Wait:
If someone else paying the bills leads to over consumption. A government paying the bills is an example of someone else paying the bills. Therefore we expect that when the government pays the bills, over consumption will run rampant.
(is that the logic? Did I miss something?)
Except:
The Canadians have a set of government sponsored single-payer systems (each province and territory has its own). The Canadians spend 65% as much of their GNP as we Americans spend on Our GNP (roughly 9% compared with roughly 14%). While it is true that some Canadians have to wait for breast enhancements, it is also true that some Americans die for lack being able to afford cancer treatments. If the Canadians are able to over consume and end up healthier for it, and pay less, I say bring it on!

Except for one thing, Andrew: Why do the Canadians flock here to the United States for medical care?

And another thing: Some years ago, Reason magazine reported that a poll of Canadian medical students found something rather bizarre. The students were asked to picture two people, call them Patient A, who was poor, and Patient B, who was rich. They were further asked to imagine that a system of clinics existed that would cater to rich people, to cure them of their ailments, and that such cures could be effected without affecting the system used by people who were not rich.

Both Patient A and Patient B had the same ailment, and the same prognosis: death within a year if not treated.

Furthermore, the wait-time in the public system for the life-saving procedure was specified as being about a year.

So, the question put to the Canadian medical students was this: Should Patient B, being rich, be allowed to go to the system of clinics set aside for rich people, and be cured promptly, thereby quite likely saving his life, while Patient A was quite likely to die, being stuck in that year-long queue for poor people?

A large majority of the medical students answered "No", saying that it was "unfair" that Patient B could "jump the queue" and get treatment sooner merely because he was rich. Even amending the conditions to state that any profits made by the system of clinics for rich people would be diverted into the system serving poor people, thereby improving it (more help, more and better equipment, etc., etc.) didn't change the poll-results much-- a majority still insisted it was "unfair".

To which I can only say, "What the f*ck??!!"

They would prefer to quite possibly KILL two people in the name of "fairness", than be "unfair" in certainly saving one life, and aiding the saving of another?

What kind of moral cretin do these CANADIAN medical students have to be to give such an answer? Or to sacrifice human LIVES upon the altar of the great god Fairness?

Yes, Andrew, our system has its flaws. Encouraging moral bankruptcy is not one of them.

Except for one thing, Andrew: Why do the Canadians flock here to the United States for medical care?
They don’t

In fact according to Canadian insurers there appears to be no interest amongst Canadian consumers in commercial insurance products to cover care abroad, other than standard holiday cover.
Indeed, given that Canadian prices are often cheaper, many Americans are heading north to get drugs and non-covered surgery...

Mr. Weidner,
If you wouldn’t mind editing my last comment to replace the end italic tag with an end-blockquote tag, I would appreciate it...

Mr. Adams,
First, you are reporting (from memory) a source you read “some years ago”. This source was itself not the source of the information, but reporting it from another source. Pardon me for having grave doubts about what you are saying..

Having said that: our system would definitely kill the poor person while saving the rich one. Our system says explicitly that human life is not equal, but entirely dependant upon your personal resources. The system could pay for it, remember, but chooses not to. Our system creates spaces where the very life of a rich person is more valued precisely because they are rich. How on Earth is that not morally bankrupt?

Doubt gravely all you want, Andrew, but the article did exist (it was printed about ten years ago in the wake of HillaryCare), and Reason is a reputable magazine.

And if the article presented the facts fairly (and I have no reason to doubt that it did so) then the conclusions I reached are inescapable, your grave doubts notwithstanding.

And so a person is to be screwed out of his life merely because he's wealthy? I, for one, don't think so.

All socialism produces is an equality of misery. Doubt THAT gravely, Andrew.

And as for the poor who need medical care, has it ever occurred to anyone on the Left, Andrew, that charity is possible only when there is wealth? Nothing can be spared for the aid of another if everyone has only enough for himself. Or are Leftists merely innumerate? And if so, what qualification do they have to lecture the rest of us on the proper sort of economic arrangements we should have?

And no, I'm NOT wealthy. I'm a working stiff like you presumably are, sir. I'm just not so misanthropic to believe that a person has LESS worth because he has a few dollars to his name. Yes, there are places in this country where people are seen to be more worthwhile for having lots of money. But if you'd actually get out in the world beyond whatever rarefied ideological circle you move in, you might just find that there are a great many more places in this country where people don't give a rat's backside how much money you have. And you'd find that the people who DO care how much money you have generally aren't the sort of people you want around you anyway.

Before we get too far off the track, our argument was not that the U.S. healthcare "system" was particularly good, but only that Krugman was using its deficiencies as a strawman for pushing his own socialistic agenda which would be much, much worse. The proper comparisons are important here.

Krugman Truth Squad

Quite so, KTS. It's just that Andrew isn't stupid, and it drives me up a wall when the guy writes truly STOOPID stuff.

Andrew, a good way to look at the insurance issue is to refer to John's remarks about homeowner's insurance. An even better way would be to look at how food is purchased in this country. Surely food is far more important to good health than medical care. Absent a medical emergency, one can go for years without seeing a doctor. Just try to go for a week without food.

Yet we don't have "food insurance". We don't have employer-paid "food benefits". You want food, you work to earn the money to go buy it.

Or, to make an analogy with cars-- car insurance only covers really big problems, like wrecks. Routine stuff like oil changes you pay for out of your own pocket. Simple, right?

Yet people will argue that going to see the doctor is different from taking your car to the mechanic.

Bull.

Andrew, sorry to smash your ideal of doctors as knights in shining armor, but guess what-- they're just as noble, venal, selfless, and greedy as the rest of us. How do I know that? My father's father was a doctor. My father's sister retired recently after 50 (yes, fifty) years as a registered nurse. Her husband was a veterinarian. Of their four surviving children (my cousins), two are doctors, one is a dental hygienist, and one is a pharmacist (and his wife is a pharmacist also).

(The rest of my extended family are in other fields like engineering and accounting.)

What's my point, you ask. Well, Andrew, doctors aren't gods. They're not saints. They're human beings, and their profession, boiled down to its essentials, is that of a mechanic. Highly trained mechanics, yes, and they perform a vital function. They certainly deserve our respect. BUT THEY ARE MECHANICS, and nothing more.

If we had car insurance that covered every little problem, it would encourage a "cost-no-object" mentality because motorists wouldn't be directly paying the bill-- the insurance company would be "paying" the bill. And I use the quotes because guess who the insurance companies get their money from-- that's right, policyholders like you and me.

It gets worse when it comes to doctors, Andrew, because people are even more anxious to have their bodies fixed than they are to have their cars fixed. And so the "cost-no-object" mentality kicks in with even greater force ("Doc, you gotta cure me!") and doctors, being human and who therefore like money, are only too happy to oblige. And the insurance companies have to get the money to pay the doctor from somewhere, and guess who pays. Not the employer-- he doesn't really care how your pay is parcelled out, he only knows you're costing him an arm and a leg, thanks to your outrageous medical insurance premiums. YOU pay, because the money that's going to the insurance company to pay those outrageous premiums could be going into YOUR pocket, for YOU to spend as YOU see fit, on as much or as little medical care as YOU want.

And here we come to it, Andrew. The odious socialistic agenda that Krugman is pushing is a strait-jacket, a one-size-fits-all solution that will fit no one very well and which no one can opt out of. (Remember HillaryCare, with its plan to throw doctors in jail, or financially ruin them, if they dared, DARED, treat patients outside the HillaryCare system?) It is fundamentally illiberal, Andrew, even totalitarian-- if we don't own our bodies, to do with them as we see fit, do we truly own anything?

Contrast that with HSAs, and the private insurance markets envisioned by the advocates of free markets. What they propose is choice-- YOU get to choose which doctor to see, YOU get to choose how much or how little insurance to get, YOU get to keep the money YOU have earned and get to spend it as YOU see fit. That is the truly liberal option, Andrew.

Mr. Adams,
Something you don’t understand, I don’t get to choose how much insurance to get, I get the most insurance I can afford. If you think I can get all the insurance I wish to have, you’re nuts. Once upon a time, I had no job and no insurance. I hurt my knee fairly badly and couldn’t afford to see a doctor. Today, years later, that knee is still painful. Not constantly, but if I exert myself too much...

HSAs are a great program, and when I get a couple grand I’ll certainly sock some money away in them. But I cannot afford one today, none of my coworkers can afford one either. Even my boss (the store manager) can’t afford one...

I tend to agree with you-- let there be markets! I love markets! But let the market be in doctors, not coverage plans. Let doctors compete to get the most patients at the most money. But let me be able to afford some doctor whenever I need one...

Let me pose this question to you:
What if we could actually cut spending on medical care, and have at least the same quality of care, would you do it?
Sound’s impossible, right? Consider this: Doctors work for profit. The health insurance companies run for a profit. If the government acts as the insurer, they wouldn’t be acting at a profit. Thus a major part of the affordability issue goes away...

According to at least one Canadian newspaper there is in fact a booming business in going south of the Canadian border for medical care, just as Mr. Adams claimed.

The language in that article is kind of vague “consultation has jumped three-fold over the past 12 months,” So, one guy a year ago, 3 guys now. Or it could be that last year a third of the country was doing it, and now all of the country is doing it. The article doesn’t say. Keep in mind, though, that it is in the best interests of the Canadian doctors to play up these stories as much as possible--the more their system looks to be on the verge of collapse, the more the doctors get in the next budget cycle...

Also, did you catch the part about how the Canadians are mortgaging their homes to pay for these treatments? Wouldn’t it suck to live in a system where only by mortgaging your home could you get treatment at all? Of course, since that system is the American one, we’re perhaps not in the best of places...

Meanwhile countless Americans are streaming north of the border to get access to the fruits of the Canadian system-- cheep pharmaceuticals...

And they are cheap because the whole world is free-riding on us. WE are paying for Pharmaceutical research. Hardly anyone else.

The purchasing-power of a whole country means Canada buys drugs cheaply. The drawback? No new drugs come from Canadian companies.

Andrew, you write:

".....Doctors work for profit. The health insurance companies run for a profit. If the government acts as the insurer, they wouldn’t be acting at a profit. Thus a major part of the affordability issue goes away..."

Not really. If doctors and insurance companies are operating with really fat profits right now under a system that is considered "private", it's only because there aren't any competitive pressures to keep prices down, and there are no such competitive pressures to keep prices down because the people paying the costs (you and me) aren't aware of the true costs or even that we're paying at all.

Once those true costs are made plain to everyone, you can bet your bottom dollar that costs will drop in a hurry, with profit margins shrinking accordingly. It's instructive to consider that supermarkets-- they're far more vital to us than medical care-- operate with profit margins on the order of 1 or 2 percent. That's razor-thin by most standards. A doctor will want a fatter profit margin that that, but he can't push it up very far because his colleagues will start undercutting him.

And if doctors in a COMPETITIVE private system have profit margins on the order of, say, 5 percent, then prices in a government-run system that only breaks even can't be that much lower than a private system-- get rid of the profit, and price drop only by that profit margin of 5 percent. Big whoop. And if you add in the federal government's legendary inefficiencies (a polite way of saying waste, fraud, and dilatoriness) in providing services, you can again bet your bottom dollar that government-run medical care will be more expensive than a competitive private system.

On top of that, Andrew, the federal government's judgement as to what various medical procedures cost is far from perfect. One of my cousins who is an MD told me the story of a doctor of her professional acquaintance who is an eye specialist. There is some procedure that Medicare pays $3,000 for, and the doctor has developed an assembly-line style method that allows the doctor to perform 20 (yes, twenty) procedures in a day. That's $60,000 A DAY in revenues, paid for by you and me on Form W-2. Yes, the doctor has very high expenses, because he has to pay for all the people who help him do the procedures, and to do the paperwork, and I haven't even mentioned malpractice insurance. But a revenue stream of $15,000,000 a year (assuming he works five days a week) leaves a lot left over even after all his expenses (perhaps a million for his help, a million for his office and equipment, and maybe a few million for malpractice insurance) are paid for. Needless to say, this man is now very wealthy, thanks to Uncle Sam's presumed wisdom in setting prices.

Government-run medical care? No thanks. Give me a world in which there are docs-in-a-box on every street corner, and who are happy to take cash or MasterCard, just like supermarkets.