Oh, by the way, two other small points. The government might say they are going to use the private sector to run their program but what they fail to point out is that if the government sets the rates and writes the rules…it ain’t private. Second regarding the government setting up a public plan to compete with the private sector is a friggin joke!! It is IMPOSSIBLE for the commercial market to compete because they negotiate rates…the government sets them. Explain that to an economist. Any form of national health care is simply just one big joke.

Why don’t the politicians start pointing the finger at those who are actually using the health care dollars, the unhealthy American public? It costs a lot to care for fat, diabetic, smokers who can’t get enough Budweiser…oh yeah, sorry i forgot that doesn’t get people elected.

If you want to use the gorilla to hold down the costs, being alongside the other options obviously doesn’t work on the root problem. Why don’t we place the ape on top of the problem? Say, have the government take over anyone who goes over (just an arbitrary number that would need to be studied by actuaries and underwriters) $500,000 in medical costs over his or her lifetime. Putting a ceiling on the risk would allow for some crisp competition for the majority of insurance policies. People could buy a “bucket” of $500K. When that’s gone, its into the government’s care you go. You could change plans from year to year to try to take advantage of the competition, but god forbid you get really sick. Then you become a line item.

Yes, it’s harsh, but don’t you think that actually might make consumers and providers work harder for cures to diseases instead of cures to symptoms?

Just my take on it, though.

The smarter premed students would pick other careers, older physicians would retire sooner (especially in lower paid primary care), younger capable physicians would transition to other fields, some would even try out Dr Rich’s suggestions.

This would dramatically speed up the replacement of cognitive and even procedural specialists with lower paid, more compliant midlevels. That might be a good thing from the policy wonks’ point of view but scary if someday you’re going to be a patient needing comprehensive care of multiple chronic problems.

I don’t see why you say “without competition from the government, private insurers will have little incentive to control spending.” Insurers have a strong incentive to control spending now: profit. The less they pay out in claims, the more they keep. If we didn’t subsidize employer provided insurance and put it on a level field with self-purchases insurance, then the price competition for purchasing the policies would be even stiffer and their would be more low cost insurance options. State coverage mandates also drive up costs.

For private insurance costs to be lower, less, not more government involvement in healthcare is required.

That kind of government intrusion would once again force the question of unionization and the right to strike, something the federal government has nicely defeated before by claiming that doctors constitute multiple different businesses and unionization would therefore represent collusion and illegal price fixing–something the government does with impunity.