Last week I promised to critique the single payer approach. There is no shortage of criticisms and you probably know them by heart: Who sets the budget and what are their priorities? Do you trust politicians to set the rules and won’t they lead to rationing? Do you believe the public sector will fight against fraud, abuse, and corruption?
My guess is that if you support single payer, these questions don’t concern you. And if you oppose single payer, these questions are enough to justify your opposition. But let me offer two more things to consider. First, the increment in marginal income tax rates required to fund single payer will have a chilling effect on economic activity. Second, single payer will almost surely have to rely on reductions in payments for medical technology to be successful. And like it or not, the entire world free rides off of the profits made by R&D companies here in the U.S. Cutbacks in U.S. spending could cause cutbacks in R&D, with potentially profound consequences.
My colleagues often say that medical R&D is the most important long run driver of the health system. I would not support any major overhaul such as single payer without hearing advocates articulate the implications of their proposal for the future of medical R&D.