Well, why the heck not? Which things are more efficient than which other things is just as much a question of fact as which things are heavier than which other things. Nobody suggests that weight is a matter of ineffable philosophy and differences of opinion shouldn’t be resolved by observation and argument.

It’s possible that the political system is simply unable to produce and sustain anything that would directly benefit the population. In which case the whole discussion is moot.

Well, if that’s the case, then it’s time to get REALLY radical, like the fellow who wrote this:

whenever any form of government becomes destructive to these ends, it is the right of the people to alter or to abolish it, and to institute new government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their safety and happiness.

(U.S. Declaration of Indepenedence.)

Political systems are a means, not the end.

“But the point stays that the US already spends an entire Europe-level budget on the elderly, and that spending even zero on everyone else still wouldn’t make the system cheap.”

So how about before we create another bigger govt health program or expand Medicare to everyone we first look to reform Medicare?

John,

What pro points did Megan need to mention?

The initial point of my posts was that to a libertarian government systems are inefficient.

How postmodern of you. Yes, we know that libertarians can’t deal with the fact that their ideology is at variance with reality, and that they react to this by simply defining reality away. Not news.

I think the New Labour government really is better. I’m not talking about literal criminal corruption, but about the political system in general. Do you think any UK government would be able to pass an equivalent of the Medicare prescription drugs law with its ban on negotiating the prices? I doubt it. Yes, Billy Tauzin, the mastermind, took a multi-million dollar bribe (and a perfectly legal one), but also a majority of representatives and senators voted for it and the president signed it.

Also consider the social security situation: they raised highly regressive SS tax in the 80s (doubled it?), used the surplus to cut the progressive income tax, now they’re refusing to pay the IOUs, and they will probably get away with it too. Could any British government pull something like this?

It’s possible that the political system is simply unable to produce and sustain anything that would directly benefit the population. In which case the whole discussion is moot. End of story.

What’s more (I did not mention this in my prior comments), is that by allowing the government to take a central role in non-Medicare health insurance markets, it makes it easier to gradually expand that role. Once a system for government intervention is established, it is easy to enlarge it and difficult to get rid of it. You would get more support if you went about universal coverage in a different manner.

(I grew up in a household where the New Yorker was Mount Olympus and Thurber was the chief of the gods, and I read The Thirteen Clocks over and over. Since when I have gone more than 40 years without reading it; but it took me about two blinks to identify that quote. The machinery having started, I could now sit here and fill pages with lines from the book. Long-term memory is an interesting thing.)

because public health spending in the US is, to a first approximation, Medicare, which is a program for old people.

And most of the the rest is Medicaid, used by the poorest and disproportionally unhealthiest.

Given the massive selection of relatively healthier people into the private insurance system, THAT is the sector where the very high costs point to massive inefficiency.

It’s true, the argument about all these great government-run programs existing elsewhere is predicated on the assumption of a reasonably honest and competent government, and in case of the US of A it’s certainly a weak one.

Is the New Labour government really better in either respect? Yet the NHS is still there.

Where our massive corruption level kills us is in getting there in the first place. If (in Fantasyland, of course) we could once get a reasonable system established, career Federal employees would run it perfectly well. (Until the next Republican administration anyway…)

Kenneth Arrow: Uncertainty and the welfare economics of medical care (AER 1963)
http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

See also these relating “Reading notes”:
http://hadm.sph.sc.edu/COURSES/Econ/Classes/Arrow.html

Hmm. Take the 2003 prescription drugs bill for example, where Medicare is specifically and conspicuously banned from negotiating the prices. If you want to design a government program to funnel tax money to corporations (for a kickback, see Billy Tauzin), it’s certainly a possibility.

It’s true, the argument about all these great government-run programs existing elsewhere is predicated on the assumption of a reasonably honest and competent government, and in case of the US of A it’s certainly a weak one.