Arnold Kling, responding to my critique of him from the other day, writes:
As I read it, what he is saying is that Medicare is not as efficient as it could be, because it operates within the context of a private health care system. Only truly socialized medicine would be truly efficient.
I wish we could pin down this point. There is a tendency for single-payer advocates to slide back and forth. Sometimes they say, "Single-payer is just single-payer. It's like Medicare for all. It's like the French system." At other times, they advocate "honest-to-God socialism." If Ezra Klein is willing to stick to a single point of view about what he means by single-payer, then he is one step ahead of Paul Krugman.
If someone on the left is willing to go along with Klein's viewpoint that single-payer health insurance a-la-Medicare "doesn't make a damn bit of difference" to total health care spending, then we can agree, and move on to debate the merits of "honest-to-God socialism."
I'm down wit dat. The shape of the river, basically, is this: I think a Medicare-style system would be better than what we have due to certain funding efficiencies, fairness issues, and eventual effects. If there really were no other private insurance options, it might eventually turn into a socialized system, and the distinction would become moot.
In a perfect world, I would prefer a largely, though not totally, socialized system, a la France. Medicare, contrary to Kling's implication here, is not that at all. For that reason, using Medicare, which is a government insurance scheme operating within an overwhelmingly private insurance/care system, to discredit the efficiency gains of a fully- or primarily-nationalized health system is simply dishonest. So here's my deal: if Kling will help me put down that slippery tactic, I'll help him pin-down the definition of single-payer. Can't get fairer than that.
