Look people, just because a nationalized health care system in America is unlikely to be as cheap as similar systems in Canada, France, the UK, Japan, Germany, Australia, and so forth, doesn't mean it won't be significantly cheaper than what we have now. This isn't even an objection. It's a diversion. As we've already seen, the incentives and practices within government care systems really can sharply cut spending growth. Between 1999 and 2003, enrollment in the VA grew by 70 percent. Funding increased by 40 percent -- as quality improved. Even now, with a population that's sicker, older, more likely to smoke, have diabetes, and abuse drugs, the VA spends more than $500 less per capita than the rest of the system. That's not to say they spend half as much, as Canada does, but they're doing a helluva lot better at cutting costs than the private system in this country. If national health care got everybody covered, improved quality of care, cut costs by only 2 percent, and merely slowed spending growth, well, you're telling me that's not worth doing?
The secondary point is that savings from an integrated system aren't all up-front. An overhaul that's spending neutral but brings the health system into some sort of coherent structure paves the way for all sorts of cost savings down the line. Within a single structure, you could impose anything from global budgets to first-dollar cost sharing to massive preventive health measures to huge improvements in chronic care treatment. Within the current system, where care is split between Aetna, and Medicaid, and Medicare, and UnitedHealth Group, and your employer, and the VA, and Blue Cross, and the state high risk pool, and FEHBP, and a thousand more besides, there's no way to impose cost-cutting measures. Were the system under one roof, there would be.
