I want to get universal coverage of the American population. I want to get that coverage in a way that frees up significant resources for other things. I want to expend my energy and efforts on plausible pathways to achieving those goals. I don’t see single payer as an end in and of itself. I see it as a means to an end. I also see it as a lower probability means to and end than other methods that involve building kludges on top of kludges to get 1% there, .75% here, slightly better actuarial value there. My preferred methodology is far less sexy, far less exciting but in my estimate, far more likely to achieve my desired end state than advocating slipshod and sloppy single payer panacea solutions.
I am skeptical of single payer plans because the American healthcare and American health finance systems are complex. Single payer is an easy/simple solution to a very complex problem. My training and experience makes me reluctant to embrace simple solutions to complex problems.
I also have not seen single payer advocates do enough of their homework to answer some of the tough questions with anything more than breezy handwaves and assertions that the aggregate will be better off so the clusters of people who are worse off won’t fight too hard because this policy makes society as a whole better off.
Others have repeatedly asked me if I have a conflict of interest in that single payer would put me out of a job.
Yes, single payer if it was implemented tomorrow morning would put me out of a job within six to eighteen months depending on how long the data conversions take. My bet would be closer to eighteen months than six months.
However, I am not worried. I have not been looking for a new position but in the past nine months, I have been headhunted, interviewed and sounded out on four separate positions, three laterals and one promotion. None of these opportunities were in the health insurance industry.
And that is with me not actively looking for a new position. I’m not worried about my employment prospects for if Mayhew Insurance was shut down, I would be in a similar paying position within two months.
I think asking if I have a conflict of interest as a grounds for my skepticism for single payer is a reasonable question. I don’t think my employment prospects drive my skepticism to the current iteration of single payer plans.