dblack, the key factor is not putting "the state" in charge of paying for medicine, it's putting one single entity in charge of it -- whoever that might be -- with an incentive for bargaining down costs. Hell, you could put me in charge of it if you want. (If I get a salary, of course. And the money to do it with.)
What happens now is that no payer has the clout to make pharmaceuticals charge here the same prices they charge for the same drugs just about everywhere else in the world. A Canadian, a Frenchman, a Japanese, an Englishman, a German -- all these people can by American-made drugs for (I'm not exaggerating here) about ten percent of what we have to pay for them here in the U.S. Why? Because the national health coverage systems in all of those countries say to our pharma companies, "You will sell the drugs for that price or you will not sell them."
Now, the interesting thing is that they DO sell them for that price, which means they must be making a profit doing so or they wouldn't do it, which means that 90+% of what they're charging for the same stuff here is pure profit -- and that's just unconscionable. There is the main reason why our medical costs are so high: a captive market, and no effective way to bargain the price down.
We know what works. We've seen it work elsewhere. The only reason we don't have it here right now -- the only reason a single-payer system rather than the Rube Goldberg ACA wasn't passed through Congress and signed by Obama in 2009 -- is because too many Congresscritters are bought and paid for by corporate interests, including the health-insurance, pharmaceutical, and health-care fields. And no, I don't just mean the ones with an R after their names.
Then by all means lets put them in charge of a health insurance monopoly! This seems like a stunningly bad idea to me, and I'm not sure how you can recognize the corrupt nature of our leadership yet advocate giving them even more power. Something doesn't add up.
To your suggestion that that consumers have no effective way to bargain and are, essentially, a captive market, I can only agree. But I suspect that you see this as some inherent 'flaw' in free market economics, rather than a byproduct of ill-conceived regulatory efforts.
It's the push toward centralization that's creating so many of our current problems. We're transferring responsibility for, and authority over ( the two are inseparable), our most personal needs from the individual to state authority. I think this will turn out to be a very bad bargain in the long run.
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