> As has been pointed out, single payer actually doesn't get
> you that much
> radical, since it leaves in place privately controlled
> hospitals and other
> care providers milking the system for profit. If the means
> have to be
> maximalist, why aren't you trashing single payer as falling
> short of true
> socialized medicine?
Nathan, the so-called "socialized medicine" as we know it is not exactly such a great thing. Been there, done that. The system was not that all inclusive as it may appear (it did exclude self-employed and private farmers) and the level of service was very uneven. The price controls backfired and resulted in wide-spread corruption and very uneven geographic distribution of services - a few big cities had decent facilities, the rest of the country sucked. The wide spread corruption made a mockery "socialized" - to get any medical care you had to pay off the doctors, the nurses, even hospital orderlies. It was not cheap at all. Central authorities decided which services were to be provided, and they generally preferred "life saving procedures" to support services, which basically left the post-surgical patients, the handicapped and their families in a limbo. Medical research was eons behind the West, some "household diseases" (such as Alzheimer disease) were not even recognized as a medical condition but as 'senility' - dog only knows whether because they did not know any better, or because the bastards wanted to save money on treatment of this "unproductive" segment of society.
Do not get me wrong, socialized medicine was a great thing when it was introduced, because it provided basic universal medical care where none had been available before, and it was also strong on prevention - but things changed since then. The health care today is far more sophisticated today than the provision of basic life saving procedures - it involves research, diagnostics, case management, long term care, support services, in addition to basic treatment. I am not sure what 'socialization' of that process (i.e. state ownership) would contribute to the process other than turning the whole into one gigantic HMO, in which bureaucrats decide which treatment is to be performed.
Most modern health care systems clearly distinguish between financing and delivery. Most indeed are based on a single payer scheme because that arrangement offers distinct benefits, such as risk pooling (i.e. lower per unit cost) and transaction cost reduction. However, most also depend on semi-private delivery (i.e. providers that are not government owned, but heavily regulated). The US is not that different from the rest of the world in the second aspect - most providers are either private or nonprofit; it differs from the rest of the world precisely in the absence of single public mechanism financing health care. That is also the cost of health care in this country is double that in other developing countries, whereas the quality is essentially the same. There are too many financial intermediaries in the loop.
If you think that you can reduce the cost of health care on the delivery end (i.e. by administrative control of fees charged by providers) - think twice. This will almost certainly lead to substandard quality of that care. Health care is expensive - period, and it is so because it cannot be taylorised and automated like say manufacturing. The only place to cut cost is to eliminate financial intermediaries in the health care system - especially insurance companies, including those owned by unions.
So the single payer system is actually the only sensible proposition on the table if you look into details and take emotional semantics out of the picture. It is also a very radical one - as it will likely take a lot of intermediary hands out of the pot.
Wojtek