appropriate single payer system would be a better economic system than we have now

"i question how much of the total costs are from the ER. ER usage compared to things like medicare, which is for old and dying people, will pale in comparison. so even if there is abuse in the ER, it is too small to say is the reason we pay more than other countries." Ah, sorry I wasn't clearer. EMTALA basically says that if a hospital accepts Federal funding, which is functionally viewed as CMS payments, and it operates an emergency room, then it must disburse emergency services regardless of the patient's capacity to pay for them. So in this case, we should look at hospitals closing their ER's as an indicator they can't afford to continue their operation. This is a point I think cross-applies to a number other arguments--while it's absolutely true that payment mechanisms have important repercussions for utilization, it's also true that money is fungible--we don't care where it comes from. Since hospitals, and especially NFP hospitals, provide significantly reduced/charity care, we care more about their aggregate funding when trying to answer care disbursement. It would be very difficult for you to segregate ER costs. The entire industry cross-finances. You next advance what I'm taking to be a version of the 'ounce of prevention = pound of cure' argument. Unfortunately, this has little basis. For example, we've recently developed reasonable evidence obesity doesn't raise aggregate health costs because the obese-ist tend to die before they can get cancer. And cancer is f***ing expensive. See, it's true that "prevention" does have an important effect, but it tends to be the obvious kind. Namely, exercise, eat nutritionally, take a baby aspirin after turning 45ish. Etc. These are things we don't need doctors to tell us to do. Or, CMS recently abandoned a pilot program that attended to assist CHF patients with drug/exercise compliance. The program was not able to generate a cost effective result. This is an individual, not societal problem. Further, I'd reference the mammogram snafu from ~2-3 years ago. You've repeated your 'administration' argument. I didn't see a response to mine: administration is misleading because government maintains a de facto monopoly. That is, we could reduce administration costs without nationalization. You continue the administrative argument, asking for evidence: http://granitegrok.com..., http://reason.com... Basically, as with many government programs, CMS doesn't count the cost of collecting taxes, doesn't count a slew of overhead/payroll, etc. Fraud's sitting at 9%. This comes down to incentive. CMS doesn't have the proper orientation to care as much about fraud prevention--it has government fiat. I don't see a response to my pointing out that CMS doesn't operate as a technical insurer since it farms out much of the actual administration of its functions. I.e. regulatory, implementation, etc. Moreover, your focus on administration is misleading. Administration can be a good thing. For example, Kaiser has higher administrative costs, but these come from more active management and collaboration with the patient. "It would be an isurer of first resort. everyone who knew they could say thousands on health insurance would jump on it. the plan cuts out the middle man,,,, there's savings availble for everyone." I call bs on this argument. You can't go from complaining CMS has lower administration costs to saying it isn't a 'middle man'. CMS is as much a middle man, and it's one that doesn't compete equally. Any attempt to paint the status quo numbers as representative of the best private insurers can do is inherently misleading for the prior reasons listed. Please respond to these. "that doesn't mean they are worse for it in terms of efficiency. they spend 10 we spend 17...." First, http://www.kff.org..., Exhibit 9: The US already spends more *government* money than many peer nations. For example Canada spends 7.3% GDP publicly on healthcare. The US spends 7.4%. Second, you mistreat the cost growth argument. Cost of care is the ultimate rationer. That is, if my insurance is comprehensive, but pays 1/3 of cost, then the cost is going to ultimately prevent me from receiving care. Hence, the only metric we should care about is the growth of cost. Or, let's wait 20 years. If the trends continue as is, then we'll be the ones with the cheaper healthcare. Third, you're comparing apples to oranges, and it's dishonest. There are a number of reasons the US spends more on healthcare. Not least of which is the free riding much of Europe/Canada does on our pharmaceutical innovation. Or, approximately a third of the annual increase in healthcare spending can be attributed to obesity--i.e. personal behavior. Re. McKinsey healthcare study. You have to get into the reasoning why a single payer would be better at lowering costs in the long run. And it's quite obvious single payers are historically less innovative. Or do we really need to rehash the Cold War? Most bio-engineering is done in the US. "energy companies can cut costs by doing things cheaper. they actually can do this. the health care industry basically pays the bills as they come in, it's not about trying to find ways to do it cheapr as it is jacking up the price to pay whatever bills come in. insurance industries can't deny care etc as easily if it means preventing procedures coming due. erengy folks cut whatever they can." I'm sorry, why do you think healthcare can't 'find ways to do things cheaper'? Regardless, you're completely and utterly incorrect. I doubt I need much evidence to prove this point, but I'll reference arthroscopic surgeries--dramatically reduced the cost of care for select procedures. ------ "even if at the end of the day single payer was lower overall is because we actually cut care or something (my speculation of what it might be..." -Administrative costs: you haven't demonstrated this claim--you haven't responded to the many subpoints on why it's a dishonest comparison, etc. -ER--you're mistreating the argument. ER is an indicator for the insufficiency of CMS, not a driver of the costs. -they spend ten, we spend seventeen--again, a dishonest comparison. There are *many* differences -insurance supplement: interesting you bring this up--Both Canada and Sweden have banned various forms of balance billing making supplemental insurance effectively illegal. Cheers, now where on the road to servitude So, you've given no reason government would be better at innovating for the future. The reasons the US has more expensive care are complex and myriad but this isn't the subject of this debate. This debate is on whether single-payers would better manage the cost of that care. Sufficiently--the US already spends as much publicly (and doesn't get the *single-payer* magic) and has health costs growing slower than your single-payer paragons. These alone should be sufficient to vote Con. If we already spend more government money than many single-payers, how could you possibly think that our version of single-payer is more efficient? The primary reason you give for single-payer is 'administration'. You'll need to respond to the ~8 arguments I have against SP's administrative sleight of hand. There's probably a roll for government to have in healthcare, but it should keep in mind that incentives matter. Patients are not economical users of care. Per RAND Health Insurance Experiment.