"But that argument doesn't work for Medicare, because if a doctor/hospital/whatever ONLY takes Medicare patients (without supplemental plan) then it isn't that they are making less money, but rather they are damned close to operating at a LOSS. You cannot make a living on Medicare patients without some sort of further subsidy, for instance a tax-supported county hospital."
True enough, but if Medicare were expanded to all, it wouldn't be just the elderly, most expensive cohort they would be treating. My thought is that the young would pay a premium higher than what would be required to cover their projected costs, in return for coverage later when they were more likely to become sick at for premiums less than what would be required to cover the projected costs. A rigorous crackdown on fraud would also be part of the solution, as would a science based approach to treatment protocols and results based reimbursements, rather than fee for serivce. The pharmaceutical industry should also be thoroughly overhauled, IMO. I'll throw out an idea here. Let a government-university consortium do the drug research and relegate Big Pharma to manufacturing the drugs, which would be sold at cost plus a margin sufficient to cover development and manufacturing costs, plus a premium to fund ongoing research, plus a reasonable profit margin akin to what the utilities are permitted. Heresy, I know, but those ba$tards are out of control and need to be reined in. We should also institute a comprehensive program of diet counseling and reintroduce physical education at all levels of the school system as part of a preventive approach to health care. If people ate properly and got a decent amount of exercise, we would eliminate an enormous of medical expense. Lastly, and perhaps I should have started with this thought, premiums should be calculated on the basis of what would be required to pay providers a salary consistent with their training, skills, and the enormous sacrifices they make in their personal lives to provide quality care. I know quite a few physicians personally, and I have seen this up close. It is a very, very demanding calling. What I am talking about here is what other developed countries seem to be doing, and frankly, I see no reaason why we can't do it here.
"As a philosophical issue a single-payer system looks pretty good, even to me. And you are correct, a lot of other people make it work. But I'm not sure if it would work well for modern America, if for no other reason than at this point I just don't trust congress and the Medicare administration. There, I said it. They have been playing games with Medicare and Medicaid for decades and I don't see why they would stop if it were the only game in town. They have a nasty tendency to set limits on what medicare will pay for a service, and they set it far below market rate.
If they stopped such shenanigans I might take the proposition more seriously."
The politics of it, unfortunately, is another thing entirely. As things stand, you are very likely on the mark, but I feel it is within the power of the American electorate to change that in an election cycle or two, if they would withdraw their collective heads from
that nether region where the sun don't shine and THOUGHTFULLY exercise their constitutional right to vote. There really is not other solution to the situation
Anyway, that's my 2 pollyanna-ish cents on the issue.
Edited to add reasonable profit for the pharmas.