The problem with communism isn't that so many of it's services are nationalized, it's that one-party politics leads to an ossified, excessively powerful, corrupt bureaucracy with no checks and balances.
Any political system that lacks dynamism and protects cronyism would suffer the same problems, regardless of it's ideological base. That's why in practice Fascism and Communism produce functionally indistinguishable resultant states.
They are usually MUCH better than the U.S. model (in that everyone has basic healthcare and nobody gets bankrupt), but I wouldn't use words like "efficient" and "cost effective" to describe them.
At least within a democracy, they don't get "that" ossified, but you do get a massive, powerful and somewhat corrupt bureaucracy (at least in my country).
I find it incredible that the waste generated is less than the waste from the U.S. insurance system, yet it is so.
He says only that the effect is to place the doctors into a sort of "prison" scenario. Prisons can be efficient and well run. The problem is that they're prisons.
Imagine your own sector being socialized.
Soviet Communists are frequently reproached for having attempted to build a socialist society but having produced something which closely resembles a prison. Such a charge is entirely unjustified. In the Soviet Union some of the inmates have larger cells than others, some eat well, others badly. There is complete confusion-a lot remains to be done to tidy up the situation. True socialism, in which everyone is truly equal, does not just resemble a prison-it is a prison. It can not exist unless it is surrounded by high walls, by watchtowers and by guard-dogs, for people always want to escape from any socialist regime, just as they do from a prison. If you try to nationalise medicine and, from the best possible motives, to guarantee work for all the doctors, you will find that they pack their bags and leave the country. Try to bring a little order into the situation and your engineers (the best ones), your designers, your ballerinas (again, the best ones) and many, many others will also flee abroad. If you continue your attempts to establish a model society you will need to build walls around it. You will be forced to do this sooner or later by the flood of refugees.