Also there is not the separation between provider and payer which results in providers angling for the most expensive treatments, only forced down by a payer who regards the patient as an unwanted liability. (This has been partially subverted in the British NHS by ill advised privatization.)

There's numerous examples in this article about how Medicare pays more reasonable prices for things than anything billed out to consumers.

Insurance companies often get the same sort of deals, but they certainly don't pass on the savings.

Yet the article says that the $800 billion a year the US government spends on Medicare is what's driving the federal deficit. So is Medicare part of the solution, or part of the problem?

Secondly, Medicare would be better funded if it was paid into like virtually every other single-payer system.

What's driving the deficit is taxes that are too low and military spending that's too high.

Might work in the short run in a small and homogenized enough population, where everybody basically only needs the same type of care; beware if you ever get a rare condition, since there is no incentive to specialize, and the regulations for "edge cases" are written as they are discovered.

The real solution to high medical prices is to lower costs, foremost of which would be insurance premiums doctors need to pay to cover their practices. This can be accomplished through tort reform. The best part of this is that if you don't like insurance companies taking money, this reduces that purely by market action.

The NHS does approve experimental and innovative treatments, and it does treat rare conditions. It also chooses whether to offer, or not offer, expensive new drugs. This, again, is democratically accountable - if it refuses a drug that is widely seen as life saving, the tabloids will pressure the politicians into turning up the heat and forcing it to change course. Also there absolutely is an incentive to specialize; the NHS pays a doctor's salary, so (provided it's willing to hire them) they do not have to pick a specialty that's profitable.

Moreover, the NHS, being free at the point of delivery, is willing to take on expensive treatment of poor people. In Britain, the idea that someone might go untreated perhaps for years for a quickly treatable illness, because going to hospital would bankrupt them, is seen as abhorrent and barbaric.

Ill health strikes randomly without regard to wealth; health of everybody benefits everybody. Therefore, everybody should pay according to what they can afford, everybody should be covered according to what they need.

I was not targeting the British NHS, in fact, I didn't mention it. However, I would point out that:

> the idea that someone might go untreated perhaps for years for a quickly treatable illness, because going to hospital would bankrupt them, is seen as abhorrent and barbaric.

Is not the same as having a rare condition. You have added (1) quickly treatable, and are assuming (2) easy to diagnose.

Doctors here in Canada can still be sued for malpractice (and with few exceptions, doctors are NOT employees of the government; they are independent contractors), so that entire line of argument is bogus, like every single American argument I've ever heard against a true universal health-care system.

Second, if I were, then small and homogenized could just as easily apply to a geographically concentrated population with the same macro drivers of external illness vectors (climate, weather and epidemiological proximity). Odds are that if the flu is going around the UK, the person coughing has the flu.

[EDIT] Third, I did say might and the short run...sometimes social engineering problems can take a while to diagnose, and can be difficult to treat.[/EDIT]

And just like anywhere that regulations spring up (Canada or not), regulatory compliance becomes a de facto legal defense against malfeasance.

I'm not sure if some of that was supposed to be irony. In terms of healthcare, the government pays almost half of the cost of providing care in this country. Not only does it give massive tax breaks to employer provided health insurance plans it also directly writes the regulations that govern almost every aspect of healthcare. In a sense, the government is already running your healthcare if not outright paying for it or compensating the hospital then running the system that provides or incentivizes the structure of the health insurance plan you have.

Libertarians, who would have you believe we should be free to do just about anything, fail to recognize that without a framework that defines acceptable behaviors, the social situation will quickly degrade into a free-for-all survivalist state not unlike parts of the world where the government has collapsed completely.

You can argue that the rules are too strict or too lenient, but arguing against rules period is insanity.

We the people, we the people.

Sorry, laws are important, as are taxes. And while you may not use roads, the rest of us do. I don't have children, but I pay taxes for schools. I'm okay with it because education is important. While you may be able to afford health care, many cannot. You reap the benefit of healthy citizens as well. Healthy people, and people out of debt, promotes a better economy.

If we do go to a government based system we need a way to make the government accountable for KEEPING costs down while still providing the best care they can to everyone. I don't think that just saying "let the government handle it" is the right mentality. We must first establish a mission for that (emerging) department of the government and keep them to it.

Also, how can we switch to a national health service, while we are over budget by about 40%? Sure, let's do it, but that would mean a reduction of government elsewhere by 40% first and THEN we could being to take other parts away while adding a national health service...

There are dozens of universal healthcare systems to study and implement against. Most are single-payer (France, the UK, Canada) but some are based on heavily regulated mandatory private insurance (Germany and Switzerland, IIRC; I could be wrong).

In every case, the government says "this is the price that you are allowed to charge for service X", which is based on cost-to-deliver plus a reasonable overhead (like the Medicare price in the U.S.).

Eliminate the for-profit healthcare crap like was described in this article and most of the American overspending on health services goes away. Not all of it, but most of it. As a side-effect, the health care system will become more efficient and could finally become an effective partner in providing health security (both for individuals and for the nation; having a functional health care system is arguably important for national security in an age where biologicals are a fear).