I always want to say I hope you had a lovely Thanksgiving holiday.
Now to your post!
Ksen, one think I'm frustrated about in this discussion is the tendency to narrow down to just an a/b choice (e.g. single-payer insurance vs. the status-quo employment-based set-up), when there must be more options than that.
The larger the cost sharing pool and the more real competition, the better the insurance deals would be. Up til now, we've relied almost entirely on employment for health coverage. That, coupled with a ban on interstate sale of insurance, has led to much smaller cost-sharing pools and very little actual competition, with one insurer often dominating entire regions. Fifty different sets of rules and regulations have historically governed insurance sales across the country, with consumers almost always bound to their employer’s choice for health coverage – and worse, should they lose their job, finding themselves suddenly without any insurance at all.
It's hard to defend such an ad hoc "system" with its innate inefficiencies and skyrocketing costs.
I think I can safely say that I completely agree with you. One thing I would add is that I believe when it comes to access to healthcare that the profit motive shouldn't be a factor in the decision making process or be so far removed from the decision making process that it might as well not exist at all.
The argument that no modern, industrialized nation should be without universal coverage is persuasive. But other Western nations have found ways to achieve it through far more decentralized means than Canadian-style single payer, or the expensive socialized medicine of the UK. The Dutch --- I've read --- have achieved universal coverage entirely through fierce competition between private insurers, and the Germans use a system of exchanges that allow German workers to move from job to job without losing insurance. The Swiss, who have made an art of subsidiarity, have achieved universal coverage through competing non-profit insurance plans.
Sure, even though I would prefer a system like the French have doesn't mean there aren't other good ideas out there. We are a country full of very bright people and given the amount of data available we should be able to take the best of what other countries have been doing and tailor a very good situation for ourselves.
Unfortunately, with respect to Obamacare, we didn't do that. We cobbled together a monstrosity. But even the "thing" we have now is better than what we had before and will hopefully move us along further to real healthcare reform, whatever form it takes.
Since medical needs must be prioritized somewhere, by somebody, I think a single-payer system will necessarily politicize many care issues in a way that takes all choices away from intermediary institutions. (By "intermediary institutions" I mean the 10,000 for-profit, non-profit, professional, philanthropic, church-based, commercial, fraternal, charitable, private, state, county, local organizations that stand between me and Kathleen Sebelius.)
The State and its boards, panels and czars will make the judgments that supplant all other judgments.
A simple f'rinstance is the HHS decision to require the provision of abortion-producing drugs, contraceptivers, and sterilization procedures with no co-pays and no deductables. Who made the decision to prioritize this particular set of goods and services, but not albuterol nebulizers for COPD, or insulin for Diabetes 1, or metformin for Diabetes 2, or epi-pens for people with severe allergic reactions, or something really whiz-bang like hematopoietic stem cell transplantation for refractory rheumatoid arthritis, or RNY's for the malignantly obese, or... .. or... (I won't go catalog on you.)
The point is that some goods and services are prioritiized, and some are not. That's necessary, of course. But who decides that? At present, Kathleen Sebelius. I can do all the arm-waving I want, and I will never, in the years left to me, be able to influence these matters one iota according to my needs, values or ethics, or those of the people for whom I am partly or wholly responsible.
It's an unresponsive and irresponsible system. It will only become moreso, the more top-down, centralized and bureaucratic it becomes. Concerned about the 130,000 elderly Britons euthanized every year via the "Liverpool Care Path"? It' ll be 10x that in the USA, and without question they'll call it by something that contains the words "Compassion TM " and "Choice TM ".