Is The US Too Corrupt For Single-Payer?

Ezra wonders:

The key to a single-payer system is that the government sets prices. Usually, it empowers boards of independent experts who set those prices low. [Uwe] Reinhardt’s argument is that in the United States, health industry interests have so much sway over Congress that the prices would end up being set by health-care interests.

“When you go to Taiwan or Canada,” Reinhardt said, “the kind of lobbying we have here is illegal there. You can’t pay money to influence the party the same way. Therefore the bureaucrats who run these systems are pretty much insulated from these pressures. Here you have basically a board of directors in the House Ways and Means Committee that gets money from lobbyists both at the regulatory writing stage and during normal operations. And they can call an administrator and demand they stop something from happening.”

The question in any argument like this is the counterfactual. Outside of Medicare, Medicaid and some other government-run health systems, prices are set by health-care interests now. But they’re much lower in Medicare and Medicaid than they are for private insurers. So it’s simultaneously possible for the U.S. government to be much worse at setting prices than, say, France’s government, but still be able to negotiate much lower prices than private insurers can manage. Still, Reinhardt’s argument is a reminder that the simple fact that a policy worked in another country does not mean it will work in this country.