One of my favourite commenters at BOP, Shah8, wrote the following:

I just don't think proponents are as aware as they should be about the limitations in the improvements gotten from single payer. Mostly, what I think will happen is that it will lay the more essential problems of US health care bare for all to see. I strongly suspect that if certain elites saw single payer as a truly viable concept in reducing medical costs, then everyone would have ganged up on the entrenched interests already and pushed for it. We are losing too much economic power to other places that have basic universal health care. I also strongly suspect that the current system is left in place because not only is it profitable for a bunch of people, it also disguises the increasing disfunction of the general health care system (instead of it plain not working, pretend that working is a function of paying extra $$$). The US isn't like France or Japan in demographics and challenges facing the health care system. It's almost not even like Canada! In the end, universal health care for 300 million plus people of very diverse heritage, over large distances constitute tremendous challenges that really should not be overlooked.

I think that's worth a formal reply.

Before Canada went to single payor healthcare in the 60's its health care costs parallelled the US's, but were higher. We have more truly isolated settlements than the US and are geographically about as large even if our gross population is lower. We are, in fact, probably the best test case possible.

So what happened when we went to single payor? We dropped our per capita costs by 1/3 and then moved in parallel with the US again.

There is no reason I find convincing why the US cant shave 1/3 off its costs with single payor. Medicare, for example, pays abouot 2% of costs on administration. Private care programs average a little over 30% on administrative costs. Right there is most of your savings.

And that's why I keep saying "single payor health care" and NOT "public health care". The two are not synonymous. In the US you may have private health care for most people, but you can't choose your doctor. In Canada I choose my doctor. In the US you are more likely to have someone who is not your doctor determining what your doctor can prescribe or what surgery you can have based on cost effectiveness than you are in Canada, where the vast majority of those decisions are made by doctors.

Canada has public provision of insurance, but at the individual level most people have more freedom to choose and receive better care on almost all metrics.

There are single payor systems which outperform the US on virtually everything, including waiting times for elective surgery (the only place where the US significantly outperforms Canada.)

Now let me touch briefly on the argument that if it was so much cheaper it would have been done already. I'm just going to make a statement: the insurance lobby in the US is insanely powerful. Insanely. I would rank it third in influence behind the Israeli lobby and the military industrial complex in terms of power. There are a lot of people making a lot of money off health care insurance; a lot of drug companies gouging the public (and yeah, when the government starts paying for all drugs in hospital it will suddenly be a lot less willing to allow such gouging) and so on. They are powerful, and while in aggregate the benefits to other economic actors of single payer are greater, those economic actors are not as organized and each one individually has less at stake than the health care companies. The only powerful interest pushing hard for single payer healthcare at this point is the manufacturing industry, but they are not as powerful as those who oppose them. This isn't the nineteen fifties, where GM was the American economy.

The easiest way to get a large cost savings in the US economy right now, the biggest no-brainer, is single payor health care. It would free up a lot of resources for other economic activities.