As I've written before, that is true as well in the more general Washington-as-single-payer concept.

* * *

“The government currently runs a well-regarded health care system through the Veteran's Administration.”

Actually, it often has been the opposite of well-regarded, and “Veterans Administration” has been stated typically and routinely in conjuction with the phrase “horror stories.” In addition to numerous accounts of this, such as from doctors when undergoing training, ome years ago there was an “I am not a number!” campaign, specifically on behalf of neglected veterans. Presumably since then there have been attempts tto improve things, and there may be mixed results. The VA is the other well-known model for future health care for all Americans by the federal government, as I've noted before, and should be examined by more people, especially those with naive faith in government, as well as those who want to know about the program and how it might be incorporated (as I've noted before) someday into Medicare (in addition to Medicaid and Indian Health, as I've listed before).

By the way, the vet community (with its experience with government) isn't necessarily in favor of the current health care initiative:

http://www.legion.org/pressrelease/2797/militar…

Inglis is a Republican. He has no reason to be “coy”.

That's a pretty good defense of status quo Medicare, but I think it is debateable whether it would transfer well to a vastly expanded new system of government monopsony.

Also, you are still completely overlooking the equipment investment problem that comes intrinsically with any year-to-year government budgeting system. There might be ways to devise a single-payer system that avoided these problems, but the current penchant for simply ignoring those problems to focus exclusively on the purely political battle is counterproductive.

She has a post up today where she acknowledges some of the more nuanced points brought up by her critics, but the central point remains accurate.

GS- that woman (and I think there was another one who said something similar to Obama at one of his townhalls) wasn't confused. What they are saying is that they are aware that the current proposals will make changes to Medicare in order to cut spending there and shift it to plans to cover younger individuals. Inglis, and Obama, are being coy in their responses when they pretend those questioners don't know exactly what they're talking about.

This is demonstrably untrue. The insurance industry admits their overhead, including profit, is 16.7% and that it won't decline. They admit that Medicare was 5.2% a few years ago and is expected to hit 3.3% next year. That is from the insurance industry trade association! No one in Medicare is working to increase overhead, and their record speaks for itself. It is private insurance that has high and growing overhead costs.

You are going to hold up the VA as a model to shoot for? DEFINITELY count me out, then.

To CS comments, “Of course, there would be political pressure to keep the costs down as much as possible, but that's not the same thing as competition (which is how this has been promoted to the public so far.)”

A big part of cost control in a public or nonprofit option is the absence of profit motive as the primary driver. Organizations, whether corporate, academic, governmental or nonprofits are driven by their *missions*. Under the current system, providing health care is subordinate to making money. My main argument for nonprofit insurance, whether governmental or not, is that our *national* goal is for citizens to have effective health care, which is NOT the mission of private insurance. Their goal is to charge as much as possible and deliver as little as possible, to “maximize shareholder wealth”. In most markets they have a virtual monopoly, probably matching what a Medicare-for-all program would have. It's 85% in many markets, held by fewer than 4 companies. In many states, a single company has over 60% of the market share. We already have virtual monopsony/monopoly control, but not in the service of health care, but of profit motive.

Additionally, a Medicare-for-all program is virtually identical to regional coops, because Medicare itself is managed regionally, and many functions already contracted to private companies. But its national advantage is clear. No private insurance touches these features: no qualification, no exclusion, no penalty for changing or losing a job or moving, lower overhead, no profit, low executive salaries, no sales or marketing cost, fancy offices, etc.

A government monopoly is still a monopoly. “Yes,” single-payer advocates might respond, “but government is intrinsically good because it operates in the best interests of the many, while business is intrinsically bad because it operates in the best interests of a few; therefore, a government health care monopoly would make decisions that are more fair, more just, than a private-sector monopoly.”

Actually, the claim that government policy is guided by the “best interests of the many” is demonstrably false. The most charitable way of putting it would be to say that government policy operates in the best interests of the many as interpreted by current ruling elites. The relevant concern here is that government employee unions that control the staffing levels of the bureaucracy and set the work rules tend to place at least some priority on ensuring the growth and sustenance of their own overhead costs and their own bureaucratic power as well as the interests of their political allies. The fact that this often results in some degree of undermining of the broader set of “best interests of the many” can be seen in a huge raft of examples, including the recent stimulus bill where the “best interests of the many” disproportionately benefited groups like ACORN and the United Auto Workers while ignoring broader groupings, most particularly interests of taxpayers who must now compete with the government in the long-term competition for available investment capital.

The idea that government functions in the “best interests of the many” is almost always promoted exclusively by people for whom “the many” is functionally interpreted as the same as “me and my friends”.

I've worked at the low end insurance billing end, the basic research/clinical end and am looking into moving into the infrastructure (software/hardware) end, so I've seen pretty much all of the aspects of the health system except for pharm/med school. It is clear from my travels that all aspects of the price chain are overly inflated and grossly inefficient [actually that's why I may take this job, because it's with a growing player that is explicitly dedicated to solving this].

There is an argument about whether the government will do a good job of being a responsible monosopy considering how they run the defense, transportation and food budgets, but I do see the need for fewer players.

—–
Watch that talking point get smashed to pieces here –>

http://www.youtube.com/watch?v=Hdr49iGZOUw

For those who are curious, the shorthand version of my vanished comment, to which George has now was responded, was this:

1. I agree with many others that (a) the current system needs to be fixed and (b) the so-called “free market” for insurance, left to its own devices, will likely NOT deliver that fix.

2. My core concern is not with government programs but with a dispassionate debate over the relative merits of cooperatives vs. the public option.

I would also like to recognize how much I appreciate the Moderate Voice. I appreciate how much Joe and T-Steel do to keep it running as smoothly as it does.

Thanks so much!!

That said, I'm going to (try to) respond to a comment from Pete Able that seems to have vanished. Here goes:

Pete–

I believe that the bigger the risk pool, the greater the risk that can be safely absorbed by that pool.

I hope that's grammatical.

I believe the relative smallness of even a large insurance company's risk pool is why they exclude for pre-existing conditions. Their pools are too small for the additional risk of people who will certainly cost money.

I'm not opposed to co-ops, but I don't really see any advantages to them either. And I sort of think they may end up needing to be bailed out.