With all due respect, it is good to be skeptical, but that does not mean being blind to the evidence — rather the opposite.

This journal has tons of articles examining international health care systems, all of which collectively finance health care, and show how this saves money so that those systems can guarantee at least a basic, often very generous, package of care, by applying two basic policy principles: 1) risk pooling 2) compulsory contributions adjusted to income.

Risk pooling dramatically reduces administrative overhead, allows bulk purchases, and most importantly, allows cross-subsidizing. Without cross-subsidizing health care systems are doomed. Even private insurers know this principle well, although of course they apply it to their, not our, benefit (Alissa Fox, vice president of Blue Cross and Blue Shield Association, was quoted by the New York Times, on Thursday November 20, 2008, as saying that “Insurance works best when everybody is in the pool”… “you need healthy people in the insurance pool to help pay for sicker individuals”…).

Compulsory contributions guarantee a continuing stream of money to finance the system, which is why in no other industrialized economy is a basic package of care left in the hands of voluntary or liability insurance.

As to what is politically feasible, to my knowledge it has never been what politicians are willing to do, but rather the cost on them of not doing what their constituents want. When people wake up to the fiscal horror of the dubious plans that are being cooked these days in D.C., maybe they will massively demand from their representatives a rational way to finance health care.

Then we will have time, and reason, to think about electronic medical records, prevention, and changing payment schemes, etc.

As far as censorship, that is not too strong a word. The White House went so far as to censor a single payer question and answer from its live blog of one of its health care reform town halls. See:

http://www.correntewire.com/how_will_white_house_make_amends_censoring_single_payer_advocates_its_health_care_forum_live_blog

Anyone who has had to deal with Medicare can vouch that it is as cumbersome and difficult to get reimbursed by Medicare as it is with private payers, if not worse. And the myth that Medicare does anything less expensively (other than CEO salaries) is just that, a myth. Just to prove a point, until this month, Medicare did not even have an online enrollment option, meaning every application had to be submitted by snail mail (all 20 pages of it). And they still don’t have any “go-to” representative in case there are questions or problems. So, unless Medicare can be quickly converted into a lean and efficient organization, I am afraid all the projections will undoubtedly fail.

I am willing to accept any system that allows full cost transparency, reduces the cost/complexity of practicing medicine, does not set arbitrary reimbursement rates (price-fixing), lets consumers (patients) decide what type of service is most valuable to them and does not interfere with the physician-patient relationship/interaction – the fact is that Medicare does not fit any of these criteria. And neither do the private payers.

The employer based system is broken and should be thrown out. Who wants their insurance tied to their employment? What employer wants ( or is able) to pay our exhorbitant premiums?

If you read the article, we do indeed have the resources to do this.

And Mr. Shoemaker, “Point taken, but it is not so clear that the single-payer approach will save us anything on this front. I see a large and lumbering federal bureaucracy administrating payment under the single-payer scenario.”

Yes, if you do not look past the end of your nose, or past the edge of our waters, you will not know that his can, and is being done. Are there trade-offs? Sure, there always will be. But it is silly to just pretend this doesn’t work elsewhere.

Mr. Shoemaker, your skepticism will disappear the moment you begin to study health care systems elsewhere. They have problems of course, as any human enterprise does, but they are light years from ours. And their problems are no good argument for not adopting what Prof. Bernstein, and thousands of others, recommend.

Mr. Barber, I recommend the paper “Paying for National Health Insurance yet not getting it”, in this journal (http://content.healthaffairs.org/cgi/reprint/21/4/88.pdf). It will clarify your doubts about whether America can afford decent health care for all. I use it very productively with my students of comparative health care policy. They are barely out of high school yet get it right away.

This is really not rocket science. And most of the debate is pure obfuscation, confusing “apples and oranges” (i.e. financing with delivery or methods of payment issues) and health policy with its politics. So follow the money as Professor Bernstein recommends and you will find out why this country, unlike every other civilized industrialized nation, rations health care according to ability to pay, thus allows its people to go bankrupt, get sick or die for lack of access to it.