain quality, along with unknown higher taxes. When the US president Barack Obama was selling the Affordable Care Act, he promised Americans that they could keep their health insurance if they wanted to. When this did not turn out to be true for everyone, there was a significant backlash.
Progressive analysts thus have turned to how a single-payer system might come about more gradually. But longer transition times do not solve the core problem.
Let us say the federal government sets up a “public option”, as it sometimes is called. Individuals would have the opportunity to buy into government insurance at some price. The new government programme would be competing with private insurance, but just how good will the new benefits be? If you are healthy and have other coverage, you probably will not switch - if you did, that would be a sign that the new government programme was of very high quality and probably too expensive for the nation as a whole. Boosting the health care of the best-covered Americans is not the policy priority right now.
Instead, the public option might be set up to attract those who do not already have good coverage. But those are the same people who do not have the money to pay a fair market price for health insurance now. In essence, the programme would come to resemble a Medicaid expansion, whether or not it would fall under the formal rubric of Medicaid.
That is a plausible option for a marginal change; many states, of course, have already done a Medicaid expansion. The question remains whether such a programme can evolve into single-payer health insurance. The answer is probably not. To become a single-payer system, as coverage climbs up the income ladder, the new reform would have to lure Americans out of private health insurance. It either has to make the private alternative worse, say by penalties like a stiff “Cadillac tax” on policies that exceed a certain level, or it has to make the public alternative especially appealing. We are then back to the change either being unpopular or spending too much money on people who already have decent coverage.
You can make a good case for continuing the forthcoming Cadillac tax on private insurance, as is embedded in Obamacare. But the point of that change was to get people to move to less health insurance coverage and to use fewer healthcare resources, not to bounce them into a system with yet lower marginal cost for a doctor’s visit or extra medical procedures.
It is worth thinking through why some single-payer systems, such as those on the European continent or in Hong Kong and Taiwan, seem to work. Typically those systems were instituted while healthcare costs were still fairly low, and then kept down by government fiat. The US is not in that position, and it is hard to see doctors and hospitals - powerful lobbies - going along with significant cuts to their payments.
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Single-payer systems can work for yet another reason: if a citizenry consumes much less health care, and it does not damage patient outcomes so much. Patient queuing is not a disaster if people who really need treatment get priority, as is the case in the better-run single-payer systems. In other words, single payer has to be sold as a way of getting us all to cut back on the consumption of medical resources. Unfortunately, the Medicare for All movement is more about easing everyone’s access and boosting the usage of healthcare resources, a typically American approach.
When it comes to access, the major problem in the US is distributional: some of the poor have insufficient access and, arguably, some of the well-off receive health care at too low a user price. Given Americans’ love for consumption, it is probably too late to fix the latter problem. There can be, to some extent, improvement for lower-income access by Medicaid expansions.
The political war along the way to a full single-payer system is unlikely to be rewarding. According to one poll, single payer is supported by only 43 per cent of Americans, hardly enough to overcome political gridlock.
Progress will come in bits and pieces. The notion of a universal cure-all is a myth, whether it comes to improving your health or improving America’s healthcare system.
Tyler Cowen is a professor of economics at George Mason University in Virginia and writes for the blog Marginal Revolution and Bloomberg. His books include The Complacent Class: The Self-Defeating Quest for the American Dream.
Business Insights
- Canada and Mexico are significant energy suppliers to the US, providing the majority of oil and natural gas imports
- The introduction of tariffs could hinder the US's clean energy initiatives by raising input costs for materials like nickel
- US domestic suppliers might benefit from higher prices, but overall oil consumption is expected to decrease due to elevated costs
Company%20profile
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UAE tour of the Netherlands
UAE squad: Rohan Mustafa (captain), Shaiman Anwar, Ghulam Shabber, Mohammed Qasim, Rameez Shahzad, Mohammed Usman, Adnan Mufti, Chirag Suri, Ahmed Raza, Imran Haider, Mohammed Naveed, Amjad Javed, Zahoor Khan, Qadeer Ahmed
Fixtures:
Monday, 1st 50-over match
Wednesday, 2nd 50-over match
Thursday, 3rd 50-over match
Company%20Profile
%3Cp%3E%3Cstrong%3ECompany%20name%3A%3C%2Fstrong%3E%20Hoopla%3Cbr%3E%3Cstrong%3EDate%20started%3A%20%3C%2Fstrong%3EMarch%202023%3Cbr%3E%3Cstrong%3EFounder%3A%3C%2Fstrong%3E%20Jacqueline%20Perrottet%3Cbr%3E%3Cstrong%3EBased%3A%3C%2Fstrong%3E%20Dubai%3Cbr%3E%3Cstrong%3ENumber%20of%20staff%3A%3C%2Fstrong%3E%2010%3Cbr%3E%3Cstrong%3EInvestment%20stage%3A%20%3C%2Fstrong%3EPre-seed%3Cbr%3E%3Cstrong%3EInvestment%20required%3A%3C%2Fstrong%3E%20%24500%2C000%3C%2Fp%3E%0A
If you go
Where to stay: Courtyard by Marriott Titusville Kennedy Space Centre has unparalleled views of the Indian River. Alligators can be spotted from hotel room balconies, as can several rocket launch sites. The hotel also boasts cool space-themed decor.
When to go: Florida is best experienced during the winter months, from November to May, before the humidity kicks in.
How to get there: Emirates currently flies from Dubai to Orlando five times a week.
Joker: Folie a Deux
Starring: Joaquin Phoenix, Lady Gaga, Brendan Gleeson
Director: Todd Phillips
Rating: 2/5
UAE currency: the story behind the money in your pockets
Film: Raid
Dir: Rajkumar Gupta
Starring: Ajay Devgn, Ileana D'cruz and Saurabh Shukla
Verdict: Three stars
Ticket prices
- Golden circle - Dh995
- Floor Standing - Dh495
- Lower Bowl Platinum - Dh95
- Lower Bowl premium - Dh795
- Lower Bowl Plus - Dh695
- Lower Bowl Standard- Dh595
- Upper Bowl Premium - Dh395
- Upper Bowl standard - Dh295
Farasan Boat: 128km Away from Anchorage
Director: Mowaffaq Alobaid
Stars: Abdulaziz Almadhi, Mohammed Al Akkasi, Ali Al Suhaibani
Rating: 4/5
COMPANY PROFILE
Founders: Alhaan Ahmed, Alyina Ahmed and Maximo Tettamanzi
Total funding: Self funded
Company%20Profile
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COMPANY PROFILE
Name: HyperSpace
Started: 2020
Founders: Alexander Heller, Rama Allen and Desi Gonzalez
Based: Dubai, UAE
Sector: Entertainment
Number of staff: 210
Investment raised: $75 million from investors including Galaxy Interactive, Riyadh Season, Sega Ventures and Apis Venture Partners
The specs
Engine: Dual 180kW and 300kW front and rear motors
Power: 480kW
Torque: 850Nm
Transmission: Single-speed automatic
Price: From Dh359,900 ($98,000)
On sale: Now
The specs
Engine: Direct injection 4-cylinder 1.4-litre
Power: 150hp
Torque: 250Nm
Price: From Dh139,000
On sale: Now
Company%20Profile
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A timeline of the Historical Dictionary of the Arabic Language
- 2018: Formal work begins
- November 2021: First 17 volumes launched
- November 2022: Additional 19 volumes released
- October 2023: Another 31 volumes released
- November 2024: All 127 volumes completed
SERIES SCHEDULE
First Test, Galle International Stadium
July 26-30
Second Test, Sinhalese Sports Club Ground
August 3-7
Third Test, Pallekele International Cricket Stadium
August 12-16
First ODI, Rangiri Dambulla International Stadium
August 20
Second ODI, Pallekele International Cricket Stadium
August 24
Third ODI, Pallekele International Cricket Stadium
August 27
Fourth ODI, R Premadasa Stadium
August 31
Fifth ODI, R Premadasa Stadium
September 3
T20, R Premadasa Stadium
September 6
'The%20Alchemist's%20Euphoria'
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COMPANY%20PROFILE
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A little about CVRL
Founded in 1985 by Sheikh Mohammed bin Rashid, Vice President and Ruler of Dubai, the Central Veterinary Research Laboratory (CVRL) is a government diagnostic centre that provides testing and research facilities to the UAE and neighbouring countries.
One of its main goals is to provide permanent treatment solutions for veterinary related diseases.
The taxidermy centre was established 12 years ago and is headed by Dr Ulrich Wernery.
RESULTS
6.30pm: Meydan Sprint Group 2 US$175,000 1,000m
Winner: Ertijaal, Jim Crowley (jockey), Ali Rashid Al Raihe (trainer)
7.05pm: Handicap $60,000 1,400m
Winner: Secret Ambition, Richard Mullen, Satish Seemar
7.40pm: Handicap $160,000 1,400m
Winner: Raven’s Corner, Richard Mullen, Satish Seemar
8.15pm: Dubai Millennium Stakes Group 3 $200,000 2,000m
Winner: Folkswood, William Buick, Charlie Appleby
8.50pm: Zabeel Mile Group 2 $250,000 1,600m
Winner: Janoobi, Jim Crowley, Mike de Kock
9.25pm: Handicap $125,000 1,600m
Winner: Capezzano, Mickael Barzalona, Salem bin Ghadayer
'My Son'
Director: Christian Carion
Starring: James McAvoy, Claire Foy, Tom Cullen, Gary Lewis
Rating: 2/5
Avatar%20(2009)
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How to protect yourself when air quality drops
Install an air filter in your home.
Close your windows and turn on the AC.
Shower or bath after being outside.
Wear a face mask.
Stay indoors when conditions are particularly poor.
If driving, turn your engine off when stationary.
IF YOU GO
The flights: FlyDubai offers direct flights to Catania Airport from Dubai International Terminal 2 daily with return fares starting from Dh1,895.
The details: Access to the 2,900-metre elevation point at Mount Etna by cable car and 4x4 transport vehicle cost around €57.50 (Dh248) per adult. Entry into Teatro Greco costs €10 (Dh43). For more go to www.visitsicily.info
Where to stay: Hilton Giardini Naxos offers beachfront access and accessible to Taormina and Mount Etna. Rooms start from around €130 (Dh561) per night, including taxes.
TO A LAND UNKNOWN
Director: Mahdi Fleifel
Starring: Mahmoud Bakri, Aram Sabbah, Mohammad Alsurafa
Rating: 4.5/5
What is double taxation?
- Americans living abroad file taxes with the Internal Revenue Service, which can cost hundreds of dollars to complete even though about 60 per cent do not owe taxes, according to the Taxpayer Advocate Service
- Those obligations apply to millions of Americans residing overseas – estimates range from 3.9 million to 5.5 million – including so-called "accidental Americans" who are unaware they hold dual citizenship
- The double taxation policy has been a contentious issue for decades, with many overseas Americans feeling that it punishes them for pursuing opportunities abroad
- Unlike most countries, the US follows a citizenship-based taxation system, meaning that Americans must file taxes annually, even if they do not earn any income in the US.
The Sand Castle
Director: Matty Brown
Stars: Nadine Labaki, Ziad Bakri, Zain Al Rafeea, Riman Al Rafeea
Rating: 2.5/5
COMPANY%20PROFILE
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City's slump
L - Juventus, 2-0
D - C Palace, 2-2
W - N Forest, 3-0
L - Liverpool, 2-0
D - Feyenoord, 3-3
L - Tottenham, 4-0
L - Brighton, 2-1
L - Sporting, 4-1
L - Bournemouth, 2-1
L - Tottenham, 2-1
'Avengers: Infinity War'
Dir: The Russo Brothers
Starring: Chris Evans, Chris Pratt, Tom Holland, Robert Downey Junior, Scarlett Johansson, Elizabeth Olsen
Four stars
