Just one caveat - I don't like the term socialized medicine because it only accurately invokes a system such as the British NHS (which while preferable in many ways to our system is flawed IMHO - cheap though.) Nobody in the U.S. I'm aware of other than perhaps some lonely loonies of the ultra-left is proposing such a system. The "left" alternative to the Rube Goldberg, hopefully-interim reformist plans of "mainstream Democrats" is "socialized health insurance." Quite a different thing - undoubtedly never will be as cheap as the British system where doctors work directly for the state, but better overall - ref. France - and ultimately probably politically feasible even in our market-fetish-uber-alles slanted system

The discussion has hinged on efficiency only. I would submit to you that there are other considerations as well.

If efficiency is the only consideration, then why aren't you also calling on federalizing the ailing public school system as well?

prediction: both Obama's and Hillary's health care plans result in costs rising 15% per year.

Neither plan has any cost-control measures, only improved access measures.

The one-word answer is "government" -- specifically, government's ability to lower service prices, streamline administration and get a better deal on drugs, thus reducing medical inflation over time.

Its tiresome making the same points, but facts are stubborn things. Medicare provides 40 years of data that directly refutes Hacker's conclusion. Medicare could do all of those things today. It doesn't for a variety of reasons. If he and others believe so strongly in a Medicare-type solution, one potential end to the stalemate would be to actually demonstrate success in controlling costs with the 50% of health care expenditures already under government control.

I can't respond to anonymous, because obviously he either isn't listening or not following things through logically. As for wisewon, even if Medicare doesn't control costs absolutely and always, it does, in fact, control them FAR BETTER than any available private carrier. Also, I just learned yesterday that Medicare not only controlled, but actually reduced its costs from 1996-98.

I'd also like to point out that "The Empire Plan" is Blue Cross -- the only real comparable private carrier to Medicare due to its size (both statewide and nationwide), and therefore the one best able to control costs and offer good benefits.

A quick question (and note, I'm all for a government-administered single payer system): if health care is nationalized, how does the federal health care administration negotiate for lower prescription costs? I understand how it works now: a pharma company wants their drug(s) used by large providers, so they negotiate a discount. But with a single, central, system, would that incentive still be present? The only way I can imagine that being the case is if the single system establishes a limited apothecary forcing pharmaceutical companies to compete for inclusion. But that would limit choice and, ultimately, innovation.

It's not really accurate to say that Clinton and Obama are offering the same plan as New York State and federal employees get. The difference is that a government employees' plan is policed by strong and dedicated unions who will notice-- and go ballistic-- if funding is cut and forces union members into crappy health care plans. In contrast, the diffuse, disinterested American public isn't going to perform that policing function, especially since a lot of them (the wealthier ones) won't be directly hurt by a funding cut.

Further, Clinton's mandate makes it worse. If the federal or state employees system is slashed, you can at least opt out of it. But with Clinton, you still have to pay for the care even if it is crappy and won't cover you when you need it.

It is simply amazing to read this pile of baseless conjecture. I live in Toronto. Here, where the grass appears to be greener to this group, we have the results of the experiment proposed and Hacker is just plain wrong. Government is NOT able to do what Hacker theorizes. As an example, government here has proven incapable of controlling one of the largest costs of providing health care: labour (labor to you). The unions are strong and very demanding and the Liberal government of Ontario will not stand up to them.
There is no containment of cost in our system except for reduction of access. Less technology provided with longer waiting times. Longer approval for and less availability of newer, expensive drugs. These are some of the hallmarks of our "socialized doesn't sound so bad after all" system.
Be careful who you listen to for advice. Be careful what you wish for, because you may get it!

Marv makes a great point, once you nationalize healthcare, physicians are now legally allowed to unionize. Which they are not allowed to do now. Don't think for a second, you can get what I do on the cheap, 1) I'll retire and do something else along with 1/3 of physicians over 55 or 2) a strong union will bring whatever demands you want to its knees rather quickly when 100,000 physicians decide to take vacation for a month or so.

Jenga,

Your point is well taken that drastic cuts will cause huge backlash and are likely unfeasible. That's why what many of us would like to do is freeze your income for about a decade, so it can go from being extremely high (top 1-5%) to just being high (top 10-15%).

Some older physicians would retire early, to be replaced by lower paid physicians who are much more eager to engage in integrated care delivery and use health information technology. In order to ease the transition to lower average incomes, there would have to be a national plan to reduce medical school debt (this would also bring more people into medicine).

To me, this is a win-win-win. Even many physicians will win in this scenario (including early retirees who will enjoy it, and new physicians who couldn't have afforded medical school before).

Tom Joad,

There are several misconceptions in this statement:

I'd also like to point out that "The Empire Plan" is Blue Cross -- the only real comparable private carrier to Medicare due to its size (both statewide and nationwide), and therefore the one best able to control costs and offer good benefits.

Blue Cross is not one private carrier but many. About 14 of them are collected together in one company now (WellPoint), but they are not well integrated and do not have the benefits of scale you might imagine at this stage.

Also, the Empire Plan is actually two health insurers, one for professional claims and one for hospital claims. Blue Cross is only the hospital side.

Also again, United HealthCare is just as big as WellPoint. It's usually smaller than WellPoint in any given regional market, but WellPoint is not a truly national health plan (with more than half the Blues still outside it), whereas United is more of a true national plan.

I realize this is all inside baseball to most of you. There aren't many policy implications here.

On a more general note: it's not clear that size alone leads to more cost control. In fact, I'd say it's clear that this is not true. Medical expense inflation rates rise and fall with no clear correlation to the market dominance of a given health plan. There are several reasons for this, but the most important is one we should all know by now: the American people consistently and vocally resist the measures needed to control costs, which has dampened efforts by health plans, employers and government to do so.

You mentioned Medicare controlling costs from 96-98. Well, you might also have noticed that private health insurers controlled costs from 94-97. That was before the managed care backlash...actually, the utilization and price controls were what triggered the backlash. And no, insurers were not making large profits in those years. In fact, this was a low point for margins and many were losing money.

Consistently controlling costs is going to be vastly harder than providing universal access to care, whether we have a private insurance system or a public one.

That's why what many of us would like to do is freeze your income for about a decade, so it can go from being extremely high (top 1-5%) to just being high (top 10-15%).

jd,

This is a lot harder than you think.

1) How exactly do you plan on freezing income given their current fee-for-service structure? Are you planning on annually decreasing reimbursement at the procedural level to adjust for growing volume (and think you can do this successfully)? Or are you making a wholesale change to how physicians get reimbursed?

2) More importantly, while the medical school tuition-lower compensation tradeoff sounds good, it ignores that physicians trained over a 10-15 year period still get a bad deal in this situation. They're either very recent med school graduates in the midst of further training, or physicians who have recently completed all of their training. The docs aged 30-45. They don't like your plan. They paid their dues under the old system, and they want their cash.

Just a little reality check here. There are no easy outs.

Wanting and doing are completely different. You also will give up all rights to pursue a malpractice claim with a nationalized system as well since the physician and nurses become government employees.