Nationalizing health care in the U.S. would increase its cost

1. Since most people in the U.S. obtain private insurance over Medicaid, even if costs were to increase by nationalizing health care, thus making the government have to pay more, it would actually be DECREASING the cost for those who are privately insured. In other words, whether or not nationalizing health care will cost you more or less money depends on who's insuring you now. It's true that increasing demand without increasing supply always increases unit costs. However, because the government will most likely not be able to significantly increase costs for patients, the most realistic scenario in this case would be citizens opting out of public health care and instead choosing to retain or purchase private insurance to ensure decent service. Private insurers wouldn't be able to market their plans at ridiculously high prices, because competition from public health care would force them to keep costs down. 2, 6 & 7. Medicare absolutely does examine claims. In fact, Medicare denies more claims than commercial insurers. To say I ignored the point regarding admin fees in R1 is simply untrue. I maintain, "The insurers add another fat layer of administrative costs, as do the employers who purchase policies. In countries where all physicians work on salary for the government, and hospitals are all owned by the government, much of the paperwork is eliminated." Since Medicare denies more claims than private insurers, I don't see how this point is relevant. In regard to birth control being the item that people most often think is covered, I offer 2 contentions: First, Pro has provided no proof that this is in fact the case... especially since I highly doubt that people on Medicare would be seeking birth control (as he pointed out). It's more about routine exams. Second, it is not valid to use Medicare as the proper basis for comparison. Medicare would surely not be the model for public health care, as Medicare generally applies only to those over age 65. This would not be the case with nationalized health care; there would be different standards. Pro asks: Why would a larger bureaucracy, with more layers of management, reduce costs? Perhaps in the world of business this would not be so. However, management when it comes to government is different than management when it comes to business. "Because this public customer is most closely connected to the top of the organization and is often very disconnected from the bottom (management), a top-down bureaucracy is an essential tool for ensuring focus on that customer... It takes bureaucracy to make sure federal managers and employees remember that (individual interests can diverge from the interests of the public as a whole)" [1]. In other words, if in a governmental bureaucracy the law-makers are those in most direct contact with customers (the public), than it is the law makers and politicians who will make it a priority to keep costs down. Reducing a lot of fluff Middle Management may be the way to go. The U.S. has the most bureaucratic health care system in the world. Over 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc. Because the U.S. does not have a unified system that serves everyone, our insurance system is both extremely complex and fragmented. The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. I highly doubt that 12 - 22% of these overhead costs are all burdened to the Justice Department! Plus, it is not necessary to have a huge bureaucracy to decide who gets care and who doesn't when everyone is covered and has the same comprehensive benefits. With a universal health care system, we would be able to cut our bureaucratic burden in half and save over $300 billion annually [2]. In regard to replacing local care with large, far-away medical centers, this point is irrelevant as I have never argued for such a thing (reduced quality of care). Obviously the concept of large centers in rural areas would not apply. Though America does have a large rural population, the majority of citizens - three times the amount - reside in more urban communities. This would be effective in urban settings, and those in rural communities can still seek to diminish costs of unnecessary, expensive medical equipment, especially since its often not used at all - or at least far less - due to far less people using such facilities. It's true that such expensive equipment is used, Pro. When hospitals compete, they often duplicate expensive equipment in order to corner more of the market for lucrative procedure-oriented care. This drives up overall costs to pay for the equipment and encourages overtreatment. They also waste money on advertising and marketing. The preferred scenario has hospitals coordinating services and cooperating to meet the needs of their communities. Competition among insurers is not effective in containing costs either. It results in competitive practices such as avoiding the sick, cherry-picking, denial of payment for expensive procedures, etc. An insurance firm that engages in these practices may reduce its own outlays, but at the expense of other payers and patients [2]. Pro adds, "The new government requirements for digital record keeping vastly increase the costs of record keeping." First, define 'vastly.' Second, the government may choose to impose these regulations on both public AND private insurers in the near future, thus making this a moot point. Sometimes additional regulations are placed in the name of safety and caution. Such preventative measures may save people's lives and more insurance money should something go medically awry. 3. We need to consider how many new drugs we get for each extra dollar we spend. If a drug company posts in 50 billion dollars in sales, how much of this goes into useful research? We also need to consider what types of drugs we get. Pharmaceutical companies have an incentive to produce the drugs they can sell. Plus, pharmaceutical companies are not the only source of drug research. The U.S. is chock full of top notch research universities. What if the government negotiates lower drug prices, then pumps billions into publicly funded research? The NIH's budget is $28 billion dollars. Meanwhile the top 10 drug manufactures are posting $80 billion in annual profits. Paying high prices for drugs probably isn't the most effective way of supporting pharmaceutical research [3]. 4. Pro notes, "The principle is that competition drives down costs, while eliminating competition causes costs to rise. Nationalized health care eliminates competition." If it weren't for public health care, the cost of private insurance would be significantly higher. Having the option of government funded care is what leads to competition amongst private insurers to keep costs down. Moreover, the government can hire people to be innovative and lower costs however and whenever possible. These people would be rewarded, thus the incentive to seek new ways to improve the system. 5. Pro writes, "Because Medicare doesn't pay enough, they (doctors) create extra office visits." The type of 'peer review' I have advocated for encourages doctors to be prudent stewards, and to make sure their colleagues are as well, because any doctor doing unnecessary procedures will be taking money away from colleagues. In addition, expert guidelines by groups like the American College of Physicians, etc., can help shape professional standards [2]. 8. I maintain that costs of health care are high due to rising costs of equipment and procedures. Aspects of American society are irrelevant, as our high population and various lifestyles make it difficult to compare us with other nations. Moreover, even if Pro is correct, I don't see how this applies to the argument that nationalizing health care would increase costs. On a final note, I haven't made any arguments in the Comments section.