Sustainability and Single Payer Revealed

George Rebane

Sustainability is the established watchword cum battle cry of 21^st century world transforming progressives everywhere.  Its most identifiable provenance was the 1992 UN conference which gave us the globalists’ plan for the future – Agenda 21.  Today sustainability is continually evoked as the raison d’etre for stultifying public policies that constrict our activities and take our properties.  However, any concerted attempt to discover a coherent meaning of sustainability yields definitions that are literally unusable in any serious exchanges between thinking people (e.g. see dictionary.com).  In what follows I intend to set the matter straight so that well-meaning, intelligent RR readers may understand and use the notion of sustainability in reasoned discussions.  In this context and as a Lucky Strike extra I present some newly, albeit belatedly, discovered information on the performance of single-payer healthcare systems that have become the holy grail of America’s ideology driven Left.

To sustain communicates the notion of uninterrupted continuance of something – a process, an activity, an accepted idea, a valued object, a framework like an organization or a defined environment.  Yet to judge that something has been sustained also implies that it has retained its characterizing features/functions which have remained more or less constant with the passage of time, inviting (compelling?) us to include the notion of ‘sameness’ when defining sustainable as a property and sustainability as a desideratum.

For example, for humans remaining a runner is not sustainable as we age.  Why?  Because even though we may as, say, an octogenarian still perform a similitude of running (with both feet being off the ground at the same time), our performance/speed is markedly reduced from what we were able in days of yore when anyone watching us would admit that we then were a ‘runner’.  The process of what is acceptably labeled as running is no longer maintained or sustained.

And finally we must acknowledge the role of the future and the fog from which it emerges.  When we seek to make something sustainable, we enter the domain of uncertain things to come.  We must see into that fog with sufficient clarity founded on reason that the sameness we install or currently experience will be maintained with the plausible resources (physical, financial, political, labor, …) then to be had.  If such knowledge is not sufficiently reliable, then we would be charlatans were we to still proclaim that we are putting something in place that is sustainable.

With these notions firmly in mind we can now submit an operational definition of sustainable (adjective) and sustainability (noun) that will serve in the discussion and debates involving public policies.

Sustainable – the property of being able to maintain the form/features/functions of something at defined consistent/constant levels over a specified interval of time during which the maintaining agent(s) can be plausibly expected to expend then reasonably available resources.

Sustainability – the stated objective of making something sustainable over a future interval while expending defined resources.

We should now realize that talking about ‘sustainability’ of something without defining or understanding how it will be made sustainable will be yet one more serving of pabulum to the listener/reader.  Let’s now proceed to more concrete matters.

The financial support of programs and projects (PPs) is an easy area in which to consider notions of sustainability.   In all cases of interest any proposed PP will compete with other PPs for limited resources, here financial.  If we assume that some defined, not necessarily constant, level of future resources will be available in the future, then we may assign these the 100% level, and all competing PPs their own fractional levels going into the future.  Considering a single PP (currently at the PP% level) in such an environment, we can draw the picture below that shows three possible future demand profiles that PP will make to retain its planned performance (form/features/functions).  If any single PP will demand an ever greater percentage of the total available resources, it will sooner or later crowd out support of other PPs and then hit the 100% ceiling, after which it can no longer be supported.  In short, PPs having the red line demand are not sustainable way before they demand all available resources.

The blue line indicates that sustaining our PP will require a constant percentage of the total resources available in the future.  We can characterize such a PP as being marginally sustainable.  The more joyful prospect is shown by the green line which indicates that a PP will be managed and maintained in a judicious manner where it will demand an ever smaller percentage of future funds available.  PPs with such characteristics are clearly sustainable.

In all cases of interest, the 100% line indicates the total available past and/or future revenues, GDP, or budgets from which maintenance resources for the PP will be drawn.  As such, their past/future growth (decline?) will have already been figured into the ‘100% level’, and so also will the required maintenance resources have been converted into appropriate percentages of the total available resources.  With this in mind we turn to an even more concrete subject involving sustainability – nationalized single payer healthcare (SPHC).

For those for whom the big question has always been ‘Are Single Payer Systems Sustainable?’  Cutting to the chase, the short answer, long argued in these pages, is not only NO! but HELL NO!  SPHCs are as sustainable as life after jumping from a very tall building, only the time scales are different.

Our socialist elites have been telling us for years that America has a broken healthcare system due to its being run by private industry that concerns itself only with profits and greed.  The obvious solution is to look overseas at all those enlightened, mostly European, countries that have instituted government run comprehensive healthcare systems commonly known as ‘single payer’ healthcare.

In those wonderful countries we are told no one has to worry about getting sick and then having to pay for it no matter your malady.  When you get a boo-boo, just waltz yourself into one of those conveniently located friendly clinics, tell them where it hurts, fill out a form or two, and that’s it.  From then on you’re in the system and in the care of professionals who will have you back home in no time, and even send someone to check up on you after you’re all better.

But the best part is that all such healthcare doesn’t cost you an extra penny; it’s all paid for overwhelmingly by other people’s taxes from here to eternity, Amen!  So what could be finer ask our progressive betters as they cite how much more those nasty capitalists are charging us this year for no better healthcare than we got last year.  And the eerie part is that we continue to believe them because we don’t really know what’s going on in Europe.  Every day we just eat up the pabulum fed us by the lamestream, and soon start musing that ‘hmmm, maybe they got something there, and we oughta do something like that also.’

Well, I’m happy to report that an internationally recognized public policy institution in no less than socialist Denmark has finally been able to dig up and collate the data on SPHC costs over time.  In doing this, the Copenhagen Consensus Center (q.v.), reports that governments make it very hard to assemble this data for obvious political reasons – their walk does not tie with their talk.  Nevertheless, the data was obtained, analyzed, and assembled in a report on the Danish SPHC system, probably because CCC was surprised that their own highly touted system turned out to be unsustainable. In response they wanted to see how Denmark stacked up against other major countries sporting SPHCs with a stiff upper lip.  (The US was thrown in because it is the most politicized remaining private system, now being debauched by Obamacare.)  You can read the entire report ‘The Danish Healthcare System’ here.

What caught my eye was the punchline data presented in the report’s Figure 7 shown below along with CCC’s explanation.

What determines growth in health care expenditures? A very general, but somewhat superficial explanation, is to note not only that health expenditures grow when GDP grows, but that in developed countries the growth rate of health expenditures exceeds that of GDP. Figure 7 shows this clearly. No country is below the 45‐degree line, showing an over proportional growth rate for health care expenditures. … Economists express this phenomenon in the following way: When GDP grows by 1%, health expenditures grow by more than 1%. Over the past 15 years this ‘additional growth’, as we call it later, has been 0.3%, i.e. health expenditures grow by 1.3% when GDP grows by 1%.

In the above figure the horizontal axis represents the percent GDP growth over the available interval for each country, and the vertical axis gives the percent increase in healthcare costs over the same interval.  The indicated line would be at the cited 45 degrees were the two axes scaled equally.  Extracting this data and doing some recalculation to present the information in a more digestible format I generated the following bar chart.

Here we show the SPHC/GDP growth multipliers ranked from the highest to lowest.  A multiplier of 1.00 would indicate marginal sustainability since the SPHC costs grow at the same rate as GDP; any lower value of the multiplier would draw its sponsoring government special commendation since less than one means that SPHC costs grow at a slower pace than the nation’s GDP, hallmark of a definitely sustainable program.  And a multiplier value greater than one indicates that the country’s SPHC costs are unsustainable.

As we see, no country has cracked the code on operating a sustainable SPHC, they are all going broke at different rates.  And that explains why all of them today are scrambling to find means of reducing their multipliers through adding taxes and lowering costs (i.e. prescriptions and medical services).  One particular and quietly implemented method is what in the US we have labeled ‘death panels ’, committees of anonymous SPHC bureaucrats which peremptorily limit lifesaving/extending medicines, operations, and procedures to patients with certain progressed diseases, and also to patients suffering from that ubiquitous disease called old age.

From the bar chart we see that economic superstar Germany’s SPHC costs have been growing over 300% faster than its GDP.  Even posterchild Denmark’s healthcare costs are soaring about 135% faster than its economy’s growth.  US healthcare costs (in red) are outpacing our GDP growth by about 110%.  While undoubtedly there are some apples/oranges effects in the levels of care provided by the different countries, everyone still should take a look at what South Korea is doing since its SPHC costs grow only around 20% faster than its GDP.

But about the sustainability of Single Payer Health Care programs, the bottom line here should be clear.  Today there is no evidence that such a program exists (or has ever existed) and the situation is so politically charged that reasoned and open public debate about such systems is no longer possible.  Yet within this context millions of Americans today still find it incomprehensible that we would ever consider putting our country’s healthcare system into such a broadly demonstrated and uniformly unsustainable quagmire before first applying the obvious regulatory and tax policy improvements to our existing private healthcare industry.

Comments

[Russ Steele]

Only a nation of innumerate people could accept sustainability as sustainable.

[George Rebane]

RussS 1239pm – As you have seen, these pages have covered the debate and data about Obamacare and its stepping stone to SPHC. Representatives of the Left have argued long and loudly about SPHC as a stable and beneficial public policy found in countries more enlightened than the US. While they have given no evidence of their claims, they have maintained that SPHCs are sustainable by simply saying so repeatedly and pointing out that no country has yet withdrawn its SPHC system (while ignoring costs and services). But when confronted with evidence to the contrary, their response is again delivered by their ever reliable crickets.

Alinsky advised this specific tactic to be used in the face of evidence – remain silent until the public forgets the evidence, then resume with your original falsifications as if the evidence was never presented.

Consider the EU, a neighbor to an expanding Russia, utterly unable to defend itself and unwilling to reduce socialism in order to afford the maintenance of its sovereignty. What kind of American wants the United States, the world’s bastion of civilization, to emulate such treacherous failure?

[rl crabb]

Perhaps it's time to face the fact that there is no "sustainable" health care under any system. The old one wasn't working. The new model isn't working. Or will only the well to do be deserving of such extravagance? And don't tell me that charity will cover the shortage.

[Walt]

RL.. Maybe just round filing the PC idea of "sustainable".
Have you found a pen or pencil that will be "sustainable" for your life span in your endeavors?
Anything and everything has it's limits.

[George Rebane]

rlcrabb 1017am - But we do know that our healthcare system of yore did not promise to crowd out all other public expenditures while delivering no better, and possibly more limited care overall. Obvious next steps toward improvement await their evaluation in the marketplace, and as obviously our adopted path is leading toward a disaster that becomes more palpable by the day.