It’s foolish to believe that private enterprise is always more efficient than a government run program and it’s foolish to think that government is always more efficient. One should not live in a world of such extremes.

Sometimes government is the efficient solution. Sometimes private enterprise is.

It's foolish to believe that private actors can by definition ever be as efficient as the state.

Private actors, by definition, must extract something from any service to pay themselves.

The government has no overhead. It can run with absolutely no profit and that is its intended model.

A private health care company that returns zero profit to its shareholders? Shut 'er down.

A private transit company that returns zero profit to its shareholders? Shut 'er down.

And yet, government services can run indefinitely at break-even because they're not beholden to the market.

Only government can be so efficient--the private sector always loses efficiency through someone scraping something off the top.

> The government has no overhead

Realz.

Like the real life experience of those private Russian mercenaries who went up against the US military in Syria?

Some things governments simply do better; health care is one of them. Denying that fact in the face of the mountain of supporting evidence is nothing but dogma.

And yet, NHS is about twice as efficient than the US's system.

Is Medicare twice as efficient as private healthcare?

It's not a great comparison for a lot of reasons (not least of which the first being that Medicare is legally not able to negotiate drug prices), but despite all of that, yes Medicare is dramatically more efficient.

Medicare is the core of all regulatory and pricing issues in the healthcare space. And if medicare were expanded to the entire population of the us, its expenditures could be 40-45% of gdp.

> Medicare is the core of all regulatory and pricing issues in the healthcare space.

I can't see a reasonable argument for that.

> And if medicare were expanded to the entire population of the us, its expenditures could be 40-45% of gdp.

Even with a naive covered-population-number based extrapolation that ignores that Medicare currently covers the elderly, who tend to have greater medical needs than average, that's not right; national health expenditures are about 18% of GDP, Medicare is about 20% of NHE, and Medicare currently covers around 15% of the population, so a naive population-based extrapolation would put Medicare-for-all at about 24% of GDP.

Medicare is the reason there is fee-for-service, which is the biggest administrative overhead design if there is one. Also all private insurance works based of of medicare in the rates they pay, the way they code themselves etc.

On the extrapolation, of course they are all simplistic and wrong, both mine and yours. You are capping the NHE of GDP to cap medicare, as if the expansion of medicare were going to eliminate out of pocket or private health. Because it doesnt, if it replaced only half of expenditures, the 24% becomes 33%.

Its true Medicare takes care of older patients, but also private insurance subsidizes medicare all along the path to that because it pays more than medicare to every provider, which means on the pool of patients, the medicare patients tend to represent losses and the rest profit. Furthermore there is the argument that if medicare expanded 7 fold, it would also be less efficient the bigger it gets, which is true of private and public organizations alike.

We cant know, its messy and even expert economists cannot get this right: but it has to be in the order of magnitude of 25 to 40% of gdp. That is state-crushing expenditures.

> On the extrapolation, of course they are all simplistic and wrong, both mine and yours. You are capping the NHE of GDP to cap medicare

No, I'm not, I'm using the current expenditures as the projection baseline. I'm clearly not using the current NHE share of GDP to cap Medicare because the projection (24% of GDP) is greater than the current NHE share of GDP.

> as if the expansion of medicare were going to eliminate out of pocket or private health.

No, you made a claim about Medicare expenditures being 40-50% of GDP if it covered the whole population, not other expenditures. Now you're moving the goalposts (and still not supporting your mutating guess with any actual concrete basis.)

> We cant know, its messy and even expert economists cannot get this right: but it has to be in the order of magnitude of 25 to 40% of gdp.

Well, that's a sudden drop in your estimate of what now seems to be total NHE from your earlier claim that Medicare expenditures alone would be 40-50% of GDP. Another round of this and you'll be conceding costs below the current 18% of GDP.