Then tell me why the U.S., which doesn’t have a single-payer system, has the most expensive healthcare system in the world and one that’s far from the best.

First off, you need to define “best”. That’s a weasel word unless it’s defined.

We have public health outcomes that are, per the UN, behind the rest of the developed world. That’s because they have universal coverage, and we don’t; that statistically brings down our averages. Pre ACA, the 75-ish percent of the population that was consistently covered by insurance had outcomes that were every bit as good as anyplace in the world, and on some metrics better.

The same UN report that ranked us 37th in the world in public health outcomes ranked us #1 in critical care outcomes. ONE. Nobody does cardiac better than us, and the rest of the world is in the rearview mirror when it comes to cancer outcomes.

So, if you’re insured, you’re getting the best care in the world. We do not need to IMPROVE our system; we need to INCREASE ACCESS to our system, in an affordable manner.

but I’m also not at all sure your claim that the cost of our system would go up in a single-payer world is true. I just don’t see sufficient evidence that that’s the case.

I can only say that I’ve done statistical analysis on this problem, both personally and as part of my job, for the last fifteen years. The single-payer estimation in California, and the experiences in Colorado and Vermont, all confirmed my numbers. For me, the matter is settled.

I see many reasons to think that a single-payer system would go a long way toward cleaning up the messy, inefficient, overly complicated system we live in.

Oh, it would. But single payer systems do not include very good cost control mechanisms, which is why the single payer systems in the world keep overrunning their budgets. The cost would be mindboggling expensive here. Single payer systems all involve tradeoffs that Americans are not willing to make; we saw that very clearly back in the 80’s when the Patient Bills of Rights were passed by many states, making certain cost control mechanisms actually illegal.

I also think that if my choice is between talented people + screwed up incentives that make those talented people harm patients to line their own pocketbooks vs. slightly less talented people working within a system that creates incentives for them to care for patients rather than to line their pockets, I’d choose the latter any day of the week.

You offer a false choice. Mine is to keep the talented people and fix the incentives. Best of both worlds.

The idea would be that, yeah, if you’re poor, you’re going to suffer as far as healthcare goes, just like you’ll suffer in every other aspect of life, and that’s just an incentive for you to better your lot.

I think the pure libertarian path is no longer viable. Fifty years ago, if we had gone libertarian instead of Medicare (which took about 45% of the nation’s total medical billings and removed them from free market cost controls) that would have worked. Today, the horse has left the barn.

Free markets, free minds. Question all narratives. If you think one political party is right and the other party is evil, the problem with our politics is you.