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

"Much of the US excess spending comes from private payers, but it's misleading to look at this as a complete picture because of the massive cross subsidy the public system imposes on the private system. Medicare/caid are now paying ~89% of cost (that is, before profit) leading to private payers paying more than they otherwise would. Many hospitals have tried to circumvent some of the CMS loss leaders by opting out of EMTALA by closing their ER's. 1/3 of US ER's have closed over the last 15 years." 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. and the fact that there is ER abuse is all the more reason to go to single payer. they will then get sensible health care instead of going to the ER for basic health problems. we still have more people covered more health care, with cheaper results. that's why we pay 17% and they pay 10. you might be talking about instead of 17, 16, or something. i suppose i could just look up how much ER costs are and it'd probably be an amount i can just deduct etc, but intuition seems pretty clear to me here. the savings again are because of the adminstrative costs being cut out. 31 percent is a lot (a third of our health care being admin costs).... a third of that 17% is 11%, about where we should be if we were single payer. it makes sense just looking at it that way that most of our waste could be attributed to admin waste.... ie, if you 'check our work', the math comes out that if we cut it out, there ya go. they say it costs a third cause of calculating the costs.... we put that over the 17% GDP, and we're where should be. "Moreover, CMS doesn't count fraud as part of overhead, and fraud runs rampant through CMS, while private payers count fraud prevention as part of administration" you might be talking about a percent, or a few percent, out of that 30% of every dollar being spent on administration rather than health care. i can't see fraud prevention being the bulk or significant compared to running the department, it's just part of doing business. we still have too much being spent on administrative costs. and, where do you get that they don't count cracking down on fraud in administrative costs? that's a pretty big assumption to just make, or repeat back to me without a source. if we have a stat that says one pays more and the other less... i would only assume it's holding all constant, unless shown otherwise. it's hard for me to just take your word on it. "But I think you're, forgive me, naive to think the government payer would operate on equal footing. It couldn't. It would either be an insurer of last resort, i.e. for the sickest, or it would muscle out the competition. Either proposition is a losing one." 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. and even if it was an insurer of last resort... at hte end of the day, that's all they have and they should be happy for it. at the end of the day they spend less and get better results, so if they have someone of last resort when we leave people dying without insurance... we're all the better for it. "You suggest that single payer systems pay less, and while it's true, it doesn't capture the complete picture. That is, the OECD average rate of cost growth has exceeded the US average rate of growth for the last 15 years." that doesn't mean they are worse for it in terms of efficiency. they spend 10 we spend 17. there could be other factors involved... such as the simple fact that they add sick people on, but it's adding them on from a lower starting point. we have a system that is inefficient due to administrative costs profits etc. but we're not adding on more people... we let them stay uninsured. etc yet we're still inefficient. "I'd also ask if, in your view, the single payer solution would apply equally to every industry--why not nationalize energy? Surely we can 'save money' by reducing their payroll departments as well? I suspect you see the flaw." 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. --------- 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 if it's not administrative costs being lower, given i don't buy your 'ER is the reason it costs too much', 'fraud prevention is the reason it costs too much'), whatever the reason.... they spend ten, we spend seventeen. if you want your own insurance supplemented.... most countries that do single payer allow for it. even if they didn't, they spend less and the pepole have more money to show for it. it gives money to the people who create the demand in an economy thats driven by demand, a demand economy. and, we cover people instead of letting them die uninsured... even if we're cutting inefficient stuff here and there to pay for it. i ultimately do think it's the administrative problem, though.