>
> Paul Krugman says that the best kept secret in the US policy
> debate is that the Veterans Health Administration --
> government-run health care -- works much better than private
> health care:
No doubt. The problem is not the reality but the perception of reality and the latter in this country is such that government is synonymous with "burden" "bureaucracy" and "inefficiency." Despite Nathan's & co, efforts to rationalize it - the main, if not only, reason of that perception is the reactionary mind-set of the majority of the US population. The best proof of this is that while right-wing candidates get easily elected and re-elected, progressive candidates barely register on the scale, receiving less than 3% of the votes. That margin of support would not win them seats even in the European-style proportional representation system (which require a threshold, usually 5 % to stay in the game).
The chief reason of that situation is the conspicuous absence of left wing institutions in the US society. People rarely think on their own, especially on issues that are of no immediate concern to them. Instead, they rely on social knowledge processing mechanisms, such as is "stock knowledge," institutions, celebrities or legitimate leaders. It is so not because most people are stupid, but because by nature people are social creatures. They learn to rely on others in meeting virtually all their needs until the age of 14-16, and cooperation is the typical response to any uncertainty and danger.
Making decisions on political issues is no different - most people do not have time and skills to investigate every relevant aspect of such issues, of which they usually have no first hand knowledge. Instead, they rely on social institutions in processing that information. That is why institutional presence of the left is so important - it is it supplies and legitimizes the progressive opinions and points of view against competing points of view. Without such institutional presence, progressive points of view loose their legitimacy - few people even hear them and if they do, they do not take them seriously.
While left wing institutions (unions, labor and socialist parties) developed in Europe - they did not in the US, mainly because of the fragmentation of the US polity and society, and the influence of religion and pro-business views. But whatever the historical reasons, the fact remains that there are no left-wing political institutions in the US, and as a consequence the political views of the population lean heavily to the right. That is why any attempt of social-political reform must be placed in a right-wing framework to be acceptable to the public.
Theda Skocpol (_Protecting Soldiers and Mothers_) makes that point when she argues that the US developed one of the most generous social welfare systems ached of Europe - but the catch was that that this system was framed in the essentially reactionary rhetoric of reparations for the Civil War instead of the progressive rhetoric calling for better working conditions (which was the case in Europe). The key reason she cites is the absence of a nation-wide labor movement due to the peculiar fragmentation of the US society and polity.
Therefore, the fact that government institutions are effective and efficient simply does not register in the US popular consciousness which associates is exclusively with burden on their, inefficiency and bureaucracy. Call it uniformed, stupid, delusional - whatever - but that is what we are dealing with, whether we like it or not. Trying to change that perception is as futile as convincing them that there is no god, heaven and hell. If you want to implement a single payer health care system - it must be separated from the government in the minds of the populace.
That is where the nonprofits come handy. Most of them are creations of government policies and government funding - without which they could not function - yet nominally they are "private," and classified as such in business registers. In fact, most health care in the US is already "nonprofit" (e.g. some 90% of hospitals) and heavily dependent on government payments (e.g. Medicare). Therefore, creating a "nonprofit" agency that handles mandatory national health insurance - funded pretty much the same way Medicare is funded - by premiums aka special taxes that are earmarked for that particular purpose (i.e. cannot be squandered by politicians and spent elsewhere) - seems like a reasonable way to go and will likely to get public approval.
Wojtek