It's baffling. However, it's also very useful.

Americans have a nasty, ignorant habit of assuming that markets = capitalism = markets. The Insurance model blows that assumption out of the water, though.

An insurance company makes its profits by not providing a good or service. The insurance company has absolutely nothing to gain from honoring its claim. You pay your monthly fees, and if something happens to you, your property, or whatever's insured, it is in the best interest of hte company that you never see a single cent of coverage. They lose money when they pay claims.

That's capitalism. The goal of capitalism is maximum profit at minimum cost. And the insurance model is 100% profit and 0% cost.

However, it is not a market. Markets are predicated on exchange; the trade of goods, services, and wealth.By definition, if you are participating in a market you are giving up one thing in exchange for something else. You still want to come out ahead, profit has its place in the market, of course. But if you are not providing a service, and are instead just taking money... you are either a thief, an extortionist, or a member of the clergy.

As far as I see it, what you said would only be true if healthcare insurance companies NEVER paid out. But they do. As an example, with my recent medical problems my insurance company has paid many times more than I have paid (including what my employer has paid in my name as part of my employment package) since I started working 15 years ago.

So that has been an exchange, and it worked well for me.

I'm DEFINITELY not saying that it can't be made better or that we shouldn't move to a universal type system. I'm just not believing what you said to be 100% accurate.

Which is my point. In their ideal world, they wouldn't pay out at all, but in reality doing it like that would expose them to the ire of their cash cows. They have to pay out enough to keep the milk flowing. But you notice every year the costs go up and the services go down...

in their interest not to pay out, but that can be said for many parts of the current business world.

Every business looks for ways to maximize profit.

As an electrician, after I bid a job and get the job, I will definitely look at ways of making the job easier and faster. If I find a way to snake a cable without having to open up walls then I do it, and maximize my profit. I want to do less work for more money.

The same could be said for the costs going up/services going down. I've raised my rates (significantly more than inflation) every year as I became more established as was able to charge more.

As I pointed out in my initial post.

However, are you so concerned with profit that you will provide a crap-quality product at gouged prices to the people who hire you? i would like to think you don't. If you had employees, would you keep them at minimum wage, advise them to go on government asistance, and hten jack your own prices up even more to cover their "added value" to your services, like Wal-mart does? Again, i'd like to assume you don't.

That's the difference between a craftsman participating in a market exchange, and capitalism.

We have a health care industry.

The term 'system' implies some sort of central planning and control, or at least limits.

under the law? It is truly an integrated delivery system.

but I'm pretty sure we'll never have a coherent health care system under for profit.

"single payer" just changes who pays-- not what's being paid for.

Medicare and Medicaid, just like the VA, Indian Health Service, and most insurance schemes still pay for procedures, not health. $20 aspirins, $5,000 scans, and a steady stream of doctors signing off on some vague thing builds your 6 hour hospital stay into a 12 grand nightmare. And if you're really sick or injured, there's no end to the nickel and diming you'll get.

In many places around the world, some with far better care than we get here, you go in to birth a baby or have a broken bone and there's pretty much a packaged cost for the whole thing, with maybe some extra if there are complications. Here, you pay every doctor and institution for every individual thing they do. My mother is racking up some humongous Medicare bills as we speak for regular trips to the hospital for some emergency or other, and a grand or so a month for care even if nothing happens. And she's not getting any better.

he push for single-payer carries the assumption that it will bring with it regulatory reforms to create a system that mirrors European models.

It won't simply be having your doctor send his bill to the treasury.

See: Canada and the UK, where healthcare is mostly free at the point of delivery (not sure about Canada, in the UK dental treatment on the NHS requires payment of a fee that's very reasonable and a fraction of what it would cost for private treatment in the US). Part of the problem is that the entire system in the US is built on a profit model, and so Medicare etc has to work within the existing system (which makes it considerably more expensive than it would be otherwise). If you had a single payer system you would also not have private for-profit hospitals and all the other things that raise the costs in the US (US per capita spending on healthcare is more than double that of the UK or France, and Americans pay 60% more on average for prescription medications than Western Europeans).

Sanders and McDermott have introduced bills to enable state single payer advocates to use ACA to get to single payer.

Public options/single payer in blue state exchanges paving the way for the rest.

The ACA may have many healthy people foregoing insurance because the penalty tax is pretty small. They know that they can sign up anytime if they need to and the insurance companies can't refuse them. This will cause the insurance companies to raise their rates which will drive away even more healthy people. After awhile they will have mostly sick people to pay for and they whole business model will collapse.

I would imagine most companies will see this coming and get out of the health business altogether. Once they start disappearing there will be a vacuum that the governmet will be obligated to fill.

It will take time to shake out but we could well be on the way to a single payer system.

We can use the "eliminate the middleman" argument.

That's what recently happened with student loans.

I have great faith in Vermont. I have to.