The thing about the federal government (that certainly isn't true about the insurance industry) is that the people ultimately control it. That's the key difference. Say what you will about money in politics, the voters vote, and they won't stand for a health care system that doesn't work.

It's actually worse than the simple "you get what your employer pays for" suggests. In many parts of the US, especially outside large cities, there's effectively a private monopoly of one insurance company.
As for whether the US would allow local government plans, I've seen somewhere that there's actually a current federal law that effectively bans state single-payer, and one potential provision in this round of reform would drop that ban.

worthawholebean, I suspect there are not many people who would agree with your claim that the people control the government.

Even if the "people" collectively do, I do not want the "people" collectively to hold such power of me individually. If the government takes over health care entirely, I have no say at all in my health care. If I don't like one insurance company, I can opt for another. This is not true of a nationalized health care system, even if the "people" collectively hold it.

jmerry -- how is what you describe about a single insurance company dominating certain areas any different from state single-payer health care? (I'd also question whether, if what you're saying is accurate about single-insurer regions is so, this is the result of government action, as many insurance-related oddities are. Such as, for example, the link between employment and health care. I suspect, though, that there are comparatively few people in areas that are only covered by one insurer...)

The difference? Sick people with dropped or inadequate coverage driven into bankruptcy or death. Denying care is profit to an insurance company.

So is rationed care to a nationalized health care.

It's just a different set of people who are denied care. This doesn't seem to be a great improvement.

I would be much more inclined towards local-government-run health care rather than one done by the federal-government, simply because I think it is easier to get a voice in at the local level. I'm not a libertarian by any means, but I think there should be some limitations to federal power, esp. when it comes to something as important and expensive as health care. As far as health care turning a profit by denying care to the sick, it's clear that California doesn't value fiscal responsibility like it should, so maybe state-run health care wouldn't be so bad...

Right up until they closed all the hospitals.

But, in your more serious comment, you give another reason to like the municipal model from a theoretical view on a lot of things. You might actually be able to influence local government without having gobs of money (But gobs of money will still help, of course -- I think this is something people overlook when they argue for the government to take over something because powerful rich people have more say in this or that private industry. Powerful people stepping past others happens in government pursuits as much (or more) than private ones.)

A copy of what is below is in my blog, for anyone wishing to respond directly to me. I'm not advertising, but I may not see responses here. Please, just PM me if you'd rather I just replace the below with a link.

At the very heart of the whole issue is this. Millions of Americans are uninsured. Quality per capita in health care isn't improving, but decreasing, despite technological advancements. What is necessary is to establish some sort of baseline which every company cannot fall below.

That is what is being attempted, using the very laws of the market.

Regulations in the classic sense have failed, so in a sense, having a government run health care plan can be seen as a new take on letting the market run itself. Using the market, not controlling. What could be more capitalist (please rethink if you intend to say that liberals are socialist Click to reveal hidden text)?

The other option is literally micromanaging other companies. That's what people seem to think the government is attempting to do.
Ignoring details, politics, alignment (hey, I had no idea about what each party stood for when I came up with my views), isn't this a noble goal?

If someone poses a proper solution to this problem besides the one currently constructed or the one which has been failing for years and is being so heavily protested, they should publish a book, because apparently it's beyond the likes of which has ever been tried before.

The Japanese, the English, the German, the Taiwanese, and so many other countries have problems underpaying doctors, while the average (according to the nytimes) gastroenterologist makes 457,000 annually (compared to the American average of 30,000).

So something must be done. It makes me wonder about our society when so many people don't understand that simply because they don't care to know or because of such massive misinformation by people like
[ends rant before he offends someone, although I don't mind offending Rush Limbaugh.]

If you want to see what I think about elections...
http://sendables.jibjab.com/originals/time_for_some_campaignin

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In summary. First, what we're doing isn't really socializing, taking over, or monopolizing health care. Second, there are problems, and they need to be addressed. That is all I want anyone to acknowledge. If they can be solved by going and letting companies run amok, then do that. If it means listening to ultra-conservatives, do that. But right now, the only plan that is even being suggested is Obama's. If it's not a permanent fix, it's something. I challenge you to do better, AND then get it passed through Congress.

PersonallyClick to reveal hidden text

It is perhaps difficult for a community of self evidently brilliant problem solvers to admit that every problem does not have a solution. In fact this is a very modern delusion.

Healthcare is an example of infinite desires conflicting with a world of finite resources. Like the Socialist Calculation debate, this is not a matter of just getting smart enough people or big enough computers. It has no ultimate solution.

This is not to say that there are not many small problems which can be solved within the constraints of the larger reality. I'll offer a personal example to counter the anecdotes that inevitably infect this debate.

When he was 3 months old my oldest son was diagnosed with bilateral retinoblastoma, cancer of the eyes. This disease leads to death if untreated and the cancer travels up the optic nerve to the brain.

A couple years before he was born the preferred treatment was enucleation of both eyes and disfiguring radiation of the skull. By 1996, however, they had developed a new technique using chemotherapy and lasers (do not claim that the quality of healthcare has not advanced in a semi-free market).

We did have insurance to help with the expenses but had we not we would have certainly spent every last penny, incurred a mountain of debt or sought charity. What we would not have done was to claim that our need placed a moral obligation on anyone but ourselves. We had no right to enslave a doctor or to take someone else's property.

I personally think that an investment in a 3 month old with a brilliant potential career is a better investment than adding a year to a terminally ill octagenerian, but it is not my place to impose that opinion on anyone else.

dj -- I think you drive at another problem with single-payer or single-provider there. What gives the government the right to prevent me from buying the service of a doctor to save or improve my life. Single-payer or single-provider will do exactly that.

I'm not against providing care for everyone (assuming we can pay for it). I'm against the government providing all care for everyone. If someone is too poor or otherwise unable to take care of themselves, then OK, they can put themselves in the hands of the state. I just don't think we should all be forced to do so in the name of helping a very (very) small percentage of the population that needs this sort of support.

... and now there are people who had insurance and still spent every penny, incurring a mountain of debt. They had no idea their insurance would stop covering them until it did.
Infinite desires? No, I'm quite happy to stay away from the medical system when I'm healthy. I'm socialist on health care because I feel that "to each according to their need" is morally better than "to each according to their ability to pay".

Is it? I'm not so sure. Where's the evidence of that, particularly if "to each according to their need" leads to nearly everyone having a worse result, as has happened in a great many socialist societies?

Is it really worth significantly reducing the welfare of 95% of people in order to help 5%? It's not obvious to me that this a morally correct outcome.

In general, I'm skeptical of anything in these areas being argued on moral grounds -- not just skeptical of the socialists, but of the objectivists as well.

If we were all ants, the answers to these problems would be very different. But we're not. We're humans, and human nature plays a big role in finding optimal solutions. I don't think we can simply reason from "first principles" like "A is A" (Rand) or "to each according to their need" (Marx) on these sorts of issues. That almost always ends in tears when dealing with humans, because humans and human society are much more complex than slogans and "moral" codes.

I agree that reasoning from first principles is difficult to encompass this complex issue, but I think it has its place.

Let's start with the first principle that people have an absolute right to their own labor. If this conflicts with a supposed "right to healthcare" would we be justified in violating the first principle and demanding a doctor work for the benefit of another?

If there are not enough doctors would we be justified in creating more? Many talented AOPS students could be pressed into service, subjected to 7 years of school and administering prostate exams regardless of how they would prefer to spend their talents.

If we don't accept the idea that we can force labor from an individual then we must offer compensation to bid for their time. Of course every successful bid means many unsuccessful bidders for the same resource. Doctors who become oncologists are bid away from being obstetricians, doctors who work for patient A are not available to patient B. And individuals with the talent to become doctors might rather apply that talent to being mathematicians or linguists.

Of course healthcare is expensive. It is the product of talent and talent always has many more uses than sources.

Granted this doesn't address the argument of whether or not patient A has a moral right to the property of taxpayer C (the forgotten man) in order to bid for more healthcare.

While I agree (very strongly) that a human society organized on those terms is likely to be much more successful than in a forced labor society, I still don't think of it in moral terms quite like that. If evolution had shaped humans to be more like, say, ants, then it might not be the case that such individualism would be a good organizing principle.