... thus giving the whole system the constraints of public funding and single-payer, so that scarcity isn't something to be feared - we're already suffering it. But furthermore, that scarcity is then leveraged by less regulated market actors to constrain competition and jack up prices, giving us the worst of both worlds.
A fully public single payer system would mean bureaucrats would produce a report concluding that more doctors are needed to keep costs from spiraling, and the number of residency slots would be increased. A more freer market would mean hospitals/doctors were paying for all of their own residency slots and they'd up the number through price signals. Instead, we have neither feedback mechanism.
We already have exactly that system: Medicare (and its bureaucrats) determine how many doctors we need, by setting the number of residency slots. The system that makes this calculation is public, single-payer, and state-driven, and it produces the outcome you experience in American health care.
Yes, I agreed with your point and then kept going.
If you're referring to my second paragraph - the difference is that the medicare part of the system does not have to fully contend with the resulting cost from doctor shortages as it sets its own prices below market rate.
The larger overall point is that system is only responsible for half of what we experience with American health care - the shortage part. But then we don't even get the benefits of the price controls until we reach Medicare age.
Medicare should fund drastically more residency slots. But that aside, I think Medicare is a pretty slick compromise between what's challenging about state-funded health care and private market health care: at the lifetime inflection point where people's medical costs drastically increase, publicly-funded single-payer kicks in; before that, people with (actuarially) far lower costs get the benefits of private market care. A thriving private market is created that provides benefits even to the publicly-funded care.
Obviously, the system has an enormous problem: it costs too much, because medical providers operate cartels that jack prices up.
> medical providers operate cartels that jack prices up.
These two statements are in direct conflict. If it were a thriving private-sector market, then providers wouldn't be able to form cartels that jack prices up.
I'd say Medicare is a good chunk of what's giving us the worst of both worlds. It's full of mandates that warp the entire system, but then fails to take responsibility for the warped system. Like sure we both agree that Medicare should fund drastically more residency slots. But my point is that the problem is Medicare doesn't actually have to pay the full cost of the high prices it has created with things like the residency slot shortage.
> where people's medical costs drastically increase, publicly-funded single-payer kicks in; before that, people with (actuarially) far lower costs
This analysis is entirely backwards on so many fronts. I'm not even really a proponent of single payer, but your point pushes me in that direction. Higher variance but lower average costs earlier in life are exactly where it would be most effective to spend public funds - keeping more people from financial ruin per dollar spent, more productive and enjoyable years of life, younger people are more likely to proactively obtain/consent to medical care, better outcomes from interventions being done earlier.
Imagine the opposite of what you're championing - use public funds to try to keep everyone alive until they've had 65 years of life, after which point part of your retirement savings would be a plan that determines how many resources might be spent on giving you a few extra years of not-so-great life. That seems both more efficient and more fair to me.
No, there's simply more than one axis on which to evaluate a health care system; one is expense, another is accessibility/availability, another is outcomes, and there are others.
I don't understand your strident "entirely backwards" argument, since I'm literally stating the premise of Medicare; I didn't make any of that up.
Sorry, I agree that is the analysis of the current system. I don't think we're disagreeing on facts here. What I was characterizing as backwards was that being considered a good public policy goal, as elaborated on in the rest of the paragraph.
And sure, there are many metrics by which to evaluate a health care system. It feels like the US system is somewhere from poor to mediocre on most of them, and only excels in outcomes for the extremely rich (enough money to stomach paying for your own concierge doctor to diligently follow your case and make up for the system's failings). Which is why your succinct description of the government-induced supply shortage resonated with me, and why I keep coming back to the general condemnation of "the worst of both worlds". But it seems like you aren't spending enough effort reading my comments to get my substantive points.
A fully public single payer system would mean bureaucrats would produce a report concluding that more doctors are needed to keep costs from spiraling, and the number of residency slots would be increased. A more freer market would mean hospitals/doctors were paying for all of their own residency slots and they'd up the number through price signals. Instead, we have neither feedback mechanism.