However I would be open to a voucher-type system where the actual providers are private, competing for customers who pay into a common risk pool. It's the tying of the risk pool to employers that's most problematic to me, and which imo severely weakens other parts of the free market, by reducing labor mobility. That might actually improve some free-market elements of healthcare, since the actual customers would choose providers, rather than their employers doing it for them.

1) long wait times for any major surgery 2) sub-par equipment/hospitals 3) elderly patients don't get treated as well as they should

Nearly all of them come over to the US and pay for major surgery.

I also find it strange that in any of these discussions, nobody that lives under universal health care will talk about the bad things.

Without this sort of honesty, I will never want a public system in the US.

I don't think every public health system is well run, but I think the better ones are better-run than the US, and lead to much greater peace of mind, because I don't have to worry if I'm covered or not--- I know I am. The total expenditures are actually lower, too, because the U.S. spends a lot of money on public healthcare, just very inefficiently. Perhaps I'm part of some evil conspiracy to lie about how I like living in Denmark, but the numbers seem to back me up. There's plenty of other things I'll be happy to complain about about Denmark and Danish culture, too, but the healthcare system isn't one of them.

I don't think I've been treated well in the US healthcare system, in any case, and there were long wait times and subpar equipment. I also had to change doctors when I changed jobs, something that Denmark doesn't require me to do. And I had to spend a lot of time on the phone with insurance companies, who seemed to always make mistakes and miscode things; anyone who thinks governments are bureaucratic hasn't tried to deal with a large corporation's phone tree.

But I suspect you are putting ideology above any actual interest in rationally evaluating different healthcare systems based on evidence.

Yes, like all other systems, universal health care has problems. Canada definitely has a shortage of specialists in rural areas.

So what? The USA has plenty of shortages.

If you desire "honesty" in a policy debate, I encourage you to start with the widely published, thoroughly vetted, and oft cited comparative studies. If you're feeling very daring indeed, and want to learn something, you could start with google.

http://www.google.com/search?q=health+care+costs+per+capita

http://www.google.com/search?q=life+expectancy+by+country

TL;DR: Canadians spend 1/2 per person and live 2 years longer.

They're just the payer. There's still an entire ecosystem of value-add private entities. Clinics, hospitals, specialists, pharmaceuticals, equipment mfg, labs, etc.

I understand everyone's reservations about bureaucratic inefficiency. The key is in the incentives.

Single payer enables the capitation model of service, where people are rewarded for staying healthy. Versus the current model where everyone profits from disease. That's why single payer is (generally) cheaper per capita with better results.

Please explain how capitation will get people to cut way back on carbohydrate consumption and exercise every day. Those two factor cause the majority of morbidity and mortality in the US.

Stil, it's a pretty good question.

Doctors generally don't push nutrition. I think that's changing as the best available science continues to improve and be more broadly accepted. I personally evangelize the "cave man diet", probably to the point of annoyance.

But the real driver is coming from public awareness and social change. There are now serious efforts to limit, tax, regulate, remove sugars from a public policy standpoint. Examples are taxes on candy, removing vending machines from public schools, etc.

Capitation, by focusing a wellness and efficiency, would accelerate that trend.

Capitation gives the same payment whether diabetics are cured or ignored. What we need are ways to preemptively deploy extra money to diabetics. They need to go to fat farms and have visiting nurses nag them at home.

In all cases where there is no longer an intrinsic or external incentives to maintain quality or innovate, sure, those things tend to drop off. A private monopoly has no near-term financial incentives, and are left with whatever intrinsic motivation the owners may have. This isn't true of a public monopoly run by a democratic government, however -- there's always incentives there, even if they aren't market incentives.

And speaking of incentives, it's a real mistake to assume that the same kinds that often work to produce effective products/services in other markets are at work in insurance. In most cases, vendors make money the more operational efficiency they have and the more utility people derive from what they're offering. In insurance, there are issues of operational efficiency, of course, but they're limited and quite secondary to the fact that insurance pools do better the less participants need them. The incentives that insurers have are to screen and pick their customers from among those as likely as possible to get the least utility out of the product. And, of course, to provide the minimally acceptable utility.

So you end up with a product where the vendor has strong incentives not to sell it to those who need it most, and to try and aggressively market to groups who are statistically most likely to need it the least (say, those who are usually able to go into work five days a week).

When the natural incentives for a given product don't line up right, no amount of market freedom is going to mean a better product. If there's going to be insurance products that are truly helpful for most everyone who needs them, heavy regulation and public monopolies are pretty much the only option.

Under such circumstances, even people who don't otherwise like monopolies might well get behind a public one.

When you can assure me this won't happen, I might start supporting universal health care.

Why don't you just go somewhere that has it available and observe the results for yourself, instead of making up hypotheticals? It costs some more money in taxes, but delivery of service works nicely in practice and patients aren't required to become expert in billing administration.

Private companies are there, but it essentially makes it so only the very, very rich can afford them..so we have only one choice.

I'm sure you could find some equivalent comparison page for health insurance in the UK, or examine offerings from BUPA, the leading firm in that market.

The only evidence I saw of government bureaucracy was when the hospital send somebody around to make sure everything was fine because it was especially important to them to make sure Medicare patients were getting all the care they needed.

When 90% of the US population is on this program, I guarantee you it won't be like this.

Or I could, and maybe this is crazy, listen to any one of my friends who has actually lived in a country with universal health insurance.

This is really an easily falsifiable statement. Australia has a government run Medicare. Innovation has not stopped because of it. There is still medical research being done within Australia. For example, there has been spray-on skin invented for burns victims, the Cochlear implant was invented here, and numerous other innovations in medical care.

Interestingly, Australia also has private medical insurance, with a large uptake. It's just that we don't force those who can't afford it to use it just to get basic healthcare.

With an ideal free market there is at least reasonable theory about how price signals will get sellers to produce the goods and services people want. So with single payer, does that payer just work very carefully to make sure the prices they offer for various medicines and services are good enough that enough doctors and hospitals will be willing to do the things that people need done?

I have to pay for police and yet I don't even get a say in what color cars they have, the same with firemen. And don't get me started on the way the navy never asked me what to call their new aircraft carrier.

Big business gets to choose which congressmen to buy - why shouldn't I get a choice as well?

I'm glad we agree.

"Big business gets to choose which congressmen to buy - why shouldn't I get a choice as well?"

a choice which makes it so the rest of us can't choose?