This point from Sarah Kliff’s valuable account of why single-payer failed in Vermont is crucial:
In a way, the fact that America hasn’t taken serious steps to control health spending makes it particularly hard for the country to move to a single-payer system in the future. Our health-care system costs $2.8 trillion annually, about 17.7 percent of the entire economy. This is way more than any single-payer system anywhere in the world costs. Take Canada, where 11.2 percent of all spending goes towards medical care.
That’s the irony of America’s health-care system: its incredible failure to control costs makes change that much harder, because so many powerful players profit so handsomely from the status quo, and because rearranging the financing creates so many losers.
“If Vermont was spending 10 percent of its economy on health care, this would be hugely cheaper,” Schoen at the Commonwealth Fund said. “But that’s not the health care system they’re raising funds for.”
Another strike against single-payer systems, compared to other American health-care arrangements: they’re financed in an unusually transparent way. And arranging that financing, from scratch, often proves impossible.
As I’ve said before, the AMA is a much bigger barrier to European-style health care reform than the insurance companies. The status quo works very, very well for American doctors. In really favorable circumstances you might be able to buy off insurance interests, but buying off practitioners would require politically impossible levels of taxation (as well as undermining the cost controls that are a crucial reason for why single-payer is superior to the American system in the first place.) Aneurin Bevan’s “stuff their mouths with gold” strategy isn’t going to be viable given the American baseline.
Nothing that Barack Obama giving a few speeches couldn’t overcome, of course…