Is this biased reporting?

[Occhidiangela]

Why don't we have socialized medicine? Because if we had socialized medicine there'd be little need for medical insurance and that is HUGE business for that tiny labor market that produces zero physical commodities.
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You ask a good question but you arrive at an incorrect answer based on a flawed perception of cause and effect. I am not particularly pleased by HMO myself, having dealt with them for some 10 years now.

The American medical system began as a private exercise. Doctors were not government servants. As the population grew, as medical methods changed and evolved, and as the demand on medicine changed, medicine adopted some of the advantages (and disadvantages) of economy of scale from the industrial revolution and industrial methods.

The system of companies offering managed health care, as we know it, was already in place by the 1960's (probably before that, Blue Cross/Blue Shield has been around for a while) and funded for many by corporate America via the collective bargaining agreements the Unions (a socialist element of our society) were able to wring out of management. It boiled down to a business tax, a cost of doing business if you will, levied by Labor as condition for work/services rendered.

The decline of Unions in the past generation, linked to the decline of American industrial infrastructure and the rise of an unstable and decentralized labor force, combined with the unwillingness of the tax base to fund a national system, has transferred the cost of health care from some "they" to "you get what you pay for." Farmers used to deal with that sort of problem by forming Co-ops. The HMO is not a Coop, sadly, it is a business that has to stay in the black to provide its service over time. That adds overhead expense a Co Op wouldn't. I imagine we share a distaste for both health care costs and HMO infringement on medical practice.

The root problem is the rise of health care costs, (for what return value?) not who we pay to manage health care, since the doctor needs to be paid for his services in any case.

In the process of this change, economies of scale available from "buy in bulk" capability of a large (capitalist) enterprise got lost. The hidden benifit of the "tax on business feature" was that it kept "everyone's taxes" for sustaining a federal medical program down to a dull roar: the Medicare tax we pay.

Change costs. One of the costs of the transformation of the workplace has come a change in how one enters into contact for health care. The corporate security blanket is gone for many people. Is that to be replaced by a government security blanket? Who pays for it? There is no free lunch. Government is funded by taxes, so transfer of the costs from the corporation to the government would necessitate a revenue/tax increase. Aversion to taxation is a common cultural thread for Americans.

While HMO's add overhead, they allegedly (not sure I buy this) achieve modest cost savings via bid and contract, a variation on the economies of scale idea. Do you assume government can and will do the same?

If you suggest the system change from a tax on business to a tax on the citizen for funding health care, you might want to offer a rigorous cost analysis of the two structures. They both require an overhead, a bureaucracy, to administer the system. If you have done such an analysis, by all means post it here, or provide a link (not a trivial analysis) to defend one approach over another. If you can show that the public bureaucracy can offer a better performance for the dollar value than the present system, I am all ears. I don't think that has been shown yet.

We have an element of socialized health care called Medicare. I am not sure I'd care to convert all health care to that format, since its capability and scope is at the fickle whim of both the voter and the legislator. Think about what that means: your neighbor can vote against your health care plan.

The policies behind any national health care seems to be aimed at keeping health care affordable and available. This is similar the cheap/affordable food policies of the past 70 years. With costs continuing to rise, either premiums rise or taxes rise. Are you sure the taxes will actually be spent on health care, even if the tax increase is presented as being to handle health care costs? I have my doubts.

The efforts to socialize medicine early on, going back to FDR's day, ran into a system already in place. Was it worth the political effort to discard that system and replace it with a government run system? For whatever reason, no.

If a government run system can be shown to be abetter cost to benefit exercise, then bring it on. The cost is the thing, not who we pay to administer the system.

Occhi