The solution to this is to replace safety nets with transfer payments. Don't provide people with healthcare, provide them with money with which they can buy healthcare or insurance. This also stops the subsidy from ratcheting up the cost of the thing, because if you can drive 30 minutes out of your way to save a thousand dollars you do it, but if the government is paying either way then you don't.

And then if people want to buy less safe cars, insurance carriers will charge them higher premiums.

> Also, the other argument goes that "people don't know how to actually get what they want for themselves, and will act against their own true self-interests".

This is nothing more than paternalism and has proved wrong time and again. It turns out that on average people understand their own situation better than far away generalist policymakers, even before you add in lobbyist influence.

Which isn't to say that an individual will never make a mistake. But legislators make mistakes at scale. Whereas if you want to get individuals to change their behavior in a way that genuinely benefits them, all you have to do is tell them about it, not punish them if they hear you out and still want to do something else.

If the government is paying, why would it be cheaper 30 minutes away? One of the main features of single payer systems is that the single payer can impose a price list, and control any “ratcheting of prices” as you put it

If they set the price too low, you get shortages or long queues or sacrifice quality and no one can do better because that would require charging more which isn't allowed.

If they set the price too high they're overpaying, which is what happens in any system where the providers have political influence, as is manifestly the case in the US. Then new competitors can't lower the price because it's set by corrupt politicians and more efficient providers can't return the difference to patients who choose them.

We're talking about a single purchaser using its power to impose prices on suppliers. It's hardly unique - how do you think Walmart keeps its prices as low as possible? By leveraging their power.

And all your aguments seem a bit moot when you look at countries with single-payer systems - they just work, at a per-person cost that is far lower than the US

Walmart is subject to competitive pressure. If they squeeze suppliers too hard and quality suffers or some suppliers refuse to meet their demands, consumers can go buy products from a different retailer.

In cases where you actually do have a private monopolist, is is terrible.

> And all your aguments seem a bit moot when you look at countries with single-payer systems - they just work, at a per-person cost that is far lower than the US

In the US the medical providers have significant political influence which results in a regulatory environment that favors high prices and there is no reason to expect a single payer system in the same environment to change that.

In some systems the providers have less political influence, but many of those systems have long queues or refuse care on the basis of cost or have other deficiencies with no recourse.

It's also entirely possible to have a socialized system which is more efficient than the status quo in the US but less efficient than a system that actually exposed providers to competitive pressure. The cost efficiency of the existing US healthcare system is a bar level with the ground.